1. < Prostate Cancer

Anyone take a Treatment Holiday? Intermittent use of ADT (hormone Tx)

Posted by seer @seer, Nov 3, 2023

I wish there was more info. on 'drug holidays' or 'intermittent use of ADT', with or without concurrent or prior surgery or radiation; especially as may relate to ADT 'orally alone' emphasizing Quality of Life, which may be a consideration particularly in order (over 75) men. I see plenty of discussion about side effects (common between ADT regimens it seems, whether injections or pills, which have lower long QT heart risk); but I see nothing dedicated to 'Orgovyx alone without any other treatment; and then 'if' one stops; and restarts... meaning is there an 'end point' of the course'; and then a patient does nothing more.

Maybe I saw one study in Japan; but not U.S. .. Again no discussion on say an older guy (over 75) taking Orgovyx … as ADT alone… without surgery or radiation. IE: QOL concern given it seems longevity is about the same (statistics don't help much; as once someone hits 80, longevity won't vary much regardless of treatment). So I'm wondering if 'ADT alone.. mono therapy' is a wise course. Also, is there info. on after successful year of treatment with Orgovyx and then PSA pops up a bit (say from .1 to 3. ..) will another few months restarted treatment be sufficient, and then 'do nothing' beyond. Or just skip it after going through a year of Orgovyx with the usual side effects (hot flashes etc.. )

May not be what supports clinics; but wonder if it's a quite reasonable choice (for 'localized' PC, Gleason Score 8; not metastasized). I have conflicting views from doctors; one for 'radiation' despite pacemaker; another: 'just pause the Orgo. and restart'; to lastly another doc: 'you had a course of Orgo; let things stabilize; enjoy life and don't think about it".

I realize there's no perfect answer; would appreciate reflections on this topic…especially if you did Orgovyx alone and stop and restarted or not. Thanks! I appreciate Coleen's efforts to help this group! (Lurking so far; my first post here ever.)

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

ajpernsteiner | @ajpernsteiner | Oct 8 9:27am
In reply to @seer "I appreciate your post greatly; as that video gave me the most information (more than three..." + (show)
@seer

I appreciate your post greatly; as that video gave me the most information (more than three docs and two radiation oncologists); only one of which would even acknowledge the topic of 'drug holidays' or intermittent. In my case I've had a pacemaker installed and probably didn't need it, as the irregular heartbeat (bracycardia) might have been triggered by too long ADT.

I was on Orgo. for 15 months and never was it mentioned as a 'course of treatment you stop' at a point or IF there are side effects. I had many of the side effects and stopped taking it on my own and almost all normalized. BUT, the PSA popped back up so starting it again and we'll test in 3 months.. even another PET scan. Due to cardio-drugs I didn't think brain fog was a factor, but now that you mention it, maybe I can attribute the 'fog' to the ADT treatment not Blood Pressure treatment or statins.

I knew about the re-loading to restart and followed that (thanks); but mostly for that video; 2 years old and far more informative than any information I've encountered on this topic. Cheers and good luck to you too!

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Hello. I am wondering if you began the 2nd time on Orgovyx? I did the same thing as you, took it 18 months, but PSA is up. Was wondering if Orgovyx works on a 2nd go round. Dr doesn't seem to know. Thanks for any info, and best of luck with your journey.

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1 reply
northoftheborder | @northoftheborder | Oct 8 1:12pm

Here's a 12-year-old news story about a Canadian study on ADT treatment holidays (note that a lot has likely changed since then).
https://www.cbc.ca/news/health/drug-holiday-an-option-for-some-prostate-cancers-1.1204872
Key quotes:

"…men who were given intermittent courses of drugs that suppress the production of male hormones lived as long as men who received continuous therapy.

But the men on the intermittent course had fewer of the unpleasant side-effects that go along with this type of prostate cancer treatment."

…

"The findings don't relate to men whose prostate cancers have spread. A companion study — which was presented recently to a major cancer research conference — found for men with metastatic cancer, intermittent therapy did not have the same safety profile. "

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seer | @seer | Oct 8 8:04pm
In reply to @ajpernsteiner "Hello. I am wondering if you began the 2nd time on Orgovyx? I did the same..." + (show)
@ajpernsteiner

Hello. I am wondering if you began the 2nd time on Orgovyx? I did the same thing as you, took it 18 months, but PSA is up. Was wondering if Orgovyx works on a 2nd go round. Dr doesn't seem to know. Thanks for any info, and best of luck with your journey.

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Hi... sure.. on the 2nd' go-round (after about 3-4 months off) the PSA dropped from 4 down to 1. Then I stopped for 4 or 5 months for this whole summer. PSA two weeks ago was back to 7 so I plan to restart Orgovyx.. probably not for another two weeks. The MO encourages it right now; but I'm getting a follow-up PET with PSMA later this month which ideally the MO would prefer to ascertain where things stand (is it still localized is the question) .. preferably before I restart the Orgo., which might suppress 'T' fast and mask the results of the PET. So probably a couple more weeks, even though I understand that the cancer can be growing while I delay (couldn't book the CT machine soon enough; hence delay). I'll be glad to update after. Good luck to you and keep us informed if you do anything similar.

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billfarm | @billfarm | Oct 9 4:06am

A lot of good comes from this site. I am planning intermittent adt. Had Gleason 9 grade 5 surgery failed. Got on adt(Oorgovyx/zytiga) erased psa to undetectable in30 days.After24 months adt I will quit and test monthly. Didn’t t buy into pelvic radiation as I had nodal involvement that wouldn’t t be helped by that. Md Anderson has a protocol on intermittent adt. Getting my oncologist on board with that.

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1 reply
ajpernsteiner | @ajpernsteiner | Oct 10 12:47pm
In reply to @billfarm "A lot of good comes from this site. I am planning intermittent adt. Had Gleason 9..." + (show)
@billfarm

A lot of good comes from this site. I am planning intermittent adt. Had Gleason 9 grade 5 surgery failed. Got on adt(Oorgovyx/zytiga) erased psa to undetectable in30 days.After24 months adt I will quit and test monthly. Didn’t t buy into pelvic radiation as I had nodal involvement that wouldn’t t be helped by that. Md Anderson has a protocol on intermittent adt. Getting my oncologist on board with that.

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Is there a link or site for finding the MD Anderson protcol? I would like to learn more. I just did a break from Orgovyx (on 18 months) but appears I will be going back on treatment. Thank you for any info you might be able to share.

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1 reply
billfarm | @billfarm | Oct 10 5:53pm
In reply to @ajpernsteiner "Is there a link or site for finding the MD Anderson protcol? I would like to..." + (show)
@ajpernsteiner

Is there a link or site for finding the MD Anderson protcol? I would like to learn more. I just did a break from Orgovyx (on 18 months) but appears I will be going back on treatment. Thank you for any info you might be able to share.

Jump to this post

I think I was googling int adt and it popped up. Was reading another lately it said quality of life improved and a few less days of life not statistically significant enough to move a chart. I will look for links for you if I can find them again.

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