I want to learn more about ADT

Don’t know what the gold standard is, but just be aware that the shots last longer than the Doctor may tell you. I received two Firmagon and one Elligard early last year and high dose radiation. I figured I’d be clear of the side effects in Sept of last year. Nope, still have side effects and I attended a webinar on the treatments and was told that each shot could last 12 to 18 months. I’m coming up on one year since ending treatment and I am still experiencing symptoms, not as bad but still there. One one of my post treatment check ups, I asked my Doctor about it, he did a double take on my question, smiled and stated , “yes, they last a bit longer than suggested”. Other than that I don’t know, it’s an on going journey. All the best Brother.

At age 75, my PC was treated very successfully by 28 sessions of external beam radiation treatments, after which my PSA was undetectable. My urologist recommended 8 quarterly Lupron injections. I made it through 5, then informed my doctor that the physical 'side-effects' of the Lupron had become more than I could bear, so we cancelled the remaining 3 treatments. Extreme muscle wasting, massive strength loss, knee and hip joint pain, all progressively worse during the 5 Lupron injections. I've just started my post-Lupron life... determined to gain some of that which was lost. I understand that, from a medical treatment of PC perspective, ADT has statistically improved long-term remission of PC... but, I'll tell you: if I had known the profoundly negative consequences of ADT, I may well have balked at it. It's a BIG price to pay.

Your clinical history would aid in the forum providing you their assessment and feedback.

I am not sure there is a "gold standard" when it comes to ADT. What there is, lots of choices depending on your clinical history, age, co-morbidities, insurance....

As to time on ADT, well, again, clinical history. Generally, if you are castrate resistant, it's a "lifetime" sentence.

If you have Advanced PCa, it can be for a defined period, how long is that, you'll find a wide variety of answers - 6, 12, 18, 24, sometimes 36 months.

You may also find that your medical team will want to add a second agent, an Androgen Receptor Inhibitor (ARI) to the treatment plan since the PCA cells .

Here's some information to consider: … https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7848164/

PSA response to ADT as a Prognostic Tool

Early PSA response to ADT and other therapies is prognostic (9, 21, 65).

In general, optimal PSA suppression takes 6–9 months (66).

A PSA ≤0.2 ng/ml after 7 months of ADT suggests a long median survival (21, 65).

Here, we plan to utilize induction ADT as a prognostic tool to determine if a patient would benefit from more intensive systemic therapy or if they would be reasonable candidates for an intermittent treatment approach such as this.
…a conservative, risk adaptive approach for determining the length of induction ADT and which patients would be candidates for continued I-ADT.
• Following involved field SBRT…a 3-month induction period where all patients receive ADT. At 3 months…checking PSA and testosterone levels, if the PSA is ≤0.2 ng/ml, the PSA level that is associated with improved prognosis, then hold further ADT, continue to follow PSA and T levels every 3 months.
• However, if at 3 months the PSA fails to fall ≤0.2 ng/ml… recommend an additional 3-month induction period of ADT.
• If after an additional 3 months (6 months following the initiation of ADT) PSA still fails to fall ≤0.2 ng/ml, this is indicative of a less favorable prognosis, we do not recommend the patient proceed further with this intermittent treatment strategy. Instead, these patients would likely benefit from continuous ADT with the possible addition of other systemic agents.
Although a subset of patients may have a prolonged clinical response and may never need subsequent treatment, most patients will eventually relapse.

From published patterns of recurrence following SBRT, the majority of patients re-present with ≤3 new metastases, allowing for subsequent MDT (46).

For this reason, and because intermittent ADT requires frequent total testosterone and PSA checks, we recommend following these values every 3 months.

If a patient's PSA starts to rise following a cycle of ADT and SBRT…repeat PET imaging when the patient's PSA rises to ≥1 ng/ml. At this PSA level, PSMA-PET performs well in the detection (> 80%) of recurrent PCa (67). While the performance of PET imaging improves with increasing PSA, this PSA cut off balances a relatively high rate of disease detection without allowing undue progression of disease that may sacrifice clinical outcomes (68).

If imaging reveals new oligo-recurrent disease, we would treat the disease with another cycle of involved field SBRT and re-initiate ADT using the parameters previously outlined.
Recurrent PCa remains a complex disease. ADT is successful in delaying the progression and improving overall survival. Unfortunately, castrate-resistant clones may be present early in the disease process even prior to the initiation of ADT, creating the need for alternative treatments.
SBRT has been demonstrated as a safe and efficacious modality. Implementation of involved field SBRT early in the disease process may reduce overall tumor burden, in turn delaying progression of disease, prolonging response to intermittent ADT and improving both the quality and length of life.

Strengths of this approach include:
• Minimizing a patient's exposure to ADT and the side effects related to its receipt.
• Utilizing large fraction sizes to capitalize on the low intrinsic (α / β) of prostate cancer to improve local control.
• Short treatment courses that improve patient convenience and reduce indirect patient costs.

Potential limitations of this approach include:
• Adverse patient outcomes in those that may have benefited from more aggressive upfront systemic therapy.
• Potential sacrifice in long term local control with the delivery of less than a truly ablative dose of radiation in order to prioritize long term patient safety.

In conclusion, the current cyclic approach balances the benefits of local treatment and limited ADT versus the potential benefit of long-term ADT in those with unfavorable features.

and this...

Research suggests that castrate-resistant clones may be present early in the disease process prior to the initiation of ADT. These clones are not susceptible to ADT and may even flourish when androgen-responsive clones are depleted.

hormone-sensitive cancers, castration-resistant clones exist yet remain at a growth disadvantage. In the setting of low testosterone, castration-resistant clones may be selected for and proliferate, which may theoretically worsen survival.

SBRT is a safe and efficacious method of treating clinically localized PCa and metastases. In patients with a limited number of metastatic sites, SBRT may have a role in eliminating castrate-resistant clones and possibly delaying progression to castrate-resistant disease.

So, there is not a single answer to your question, which agent(s), do you combine with SBRT, how long on ADT...I will say Orgovyx is generally better than Lupron, lower CV side effect profile, no flare, faster to castration, higher sustained castration while on it, faster recover of T. It may be more expensive, depends on your insurance and requires self discipline to take very day!

Kevin

@hlcampb, you're asking good questions, some of which you will also want to ask your cancer team. Here is a list of discussions about ADT using related search terms:
- ADT https://connect.mayoclinic.org/group/prostate-cancer/?search=ADT&index=discussions
- Orgovyx https://connect.mayoclinic.org/group/prostate-cancer/?search=Orgovyx%20&index=discussions
- intermittent https://connect.mayoclinic.org/group/prostate-cancer/?search=intermittent%20&index=discussions

To search other keywords, go to the group's homepage https://connect.mayoclinic.org/group/prostate-cancer/ and enter the search term.

Why are you switching from Eligard shot to Orgovyx pill?

I didn't like the shot in the abdomin. And I am experiencing several side effects (a lot of hot flashes, light headedness, and some balancing issues) from the shot, which I thought I would maybe have more control over with the daily pill.

You might want to review the research study referred to in this post

This morning there was a relevant link shared under a new topic "Cognitive Impairment Amongst Prostate Cancer patients." by @gkm The article was not so much new research, but rather highlighting that cognitive impairment can be a side effect of treatments for prostate cancer. The article also highlighted that this is an aspect of care that is receiving little attention. Here is the link https://link.springer.com/article/10.1007/s12325-023-02721-9