PSA Nadir main deciding factor when one can start on Intermittent ADT?

It definitely happens. Something don’t have it come back for years and others. Have it come back within months.

That’s one of those things the decipher test can tell you you’re probability of it happening

How many times you had PSMA pet scan before September 2024?

People have come into the Ancan.org advanced prostate cancer meeting after having this happen. It is not uncommon, but I would guess that more than half of the people who are on ADT for that long can go for more than a year before a reoccurrence.

Reoccurrence is not guaranteed. I’ve seen a few people over the years with Gleason nines that have gone a long time without reoccurrence, In some cases, 20-30 years,.. Gleason 10 is so rare that I cannot comment about that, very few people have a 10.

JeffMar, Are you a doctor? Just curious where you are coming from with these numbers. I am Gleason 9 Grade 5.
Thanks

I am not a doctor.

Here are the latest numbers from NCCN directly
https://www.nccn.org/professionals/physician_gls/pdf/prostate.pdf
Just some excerpts
* unfavorable intermediate-risk prostate cancer treated with RT, short-term ADT (ST-ADT) (4-6 months) is recommended. Concurrent/ adjuvant ADT is preferred over neoadjuvant ADT in this setting.
* For high-risk and very-high-risk prostate cancer treated with EBRT alone, long-term ADT (LT-ADT) (18-36 months) is recommended.
* For high-risk and very-high-risk prostate cancer treated with combination EBRT + brachytherapy, a shortened duration of ADT (12 months) can be considered.

Intermediate is grade group 2 or 3
High-risk and very-high risk GG 4 or 5 with very-high being a PSA over 40

A lot of the other information I provide is from user groups and webinars I attend.

For at least 3 years I have attended weekly Ancan.org Advanced prostate cancer 2 hour meeting. I hear about a lot of people‘s treatment and how it worked. Other than the new people that come in most every week, other people come in to ask questions about problems they’re having
I also attend biweekly’s CSC 2 hour advanced prostate cancer meetings and monthly UCSF meetings

With all of these, I hear about what’s going on with peoples treatments.

I also attend seminars regularly.

Excellent information! Gleason 9 Grade 5, staging 3ab, Cribriform 3,4,5. RP 2.5 years ago, BCR .22 at 2-year post RP. Undergoing 25 salvage with 6 months ADT. Seems light from what you pasted.
Thank you for the information. Sadly, no NCCN center here.
Chip

Jeff,
I was reading about another Biomarker Test "Oncotype DX" Genomic prostate score that accurately predicts long-term risk of metastasis and death in men with localized disease. They have certain eligibility restrictions for this test like "No biopsy in the last 3 years" which I don't understand.
Are you aware of this?

Chippy, if you are not done with your 6 mos ADT, I would try talking to your medical oncologist about staying on it for another six months. Your RO may not be looking as closely at your combination of factors, you know?
I had 6 months Orgovyx during salvage radiation and my original Gleason was 4+3 - and it took 5 years to slowly recur. Your situation seems a bit more aggressive so longer ADT would probably be a benefit.
Yeah, it sucks all around but what can you do but grit your teeth and plow ahead. Best
Phil

Thank you. Currently gritting and plowing. 2 months in and ADT isn't much of a problem but maybe still early. I will finish 25 sessions of radiation this Friday and it has been more of a problem with side effects. That will be a question for my Oncology Urologist. Frankly I no longer feel he is 100% invested in my care and will be contacting my insurance and see if they will pay for my entitled second opinion at Mayo Baltimore area. It's a hike but closer than Duke.

So, my experience...

I've done ADT twice, first was as part of triplet therapy staring in January 2017. Original treatment plan was six cycles of Taxotere, 24 months Lupron (8x90 day shots) and WPLN radiation (25 IMRT 45 Gya). There was also consideration to adding an ARI should my PSA not drop to undetectable in the first six months.

We did not have to add the ARI and Dr. Kwon agreed to stop Lupron at 18 months based on my response to treatment and studies that looked at 36 vs 24 vs 18...

The next time was in April 23 when I did SBRT (5x8Gya) and 12 months of Orgovx. My oncologist wanted to do 24 months based on studies such as EMBARK, he also wanted to add an ARI. I pushed back discussing studies that pointed to 6-12 months combined with SBRT. We reached a shared decision, SBRT, 12 months of Orgovyx, only add the ARI if PSA did not drop to undetectable in the first three months, labs and consult every three months, then revisit the decision at 12 months, decide whether to come off treatment or continue to 24.

We did not add the ARI based on my response, we stopped at 12 and per our original decision, do labs and consults every three months. PSA tests over the first nine months are "undetectable," next one is in April.

Both times my T recovered rapidly in the first three to six months. Time off treatment the first time was roughly four years, second time at 10 months currently.

I am high risk - GS 8, GG4, rapid PSADT and PSAV, 18 months to BCR...

Kevin