How long will I need ADT?: Had RP in... - Prostate Cancer N...

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How long will I need ADT?

Runner1957 profile image
29 Replies

Had RP in Oct 2020 with recent reoccurrence. I started ADT 3 months ago which is planned for 12 to 18 months. Start 37 sessions of radiotherapy mid January. My psa last week was 0.01 down from 12 and rising before ADT. Wondering if ADT is not curative maybe this might be shorter??

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Runner1957 profile image
Runner1957
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29 Replies
Tall_Allen profile image
Tall_Allen

You are attempting a cure with a combination of salvage RT and ADT. With your high post-prostatectomy PSA, 18 months sounds about right. I am assuming that no cancerous pelvic lymph nodes were found. If so, 2-3 years of adjuvant ADT might be better.

Runner1957 profile image
Runner1957 in reply to Tall_Allen

1 suspect pelvic node found by PSMA PET Scan. Radiotherapy us to treat all pelvic lymph nodes and prostate bed to try for a cure initially. Did ask for a spacer prior to Radiotherapy but Consultant doesn't want to miss anything if between prostate bed and bowel.

Tall_Allen profile image
Tall_Allen in reply to Runner1957

2-3 years of ADT is standard if there are ANY detected LNs. Spacer is not used for sal vage - it is only used to add space between the rectum and the prostate. Your prostate is gone.

Runner1957 profile image
Runner1957 in reply to Tall_Allen

If ADT is just to slow or stop cancer growing, once you have undeniable psa why continue for 2-3 years?

Tall_Allen profile image
Tall_Allen in reply to Runner1957

Because it is not "just to slow or stop cancer growing." It interacts with radiation to get better cell kill and kills off any sub-lethally killed cancer cells left over from the radiation. It has been proven to increase survival.

Runner1957 profile image
Runner1957 in reply to Tall_Allen

Really appreciate your informed replies.

Define “suspect.” Definite slam dunk enlarged lymph node with avid uptake or a maybe?

Runner1957 profile image
Runner1957 in reply to

Potential avid uptake

Runner1957 profile image
Runner1957 in reply to Runner1957

Initial psma pet scan showed suspect 2 x ribs and femur. It was too early for definitive diagnosis so had second scan 8 weeks later and just the 1 node identified.

London441 profile image
London441

As TA said, better to stay with the ADT for at least 18 months, particularly with that much rising PSA post op. Even a bit longer if your side effects are not crushing. How much do you exercise and what kind? You will need plenty of that.

True that the ADT is not curative, but it helps the radiation do its job.

in reply to London441

With regards to length of time of ADT post radiation, what is the definitive study for suspicious nodes or oligometastatic? Has there been a specific study comparing survival rates of say, 6 months vs two years, or one year vs. two years?

Runner1957 profile image
Runner1957 in reply to London441

I run between 25 to 30 miles a week plus a couple of 30 min excercise routines with weights.

London441 profile image
London441 in reply to Runner1957

I had the same questions in 2019 since I presented oligometastatic as well. I entered into a post op clinical trial which included a 2 year ADT protocol, but it was cut in half.

This only because I was honest about the side effects when asked at that one year mark, though I didn’t find them nearly as severe as I’d heard about.

I was uneasy about stopping early but even a second opinion didn’t change anything. All the data seems to be 6 months vs 2 and 3 years, not 18 months vs 2, 1 vs 18 or 2 etc.

Doctors are starting to consider quality of life more routinely on length of ADT. This is good, but it also makes treatment decisions tougher.

Longer courses of ADT are harder on the body, no question. But of course if it actually makes for a significantly better outcome it’s worth it.

This is what we essentially cannot know for sure. The heterogeneous nature of the disease makes this especially so.

You like your running I’m sure, and it’s great for you no question. However I would strongly consider more emphasis on weights as you get further into ADT.

Add to your existing routine or just change the ratio? It depends on how hard you train. If it were me I’d try to keep the running and make the strength training both more intensive and more frequent. But if time and/or stamina is a factor I would run less.

Either way, you really want to to be extra diligent with the weights, otherwise the sarcopenia is dangerous, ugly and too much work to reverse.

Compensate!

Runner1957 profile image
Runner1957 in reply to London441

Good advice which I will adapt and follow London441

jjpeabody profile image
jjpeabody

I don't know about definite studies, but since Dr. Kwon has been mentioned in recent posts, it appears based on his extensive experience for local recurrence he recommends 18mths. Like London441 suggests I would stick to that, it gives you plenty of time to research etc. Good luck.

Runner1957 profile image
Runner1957 in reply to jjpeabody

Thsnk you

in reply to jjpeabody

he may be backing off of that. I say "may" because I don't know anything, just my general impression. There been a lot of discussion about ADT causing the cancer to change into something more lethal. It seems to me that Dr. Kwon is moving more toward favoring chemo. That's just my gut after following him for awhile. These doctors all try to follow the herd and nobody knows for sure what is going on, the disease is too complicated. I give him credit for trying to make sense out of it and being the maverick.

Runner1957 profile image
Runner1957 in reply to

Thanks Anomalous. I hope its a good year.

Runner1957 profile image
Runner1957 in reply to jjpeabody

Interesting guy. Thank you for the information

conbio profile image
conbio

Hey Runner - best of luck to you. I'm 3 months into my 18 month ADT routine. I'm 65 - pretty active - still climb, ski, bike, mountain bike. Had a good day backcountry skiing yesterday. Would strongly advise getting a trainer for weight training - dynamic workouts. 1) so you don't screw anything up with bad form, and 2) a trainer will work you harder than you would alone.

I go to a trainer once a week and do weights on my own another day - plus my usual stuff. The resistance training will help your energy, keep weight down, and wonderfully clears your head. I was not used to doing things like weighted squats and deadlifts, so a trainer eye on this will sharpen your form.

I have mild hot flashes and that is about it. Ok - libido is in the toilet, that is just unavoidable. And I'm climbing stronger and my cooked back feels much better after a hard day of skiing. Commit to it and you will come out far better. Cheers in the New Year

Runner1957 profile image
Runner1957 in reply to conbio

ConbioThanks for your reply, appreciated.

I hope 2022 is a good year for you.

dadzone43 profile image
dadzone43

Crystal ball question. We can only give estimates/guesses. Or, "as long as it takes." I wish the forum could do more. But we are not seers.

Mel8425 profile image
Mel8425

Hey Runner,I have been on Eligard for 4 months prior to radiation and seeds. My prostate was large, so this is supposed to shrink it.

It also reduced my PSA from 4.7 to 1.54.

I absolutely hate being on testosterone reducing drugs, but I also like living.

I have all the side effects, hot flashes, fatigue,

Abd No sex drive. My doc is talking 3 or 4 years of this stuff. After Rsdiation, we will discuss it again,

What everyone else said here is true,

You need to exercise and use weights or your muscle mass will disappear,

It’s also good to fight the fatigue.

Wishing you the best,

JRPnSD profile image
JRPnSD

A similar situation (GL9 with microscopic evidence in 1 of removed LNs...RP 8/2019, started ADT due to recurrence at .16 PSA 10/2020 and have been undetectable since then, Salvage Rad. (38 Sessions) and discussion now with my URO about stopping ADT at 18 months (4/2022). Despite exercise...ADT still shows on the body at 68 :( Using Relugolix and hoping to see T return soon after. If PSA reappears...then back to ADT. No golden ball/guarantee...but QoL is a significant issue....and want to feel/look like me again.

Best wishes.

Olivia007 profile image
Olivia007

My dad has been on it for 8 years every 3 months he gets Lupron shot. But his cancer has spread to his bones since 2014 and Praise God no where else he hasn’t had any surgery and only did radiation and is on Xtandi and xgeva injection once a month

Runner1957 profile image
Runner1957 in reply to Olivia007

Thanks Olivia007. My thoughts and prayers for your dad.

billy1950 profile image
billy1950

Hi Runner….

My RO has put me on firmagon for the last 3 months. He is hoping that i do something more “curative”…However, It’s challenging to have any more radiation. I am not sure how long I’ll be on ADT…Taking it day by day!

Here’s for a Happy and Healthy New Year!

Runner1957 profile image
Runner1957 in reply to billy1950

Happy new year to you Billy

Reading the comments above leaves me a little concerned. I am in the state funded hospital system in New Zealand and am worried that cost saving may be a factor in my treatment.

First off, my cancer is T3b, with Gleason score of 4 + 3, psa peaked at around 11 before commencing ADT.

The surgeon I saw initially recommended RP, but his boss said that if RP was my preferred(?) option then he would recommend EBRT as well, so best just go for EBRT alone

I have just finished 20 sessions of EBRT after only 4 months of ADT (Zoladex), early start may be to get it over and done with before Christmas.

However with others in NZ and on this forum, 35 plus EBRT sessions plus at least 6 months ADT pre EBRT seems to be the norm. Any ideas why mine is less?

And with Covid lockdown, access to the specialist is tricky. I'm due to see him at the end of January, but whether thats face to face, video or telephone depends on what restrictions and are in place.

Any recommendations on what should I be asking him?

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