ADT as a stand alone treatment

I wonder if it would be helpful even if you were doing watchful waiting. For example, an equivocal node was tested by taking a 2 months ADT. If the SUV (standard uptake value of agent registering cancer activity) on the node remained after ADT they would know that it wasnt' cancer. If the the node was gone on a subsequent PSMA they would know that it was cancer and would treat the area.
So while ADT supresses tumor growth, it might compromise the ablility to detect cancer metastasis or low activity spread.

Radiation or surgery aside, with advanced stages of prostate cancer ADT is often paired with an ARSI these days to increase the time to castrate resistance (or possibly prevent it altogether in many cases — there aren't enough years of data yet to be sure).

ADT prevents your body from producing testosterone; an ARSI like Erleada prevents any hidden cancer cells from receiving it.

(As always, layperson writing here, so talk to your onco team.)

The answer, it probably is...

However, that depends....

More and more mainstream clinical practice is not to do mono therapy, rather, doublet or triplet therapy.

For example, the cells that make up your PCa are a heterogeneous group, some, well most, will die off in a low testosterone environment, initially. Others can survive which is where the ARIs, radiation or chemotherapy come into the treatment picture. The problem mono therapy presents is by reducing the cells which cannot survive on a low T environment it may create an environment have less "competition" and thrive!

The two latter ones kill PCa cells so there's that.

The former can stop testosterone production from other sources such as the adrenal glands and prevent the remaining cells from either binding with any remaining testosterone and the subsequent growth or if I understand correctly (remember, I'm a layman like you!) block these cells from producing their own T.

So, short answer, yes, but increasingly no..,

I'm at the gym now but when I get home I think I have a more medical based answer on my laptop, if so, I'll add it.

As always, discuss with your medical team.

Kevin

@tango32652

My COT, course of treatment, was going to be ADT, specifically Eligard, for 6 months paired with 25 fractions, med speak for sessions, of Proton Therapy to treat my Gleason 4+5, cT3bN1M0, NCCN Very High Risk prostate cancer. However, the RO, Radiation Oncologist, decided the volume of tumor cells in my prostate and pelvic region plus the proximity of some tumors to vital organs such as the rectum and bladder precluded Proton Therapy for the present. Thus the MO, Medical Oncologist, switched my COT from Eligard + Proton to Eligard + Erleada + Wait and See for 4 to 6 months with periodic diagnostics. The hope is Eligard and Erleade will shrink the volume of tumor cells and in shrinking provide sufficient space between the edge(s) of the tumor(s) and the vital organs to permit Proton Therapy. Or perhaps some other form of External Beam Radiation. During the consultation with the MO I advocated to no avail for chemotherapy in addition to Eligard and Erleade. Brachytherapy, radioligand, and immunotherapy were not discussed.

To state what has been stated ad nauseum, a balance exists between maximizing the aggressiveness of the COT and the degradation of the QoL, Quality of Life. I am 83 but in good health so I advocated maximizing the aggressiveness of the COT. The MO pointed out that chemo at best degrades QoL and at worst is unbearable. Nothing is guaranteed, i.e. 18 weeks or more of chemo does not guarantee more than 18 weeks of good QoL as a reward. It was a risk I was willing to take since no one knows how they will respond to chemo without getting it.

The moral of the story is you have to consider what you think is the optimal COT with what your care team thinks is the optimal COT which may be the SOC, Standard of Care, COT. Not to be overly melodramatic, it is your longevity on the line versus their medical expertise if a divergence exists.

As an aside I have been on Eligard since 25 April and Eligard + Erleada since 4 June with absolutely no side effects. Eligard alone in 3 weeks decreased my PSA from 37ng/mL to 25ng/mL and my total testosterone from 517ng/dL to 57ng/dL.

Fortuna Erudites Favet

That was a good reply. In my case, chemo wasn't indicated (just one metastasis), but I made it clear that at age 56 I was willing to take aggressive measures, so my radiation oncology team "threw the kitchen sink at it" (their words) with 60 gy (curative dose) to the prostate on top of 20 gy to my spine after debulking surgery, together with ADT and ARSI (indefinitely).

The radiation did cause some permanent damage (mild radiation cystitis and proctitis), but I've adjusted to living with it, the same way I've adjusted to living without testosterone (e.g. carry a small face towel in my backpack for hot flushes).

At age 90, I might have made different choices and gone the palliative route — or then again, maybe not. The older I get, the more I appreciate being alive, and I expect that will continue into future decades if I'm lucky enough to have them (I'm 59 now).

(Fortuna inconstans est, neminemque diu favet.)

I am 3+ 3 in one core and doing watchful waiting I had one doctor that wanted to put me on casodex which is. Old hormone therapy but I said no as I could find no protocol for doing this

@tango32652, you got some great replies. I'd be interested to hear what you learned from your oncologist. Did you discuss ADT as a standalone treatment with your team?

I seem to remember Dr Shultz of PCRI fame mentioning that while uncommon, Casodex as a stand alone therapy could be considered though he wasn't recommending it.

Yes. I was not recommended at this point in time. I am six months past RP with PSA remaining at or below .1 I am essentially in "wait and see if PSA goes up" mode but was wondering what I might be able do in the meantime to knock this down if there is cancer still in there.

Casodex is a 1st generation anti-androgen, or bio-genesis inhibitor. The only place I see it being used these days is for a short course prior to starting Lupron and similar ADT drugs to suppress the testosterone spike.

I've also read that casodex is the ADT treatment most likely to cause breast enlargement. I'd stay away from it when much better meds are available!