How long will Lupron work before prostate cancer becomes resistant?

I understand your anxiety bruningk and empathize with you. Unless I missed it I didn't see anything about your staging. Where was the cancer located when you were scanned prior to going on ADT? I presume not confined to prostate? And what was the radiation field?

I've tried to understand the answer to this question and have come across several interesting facts, anecdotal evidence and opinions. Most of this is from memory from things I've read in studies or seen/heard oncos say at conferences or in youtube vids.

1. Disease burden matters. The more extensive the mets, the more mutated the cancer cells and less like the "mothership" they become. Thus they become less susceptible to drugs designed to starve cancer cells of the fuel, DHT or testosterone. I've spoken with guys who've had mets and have been battling PCa for many years, 25+ in one case. I think they had a relatively low, though advanced, disease burden when diagnosed.

2. PSA doubling time is a strong predictor of eventual metastasis and the subsequent transition to CRPC 2-3 years later (though you can become CR without metastatic disease). There is a point of inflection in the curve showing probability of developing distant mets versus PSADT. That occurs around a PSADT of 7 months and increases as PSA decreases further. My PSADT when my PSA took off after RP was around 8 months, so it was aggressive but possibly controllable over the long term. You should ask your onco what your calculated PSADT is based upon it shooting up from 0.05 to .39. There may be some nuances in the calculation I'm not aware of but on the surface it appears you have a pretty short PSADT. Of course this particular graph is probably not directly applicable to your question, but its a morsel of data.

3. Dr Mark Scholz made a very puzzling statement on one of his videos a couple of months ago regarding how long ADT treatments work. He didn't explain the exact context, but his comment was that these days with newer treatments the time to CR has been estimated to be around 17 years. I rewound the tape and relistened to it several times, but that was basically what he said. I'm not even sure how that is possible when the latest ARSIs have only been on the market about 5-7 years, though it is certainly possible to estimate parameters like that given data collected over a shorter period of time. I even called their (PCRI) support staff and asked about it but they had no answer.

I understand your anxiety bruningk and empathize with you. Unless I missed it I didn't see anything about your staging. Where was the cancer located when you were scanned prior to going on ADT? I presume not confined to prostate? And what was the radiation field?

I've tried to understand the answer to this question and have come across several interesting facts, anecdotal evidence and opinions. Most of this is from memory from things I've read in studies or seen/heard oncos say at conferences or in youtube vids.

1. Disease burden matters. The more extensive the mets, the more mutated the cancer cells and less like the "mothership" they become. Thus they become less susceptible to drugs designed to starve cancer cells of the fuel, DHT or testosterone. I've spoken with guys who've had mets and have been battling PCa for many years, 25+ in one case. I think they had a relatively low, though advanced, disease burden when diagnosed.

2. PSA doubling time is a strong predictor of eventual metastasis and the subsequent transition to CRPC 2-3 years later (though you can become CR without metastatic disease). There is a point of inflection in the curve showing probability of developing distant mets versus PSADT. That occurs around a PSADT of 7 months and increases as PSA decreases further. My PSADT when my PSA took off after RP was around 8 months, so it was aggressive but possibly controllable over the long term. You should ask your onco what your calculated PSADT is based upon it shooting up from 0.05 to .39. There may be some nuances in the calculation I'm not aware of but on the surface it appears you have a pretty short PSADT. Of course this particular graph is probably not directly applicable to your question, but its a morsel of data.

3. Dr Mark Scholz made a very puzzling statement on one of his videos a couple of months ago regarding how long ADT treatments work. He didn't explain the exact context, but his comment was that these days with newer treatments the time to CR has been estimated to be around 17 years. I rewound the tape and relistened to it several times, but that was basically what he said. I'm not even sure how that is possible when the latest ARSIs have only been on the market about 5-7 years, though it is certainly possible to estimate parameters like that given data collected over a shorter period of time. I even called their (PCRI) support staff and asked about it but they had no answer.

We are on new ground here. ADT with the ARSI's along with triplet therapy are new. The doctors really do not know how to estimate OS because those of us on triplet therapy are the new active metrics.

Thank you for the info but my head is spinning! That’s a lot to absorb but shows I’m not up to speed on my situation. I think if I understand my situation, no Mets yet. They mentioned lymph nodes but bones seemed clear. So if I understand you, my cancer doesn’t become CR until it spreads? Not while it’s contained in the prostate?

Thank you for the info but my head is spinning! That’s a lot to absorb but shows I’m not up to speed on my situation. I think if I understand my situation, no Mets yet. They mentioned lymph nodes but bones seemed clear. So if I understand you, my cancer doesn’t become CR until it spreads? Not while it’s contained in the prostate?

The "triplet therapy" is hitting advanced prostate cancer with three different attacks up front (e.g. radiation, ADT, and chemo). I think it's less common with castrate-sensitive, oligometastatic PC than it is with castrate-resistant and/or widely metastatic PC, but I am neither a medical professional nor a research scientist, so please verify with your own onco team.

ARSI (androgen-reception signal inhibitors) like Zytiga, Erleada, and Xtandi complement ADT (androgen-deprivation therapy) — the ASRI prevent the cancer cells from receiving the testosterone signal (even, to a certain extent, if once the cells have become castrate-resistant). I think it's becoming standard to prescribe both for advanced prostate cancer these days rather than just ADT alone, especially after the significant improvement demonstrated by big studies like TITAN, but they're also expensive (thousands of $$/month) if you don't have your government, private insurance, or a patient-access programme covering them.
https://www.nejm.org/doi/full/10.1056/NEJMoa1903307

Thank you all for the great info. One last question, my doc said incurable now since radiation failed. Do you all agree with that and things like salvage prostectomy, cryoblation, and Brachytherapy are off the table?

Is "Johns" Johns Hopkins Medicine? I'd love to read more from that source if you have the link.