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Timing of ADT + Zytiga - Anyone else start them at different times?
I have locally advanced disease (+ pelvic nodes). My treatment is based on the intensification experiment in one of the arms of the STAMPEDE trial in which abiraterone (Zytiga) was added to radiation and regular ADT (i.e., Lupron) for 24 months in the experimental arm, with then Standard of Care of RT + ADT in the control arm. The benefits from the intensification with abiraterone in the trial were substantial in terms of BCR failure-free duration.
I started Orgovyx in July 22 but didn't start Zytiga until April 23. The reasons for the delayed start aren't relevant to my question. As I will have taken Orgovyx 24 months at the end of this June, the question that naturally arises is: (a) do I stop taking these two meds when each hits 24 months (this July for Orgovyx and May 2025 for Zytiga); (b) stop both this July; or (c ) take both until May 25?
I've gotten two different answers ( (a) and (c ) above) from two oncologists from two NCCN designated cancer centers. Ultimately it will be my decision to make, just wondering if anyone else is in this situation and if so, what guidance you've received. I'd like to stop both in July because I'm wearing down from the intensified treatment but don't want to compromise the results proven from the trial. Typical PCa dilemma!
Thanks!
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It seems that as of now, the scientific evidence is that at PSA less than 0.1, 99% of the cancer is dead. Some suspect that the 1% is also dead but there is no scientific proof as yet. They new hypersensitive tests can go down to PSA 0.003. Those labs would call that undetectable. It seems there are some scientists ware trying to show that PSA < 0.003 provides better outcome than < 0.1. It may be intitively sound. Proving it may take some years.
Dont mind me. I am just another layman trying to make sense of the whole thing,
Well, that is a horse of a different color.
After BCR, my Rad Onc (RO) at Johns Hopkins (JH) ordered an Ultrasensative PSA (uPSA), which was performed at Quest Labs (I am out of state and 90 mins from a JH facility, and he said that it was fine to use Quest). Quest's detection level is < .02, and my PSA was " undetectable".
FYI: uPSA detection limit at JH is < .03
And, a radiation treatment friend of mine at JH has a different RO, and following the same tx for BCR, he had a regular PSA test and was "undetectable " at < .1
My take is that < .1 is the practical standard to use because I don't think that they treat < .1 anyway
Having said that, I will continue with the uPSA in later Feb and lose my mind when my levels exceed .02, even if they are still < .1
The conundrum of information, or TMI.
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1 ReactionTotally understand….still always on your mind.
In my case had BCR about 5 years after surgery waited till number went to .4 decided to do SRT and 6 months Lupron. PSA tests since 2020 have been 0.00. Hoping this will,continue. annual psa test since then.
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