1. < Prostate Cancer

RT + 3 years ADT + 2 years Zytiga initial treatment?

Posted by akiwi @akiwi, Sep 22 3:55am

Is anyone here being treated for non-metastatic disease with 3 years ADT + 2 years abiraterone (e.g. Zytiga) as a first Hormone treatment?
I'd be interested in hearing your experiences or what was communicated by your oncologists.

I as wondering because the European guidelines on PCa suggest this as a treatment.

"Offer IMRT/VMAT plus IGRT to the prostate in combination with long-term ADT and two years of abiraterone to cN0M0 patients with ≥ 2 high-risk factors (cT3-4, Gleason ≥ 8 or PSA ≥ 40 ng/mL)".
I was diagnosed with T3b GS 4+4, intra-ductal cribriform, cN0M0, PET PSMA negative, PSA 10.3 and have been treated with EBRT (whole pelvic + prostate/SV boost completed 24 July 2024) and Orgovyx.

So I was wondering if this has made it into clinical practice in other places?

I asked my RO (who knew about the trial results) about this but he thinks the benefits were not enough to justify the side effects. I should have been asked to decide ☹️, more likely it is not part of their standard of care yet.

Interestingly none of the hospitals that I got opinions from (of the four I consulted 😉) suggested this, but at one hospital the RO was one of the authors of those guidelines.

Any other thoughts about it that may be relevant (please don't hesitate about opinions - I'm capable of making up my own mind and will check everything).
You can always direct message me as well.

These are my Chatgpt discussions this morning and again I will check it carefully, (Chatgpt is often wrong or misleading).
https://chatgpt.com/share/66efd872-9b34-8013-b283-e7efc24ad238
p.s. The European guidelines are meant for Doctors but are very useful for patients as well with a bit of effort.
There are two versions, the full version and a pocket version (with just recommendations). I could not find a publicly accessible US equivalent but if anyone knows one I would be interested.
https://uroweb.org/guidelines/prostate-cancer
pocket: https://d56bochluxqnz.cloudfront.net/documents/pocket-guidelines/EAU-EANM-ESTRO-ESUR-ISUP-SIOG-Pocket-on-Prostate-Cancer-2024_2024-04-16-125527_rzmb.pdf

"Pocket" Version Page 102 (recommendation)
"Pocket" Version Page 112 (decision tree)

An article based on the Stampede trial
https://www.nejm.org/doi/full/10.1056/NEJMoa1702900

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

billfarm | @billfarm | Sep 22 12:41pm
In reply to @jeffmarc "I think you will find that you have to have multiple metastasis as well as being..." + (show)
@jeffmarc

I think you will find that you have to have multiple metastasis as well as being castrate resistant before they really push for triplets therapy. You don’t want chemo until it’s appropriate.

I’ve had PC for 14 years but only one metastasis which was zapped. Chemo is not appropriate in my case and it doesn’t sound like it is in yours. Mayo doctors want to do what is best for you. Chemo is hard on your body and mind, best to put it off until it is most effective, which is when you have multiple metastasis that can be treated all at once

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My idea was to slam dunk and be done. Maybe too simplistic.

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billfarm | @billfarm | Sep 22 12:44pm

Alternatively I am considering intermittent adt per md Anderson protocol hoping to prolong time to resistance.Any thoughts on that?

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jeffmarc | @jeffmarc | Sep 22 12:53pm
In reply to @billfarm "Alternatively I am considering intermittent adt per md Anderson protocol hoping to prolong time to resistance.Any..." + (show)
@billfarm

Alternatively I am considering intermittent adt per md Anderson protocol hoping to prolong time to resistance.Any thoughts on that?

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If your PSA stays undetectable, you can stop ADT until the PSA starts rising. Results can vary, some people get less help from drugs when they stop and start. That can depend on how extensive your cancer is as well. I know someone that did this for 4 years. He now has to move to a second drug and stay on two drugs constantly, cancer can get progressively worse for many of us.

If you want to get some professional advice attend Monday’s Ancan.org meeting and you will have a number of people that can tell you what works best with your particular situation. New people are always first to talk. There are always a couple of doctors there as well. I know that Rick, one of the leaders, does not like using intermittent, but is all for stopping when you are undetectable for a while.

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akiwi | @akiwi | Sep 22 1:18pm
In reply to @billfarm "On orgovyx and abi Went to mayo in search of triplet therapy. Was told that was..." + (show)
@billfarm

On orgovyx and abi Went to mayo in search of triplet therapy. Was told that was serious overreaction. Does resistance failure have to occur before triplet therapy is authorized?

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Hi @billfarm

Thanks for posting. I actually followed your previous posts and found some interesting threads!
😃
For others who may be interested
https://connect.mayoclinic.org/discussion/orgovyx-and-zytiga-combined/

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billfarm | @billfarm | Sep 22 1:25pm
In reply to @jeffmarc "If your PSA stays undetectable, you can stop ADT until the PSA starts rising. Results can..." + (show)
@jeffmarc

If your PSA stays undetectable, you can stop ADT until the PSA starts rising. Results can vary, some people get less help from drugs when they stop and start. That can depend on how extensive your cancer is as well. I know someone that did this for 4 years. He now has to move to a second drug and stay on two drugs constantly, cancer can get progressively worse for many of us.

If you want to get some professional advice attend Monday’s Ancan.org meeting and you will have a number of people that can tell you what works best with your particular situation. New people are always first to talk. There are always a couple of doctors there as well. I know that Rick, one of the leaders, does not like using intermittent, but is all for stopping when you are undetectable for a while.

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Undectable since April 2023. Scheduled to go off march 25. 24months Oorgovyx and abi. Post op 1.83 went to 2.53 in 30 days. Went from 2.53 to undectable in 3wks

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jeffmarc | @jeffmarc | Sep 22 1:31pm

You are a perfect example of someone that can try stopping everything because you are undetectable for a long time. I know people that have gone two or three years that way, in the Ancan.org group, but most eventually have to start back up on ADT.

Waiting the recommended amount of time to stay on ADT gives you the best chance of having a long vacation from the drugs.

Make sure to get quarterly blood tests, and if it starts rising monthly.

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billfarm | @billfarm | Sep 22 1:43pm
In reply to @jeffmarc "You are a perfect example of someone that can try stopping everything because you are undetectable..." + (show)
@jeffmarc

You are a perfect example of someone that can try stopping everything because you are undetectable for a long time. I know people that have gone two or three years that way, in the Ancan.org group, but most eventually have to start back up on ADT.

Waiting the recommended amount of time to stay on ADT gives you the best chance of having a long vacation from the drugs.

Make sure to get quarterly blood tests, and if it starts rising monthly.

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Normally monthly and comprehensive blood panels quarterly

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jeffmarc | @jeffmarc | Sep 22 1:49pm

Even better. Especially when you first stop ADT. Never know how your body will react.

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billfarm | @billfarm | Sep 22 8:59pm
In reply to @jeffmarc "Even better. Especially when you first stop ADT. Never know how your body will react." + (show)
@jeffmarc

Even better. Especially when you first stop ADT. Never know how your body will react.

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Also consider staying on orgovyx/abi indefinitely. Orgovyx is new enough that no long term studies say you can t. Sort of a puzzle. When I declined indescriminate photon bombardment of my guts the drs told me I would get resistant and cancer would explode. Not sure they can know that. Anyway I got the mayo radiologist to admit the the bombardment wouldn’t have any effect on Mets in my lymphatic system. Fell pretty good excepting various levels of fatigue.

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jeffmarc | @jeffmarc | Sep 22 9:34pm
In reply to @billfarm "Also consider staying on orgovyx/abi indefinitely. Orgovyx is new enough that no long term studies say..." + (show)
@billfarm

Also consider staying on orgovyx/abi indefinitely. Orgovyx is new enough that no long term studies say you can t. Sort of a puzzle. When I declined indescriminate photon bombardment of my guts the drs told me I would get resistant and cancer would explode. Not sure they can know that. Anyway I got the mayo radiologist to admit the the bombardment wouldn’t have any effect on Mets in my lymphatic system. Fell pretty good excepting various levels of fatigue.

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Many people stop taking all ADT when their PSA stays undetectable for a long time. Staying on Orgovyx it’s pretty much the same to your body is staying on Lupron. Your testosterone never increases and you have all the side effects of the drug that near eliminates your testosterone.

I have to stay on Orgovyx or equivalent all the time (7 years now) because my PSA rises quickly without it. I have to live with brain fog, muscle, deterioration, and hot flashes. It’s good for people to get off of it, if they can.

Staying on Abi for more than four years, can lead to neuroendocrine cancer. Something they discovered recently and announced at the latest PCRI conference.

Abi also has negative effects on heart, Staying on indefinitely just continues to cause more problems. Another drug to get off if you can.

I wonder if you were just being sarcastic!!!

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