Late ADT a Problem in Prostate Cancer — Late dosing of LHRH agonists happens too frequently: MedPage Today April 22, 2021

[cujoe]

Make sure to count days and not months between ADT injections. Interesting article on the importance of counting days not months when scheduling ADT injections. (In order to maintain continual suppression of testosterone.)This would also suggest one place a very high priority on not missing appointments for sequential ADT shots.

While not discussed here, it might also imply the same issue for maintaining daily dosing for those switching to oral formulations of ADT.

From the article:

"Crawford observed that the trials that resulted in FDA approvals were based on 28-day dosing or multiples of that for 3-, 4-, and 6-month dosing. Yet "84% of injections given as documented in our analysis of over 22,000 administered were late," he pointed out." (emphasis added.)

Article is here:

Late ADT a Problem in Prostate Cancer — Late dosing of LHRH agonists happens too frequently, researchers report by Mike Bassett, Staff Writer, MedPage Today April 22, 2021

medpagetoday.com/meetingcov...

Full Report in Journal of Urology is here:

Impact of Late Dosing on Testosterone Suppression with 2 Different Leuprolide Acetate Formulations: In Situ Gel and Microsphere. An Analysis of United States Clinical Data - Journal of Urology - February 2021

auajournals.org/doi/10.1097...

Mark your calendars accordingly - and Stay Safe & Well - k9 terror

[NPfisherman]

K9 Terror,

I believe some of this may play a role in getting to MCRPC.... I had a message from someone and it looks like there was a delay of almost 2 years to start treatment.... With the handing off of the ball from surgeons to MO's or MD's, there is the potential for things to "go through the cracks" ...So important to drive your own ship....or at least be near the tiller...

Fish

[cujoe in reply to NPfisherman]

While we are on the same page re: delayed initiation of ADT. Only time will tell whether starting it sooner after my BCR would have resulted in a better DFS? So far, so good; i.e., coming up on 4 years and counting.

However. in this case the delay analyzed was the actual time between early/on-time administration of ADT injections vs. being late, thereby allowing T to begin to rise during the calendar gap. It seems 28 days or less is the interval that should be preserved at all costs. Worse case example would be for 6 month depot given based on calendar months with 3 mos @ 30 + 3 @ 31 = 90 + 93 = 183 days vs 6 x 28 = 168 days for a difference of 15 days or more than 2 weeks. Obviously, the gap is smaller for shorter interval depots.

[NPfisherman in reply to cujoe]

Agreed... late shots allow the testosterone levels to reach a noncastrate level and feed the beast... keeping things under control allows a chance for senescence to occur...

Fish

[marnieg46 in reply to NPfisherman]

Even then Dave...at least in relation to being near the tiller...things do fall through the cracks and can be missed if you aren't told directly, interpret the information incorrectly or don't clarify. I had no idea, until I just read cujoe's post, that it wasn't an injection every 3 calendar months. Such a simple thing and yet so very important to get right.

[NPfisherman in reply to marnieg46]

As a provider, I say this falls on providers to make sure EVERYTHING is done right for patients, and certainly, the most important things...One person posted on a forum that they had a physical for 9 years straight and never got a PSA ordered by the MD...just horrible medicine...

Fish

[cujoe]

Hey, Nal,

Why isn't Vantas ever mentioned by mainstream purveyors of PCa SOC? It seems like a viable option and requires LESS medical interventional costs over it's one year effective life-span?

On another topic, are you back in your mtn home yet? And how's the lady of the house doing these days?

Ciao - K9

[cujoe]

Nal,

Sorry to hear Mary's troubles persist. I'm sure you will get her on a wellness program that works. She has the ultimate patient advocate living under the same roof with her.

Last year has been a real bxxxh for you two. Mold in the condo, Mary with serious respiratory issues, having to completely reconstruct you physical living arrangements in your summer home - all happening during the massive disruptions and related daily stress of COVID. That you have seemingly kept your calm focus through all this and even find the time and energy to remain a mainstay contributor to the HU forum community is a real tribute to the kind of person you are in both your real-life life and the one you live here on HU. יברך אותך הא

As for the Vantas implant, I expected that you would confirm my suspicions that it had to do with Big Phrama running the show on SOC. Follow the money is still the order of the day. Once a year doc visit to insert low cost implant + periodic labs to monitor vs. 1,3,4,6 month visits for injects of pricey ADT drugs + labs to monitor . . . Hummmm, which one puts more dollars into the pockets of drug companies, docs, medical care facilities, and insurance companies? As we used to say when I was a kid: "Two guesses - and the first one doesn't count".

Stay well and good luck with the upcoming move-in.

K9 terror

[NPfisherman]

Nal,

I gotta say that Vantas implant is on my list if I have to go back on ADT... It just makes sense to get the implant and forget about it...3 month Lupron is over $2000 a shot at Cleveland Clinic... with Vantas, you will not be late on getting a shot... common sense...

Fish

[cigafred]

My urologist's distributor is unable to obtain the Vantas, so I have been calling the manufacturer, Endo Pharma, 1-800-462-3636, from time to time for a year or so, and always the answer is "not currently in production." Is there another route?