ADT duration data measures

[SimMartin]

odd query but when reading studies and research on ADT duration they refer to months or years - I am curious as the implants are often prescribed monthly or 3 monthly but that actually means 4 weekly or 12 weekly with such ADT as goserelin - so are the studies that say 4, 6, 18, 24, 36 months referring to 28 days or calendar months ?

[Justfor_]

Calendar months of course. What do you think docs are? Banks to calculate interest on 12x30=360 days year.

[j-o-h-n in reply to Justfor_]

That's interesting..........

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 08/28/2023 7:32 PM DST

[SimMartin in reply to Justfor_]

Not sure I’ve been clear - the prescription is for goselerin at least but others given every 28 or 84 days NOT calendar months - the prescription guideline are quite clear about that (maybe a day either side but not regularly).

Hence the research saying 6months on ADT but is that 6x28 used in the research ?

[doc1947g in reply to SimMartin]

Yes, a month is equal 🟰 four weeks.

[RyderLake2]

Hello,

I have been taking Zoladex (goserelin implants) once every three months for over ten years. Definitely calendar months. I set up four appointments every year with my family physician. He gives me an injection the middle of March, June, September and December. Hope that helps!

[SimMartin in reply to RyderLake2]

Maybe if long term kind of academic as T will be at minimum but the prescribing instructions are quite clear every 84 days or 28 not calendar months

[ARIES29 in reply to RyderLake2]

Hello Ryder, Do you have any Arthritis issues with Zoladex? after 6 months on Zoladex I could almost not walk but after stopping it went back to usual knee arthritis.

[RyderLake2 in reply to ARIES29]

Hello,

Not really. My fingers tend to be little stiff but I think that has more to do with my age (78) than the Zoladex injections.

[JohnInTheMiddle]

Firmagon / Degarelix ADT every 28 days on the same day of the week. This is probably more important than the 90 day or longer periods I would think. Was actually a slightly tricky to set up with the hospital until we finally agreed yes it should be every 28 days.

[SimMartin in reply to JohnInTheMiddle]

Yes that’s what I saw on the prescription guidelines - so when they do research on survival etc wuth say RT plus 18 months ADT do they mean 18 x 28 days ?

[JohnInTheMiddle in reply to SimMartin]

It's weird it's not really clear. I think one can persuade one's doctors that it means either 28 days or month by month. Then there's the question as to why hormone sensitive evolves to hormone resistant. Maybe if people have a casual approach to timing, that could explain testosterone spikes and failure over time? At least in part perhaps? I looked but haven't found any really good literature on this subject. I'm trying to give to the exact timing.

[LongevityAT in reply to JohnInTheMiddle]

I did speak to Firmagon. When going every 28 days for an injection, a couple of my injections fell on holidays. They said that starting with your 2nd injection, you can actually schedule your next injection within +/- 7 days of your 28 day schedule. This give plenty of flexibility to work around holidays or doctors offices schedules.

[JohnInTheMiddle in reply to LongevityAT]

You meant the Ferring people? Great feedback! I have also spoken to them and they are very helpful.

As for their guidance it's very interesting about plus or minus 7 days. I just looked up and apparently Degarelix half-life is 53 days. I wonder if this explains that I can still feel last month's subcutaneous stomach depot even as we are injecting this month's, on the other side?

Also I suppose if you do a graph of declining blood serum levels at 28 days, it's not going to be that much different around the 28th day two-week window? The Ferring people are probably suggesting that the blood serum level of Degarelix will still be well above what is required for testosterone suppression during that two week window?

I wonder what Tall_Allen thinks? I have tried to keep to the 28 days. I'm high volume metastatic; maybe the risk is higher compared to not being metastatic.

[LongevityAT in reply to JohnInTheMiddle]

Thanks for the name of the company. I knew it wasn't Firmagon but didn't realize it was Ferring. And yes, I believe it was because of the effective life span of each injection. Makes sense that they have an overlap "range" for scheduling injections but it also makes sense that they don't publicize that fact. Fortunately, my last Firmagon injection is on Sept 5. I'm assuming it will be 6 - 7 weeks after the 5th before all of the drug has been absorbed.

[maley2711]

The goal is zero T, and my humble guess is that these instructions are conservative....very much doubt youd see different long-term outcomes whichever way you interpret the studies. Primary problem is recovering T when ADT is terminated !!!

[dhccpa]

Could they be referring to the length of time before one becomes castrate resistant on that treatment? Wasn't sure if I understood your question.

[Mgtd]

OK! Let’s get back to the real world. You just completed your 6 or 3 month Lupron shot on Jan 10 and you are at the appointment station to schedule your next three month shot.

The gal at the computer is really nice and pleasant and she has good to excellent typing skills but her math skills stopped in high school.

Do you really expect her to calculate 28 days and come with a next appointment or has she been trained go Feb, March, April 10 and asks do you prefer AM or PM.

My guess April 10 is your date rather than April 9.

Just saying!

[SimMartin in reply to Mgtd]

lol - I get you’re point ! But with over 65years as a professional patient and over 35 as a psychologist if left decisions around treatment and timings to ‘the person behind the desk’ or actually the medic who happens to be in front of me - I would have been dead or much more impaired than I am, 68 years after becoming a disabled person. Equally I don’t step back from questioning my own patients’ doctors edicts or the way they are treated and encourage informed seller advocacy.

OK I am a realist - i can’t change the world or the system every time for myself as a patient or my patients as their psychologist - but I refuse to just accept that the patient should not come first. So I calculate the 84 or 28 days and book in advance the day I am due - a date either side is fine.

Over 2-3 years counting calendar months does make a difference in total time - my query was simply how do researchers control for this variable - or don’t they when they say best overall survival is x number of months.

[Jpl506]

I kept my 26 months of ADT duration on calendar months but fixed my dosing schedule to 28 day months. So I always scheduled my return visits for Lupron at 84 days. In the grand scheme of things I’m not sure it mattered to anything other than my own mental health.

[SimMartin]

I am curious at the 26 weeks then ? As the guide lines are 6 or 12 or 24 or 36 months - so why 26 weeks —-was that because the oncologist suggested 24 calendar months or two years? Or did it include the RT neo adjuvant not just adjuvant?

[Jpl506]

It was 26 months. I as on Lupron alone for 2 months prior to RT and then Lupron + Erleada for 24 months afterwards. My MO came up with the schedule since Lupron + Erleada is not SOC for high risk nmHSPC.