PSA Nadir is main deciding factor when one can start on Intermittent H

The length of time you stay on ADT (Orgovyx) is pretty dependent on your Gleason score.

If you were Gleason 8 then 18 months is recommended. If you are a Gleason nine or 10, then 24 months is recommended. Gleason 7 then 6 months.

You’ve been on Orgovyx Longer than someone with a Gleason seven would need to be on it. You can discuss this with your doctor. Some doctors let people stop ADT if they’ve been Undetectable for a long time and didn’t have other issues that could cause reoccurrence.

Did you have a decipher score? That could also be a factor in deciding how long you should take ADT.

I was Gleason 9(4+5) and decipher score 0.98
My Radiation oncologist (Amar Kishan) says 1 year, my oncologist at UCI says 18 months, but Dr Scholz of PCRI says, I should take a holiday from ADT, as I get very little benefit by continuing on ADT, sacrificing quality of life. Dr Scholz told me that I can stop when I was on ADT for only 9 months and PSA was 0.06. My oncologist at UCI says even if my PSA is ZERO, I should stay on ADT for 18 months, if I can tolerate it. He says cancer cells are not dead; they are just sleeping and can wake up when you stop ADT too early. Dr Scholz says, I go back on ADT if that happens.
I am getting an MRI on April 8th, per Dr Kishan's recommendation.
For now, I will stay on ADT. I will post it here my MRI results.

Dr. Scholz has told many people that have come to him and then reported in meetings to Stop ADT. He is pretty aggressive. NCCN guidelines say you should be on it for 24 months so even 18 is fewer than the guidelines suggest. With your high decipher Score and a Gleason nine you’ve gotta be careful. If you do stop ADT, make sure to get PSA tested at least every three months.

In some cases, with the Gleeson nine, the cancer can spread a lot if you stop the treatments. With other people, it ends up being very slow growing or doesn’t come back for a long time. Of course they don’t differentiate decipher scores when I hear about this. Some of the long timers weren’t tested because decipher was not available.

Thank you, Jeff. It looks like Dr Scholz follows latest trials more closely. A friend of mine who is a radiation oncologist that treats Breast cancer, told me but not prostate cancer told me when I ran into her at a party told me when I asked her about NCCN guidelines in light of Dr. Scholz's recommendation that it takes time for the guidelines to change as it requires agreement of all the participating institutions.
Yes, Dr Scholz told me about regular PSA check and if it reaches certain threshold, I need to get a pet scan also.
My oncologist at UCI told me that UCI is running a trial being on ADT for 12 months vs 18 months.
For all of us there is no one perfect pathway going forward! It looks like we have to take our chances ultimately and hope for the best!

@ava11
The positive side is that you are looking at multiple sources and evaluating each as you get new information.

The negative side is that your experience with sources from doctors and institutions is a perfect example of doctors making educated guesses that are not always accurate leaving someone unsure and a little scared.

Maybe more frequent psma pet scans or PSE tests could allow you to "catch something" a bit sooner so you can treat again at the appropriate time?

I was gleason 10. I had 45 Radiation and 18 months Orgovyx. My Dr had initially wanted 24 months. My PSA had dropped to .04 at the end of radiation, and stayed there for the next 12 months . At 18 months on Orgovyx it was decided to try a holiday, that was March of 2024. By September my psa had gone to 1.5, by Oct 24 to 2.5. I went back on Orgovyx and had a PSMA scan. It showed lesions on my spine, rib, femur. I am now on Orleada and Orgovyx. Just finished cyberknife on my rib and spine, still have the radiation coming up on my arm. Not sure if a longer stay on Orgovyx would have changed anything, but what I have now is a much bigger struggle than just being on Orgovyx.

I am so sorry you had such a bad outcome. For 12 months on Orgovyx did not bring down PSA from 0.04? Does it mean ADT was not helping you or 0.04 is your Nadir? What was your Testosterone level after 12 months on Orgovyx?
JeffMar was warning about stopping Orgovyx too soon and what could happen. But you didn't stop too soon.
Be positive. At least your Cancer didn't spread to any soft tissue. I understand radiation is effective killing cancer cells in the bone.
Prayers to your health.

I know a few people that have stopped ADT, For a holiday, and within a six months to a year their cancer has come back with many metastasis.

Taking a holiday can be attractive, but it can also be dangerous. I personally would want monthly test for the first six months, But then with my having BRCA2 I really can’t stop taking the cancer drugs.

I know someone who manages an online webinar that has BRCA2 And he has gone on holiday twice. He now lights up the PSMA PET scan like a Christmas tree.

I was on orgovyx for 18 months, and .04 was my nadir. I took the holiday at 18 vs 24 months. My testosterone was in single digits when I stopped.