ADT For 78 year old

[DoubleIPA]

I'm 78 years old. In May/June 2024 I had 44 sessions of IMRT. I've been on Orgovyx for one year. The ADT is really affecting me - I've gone from a very active happy life to one that is quite dreary. The main SEs are lack of energy and weakness. My urologist and RO want me on Orgovyx for at least another year. I'm looking for rationale to cut that short. Has anyone seen information regarding time on ADT taking into account life expectancy? Simply put, at 78 I don't need confidence in long term "cure" - I'm concerned about 10 or, at best, 15 years. I was Gleason 8, TC-3 and PSA 12.

[Tall_Allen]

I assume you were diagnosed with high-risk PCa. Here's the dilemma: You can take your medicine now, for one more year, or take the same medicine permanently later. Stopping too soon will guarantee that only the most resistant cancer cells survive and replicate. Those cells will cause painful and crippling metastases later, for which you will beg for the same medicine for the rest of your life. I wish you had another alternative.

[CAMPSOUPS in reply to Tall_Allen]

This comes up often and as is often the case you convey the science (the particulars of PC and treatments) perfectly as it pertains.

This reply is one of many that should be carved in stone.

Thanks again for everything you do here!

❤️❤️❤️

[SimMartin in reply to Tall_Allen]

whilst this is indeed the current SOC backed by the best research evidence there has been some wobble room since PSMA use in so far as the SOC studies included patients with high risk who did not have PSMA available and so a proportion of these included in the study with localised high risk probably had spread which would have been seen on a PSMA scam - so they will have skewed the results to some unknown degree . So if the PSA reaches a quick undectable level with true castration leven testosterone throughout and there was a previous negative PSMA/PET scan then with RT and 18 months of adjuvant HT may be as effective as 24- 28 months

Unfortunately we will probably never know as the Canadian study is inconclusive but interesting as had drop out issues in the longer arm and these days the treatment of high risk local PCa with a negative PSMA has change would probably involve brachy boost plus maybe combination HT - or am I missing something here ?

[Tall_Allen in reply to SimMartin]

I think biomarkers are better than detection of larger metastases with a PET scan. Unfortunately, even the best PSMA PET/CT has only about 40% sensitivity. There is a clinical trial that will see whether a Decipher score is a good biomarker for determining if an intensified shorter course of hormone therapy gives good results.

[Nodrogear]

Hi there. I am 84 .nine years ago I had brachytherapy to treat prostate. Showed all clear for six years then PSA rose to 12. Was treated with two doses of ADT, six months apart and PSA fell to 0.02. Was advised to continue ADT for another year but declined as the side effects were loss of libido, skin rash etc. was advised that if PSA rose again to 5.00 I could return to ADT. After four months the pSA is back at 3.10 so I will review in two months. Also had PET scan last year and was all clear. My only fear is the mastacis which may occur if I continue to do nothing! I guess the deal is around your quality of life, while you live😉

[BigAla]

What did your PSMA PET CT show?

[Nodrogear in reply to BigAla]

All clear

[DoubleIPA in reply to Nodrogear]

"Impression: Abnormal uptake in the left side of the prostate. No lymphadenopathy, bony metastatic disease of distant metastatic disease was noted."

[maley2711]

You might review this study of something like 10,000 men that looked at a continuos range of ACTUAL ADT use... The author and his colleagues used overall survival as the endpoint ...but many have the opinion that metastasis -free survival is what men should prioritize. The benefit for overall survival with longer ADT declines significantly once ADT hits 12 months, but the benefit continues to be significant for a much longer time.

urotoday.com/conference-hig...

Have you reached your nadir.....I don't have the studies at hand, but a nadir of 0.2 PSA, and with some studies an even lower number, will increase the probability of long-term success.

Remember, all results of all studies are just averages or medians, and don't predict what your result will be. There are ongoing studies to help patients and doctors determine more accurately which men will more likely benefit for longer duration time......mean while, we have studies like the above.

[DoubleIPA in reply to maley2711]

Many thanks. I've been <0.04 since radiation - I'm very fortunate. It seems like 18 months is the sweet spot for the persons in the trial. At one year, another 6 months seems doable. But then, at that point, the full two years may look okay

Again, thanks

[Don_1213 in reply to DoubleIPA]

You're facing the same sort of decision at the same point in life (close in age) that I faced.. and I decided 18 months was enough. That was backed up by one study (pretty widely referred to) showing little to no benefit to longer term ADT on the part of high-risk (I'm G10) patients. If you have a good medical oncologist this is something to make a plan to discuss the next time you see him/her - and ask about the other issues caused by hypogonadism (which ADT directly causes, I think without fail if you're on it long enough, such as heart and circulatory issues, bone density issues, memory/cognitive issues.

I think the more recent studies come to a conclusion that more men dies from the complications of long-term hypogonadism than die from a PCa recurrence after stopping ADT.

Check my bio - and if you have any questions - feel free to message me.

[maley2711]

Whoops..."continues to be significant for a much longer time" for metastasis free survival is what I should have written!!!

[Mgtd]

Boy that is a tough call! I was at the same age as you when I had to decide on ADT length. What I did or what anyone else did may not really help you make a decision but here are some things to consider.

What is your current health status? Do you have any on going medical issues other than the cancer?

How much do you currently exercise? I am not talking about casual physical exercise. I am talking about a formal aerobic and resistance weekly training regime.

What is more important to you - quality or quantity of life?

On PCRI.org there is a short video by Dr Mark Schult that deals with ADT in the 80 year old age group. At 78 I would expect that it applies to you too. I was 78 when I had to make my choice.

Have you discussed this issue with your loved ones or people close to you? Likewise do you have an Advanced Medical directive and did you discuss this with them also. If you have not I suggest you do that. In my case this allowed the focus on the ADT decision to be much easier.

Like I said it is a tough one! Facing your own mortality head on is never easy. I wish you peace in your decision. Only you can make this decision.

[Mgtd]

I forgot to add my planning horizon was shorter than yours. I was looking at the 5 to 10 year range. I had no desire to really live much longer than that. Sitting in a long term care facility was not a choice.