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

The strange thing is that the test requires tissue from a biopsy?

Now that needs clarification.

@heavyphil has already said what I would recommend you inquire about.

NCCN is a standards group that sets guidelines for treatment of cancer. Doctors use it to backup their recommendations.

Metastatic prostate cancer can still occur while on ADT. There was a study that showed that was possible, search the web for info, and at ASCO there was a lot of discussion about it.

Even though your PSA is undetectable it is possible you have reoccurrence. Of course you could also be cured.

Stay tuned.

Thank you for seconding his suggestion.

Going to take a copy of the protocol in with me and ask about it.

Yes, it does require a tissue from Biopsy.

@jeffmarc
If Gleason 7 unfavorable (4+3) and only got 20 fractions of 3 Gy’s each and decipher .88 How long should I stay on orgovyx.? Lymph nodes not radiated. No boost to tumor. Radiation started on day 11 of orgovyx no testosterone was 750 before radiation psa had gone from 9.4 to 11.9 diagnosed prostate cancer July 20. Radiation started Nov 10. Psa today .209 and testosterone < 2.5. I am I month post radiation and 2 mo post onset of orgovyx. I wanted boost to MR detectable tumor doctor refused also wanted whole pelvis radiated doctor denied. Now recommending only 6 month of adt. I think I need it longer as
Decipher.88 and radiation treatment borderline?

@pfj0650

Below the NCCN guidelines for how long you should be on ADT. You seem to fit right into the six month group. The decipher score isn’t being taken into account for this recommendation.

One thing that could increase the amount of time you need to be on ADT would be if you had one of these factors in your biopsy.

Were any of these things found in the biopsy intraductal, cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive and require longer ADT..

Here are current NCCN Guidelines in 2025. They now suggest 0 (zero) months of ADT for low intermediate (GG2); 4-6 months for high intermediate (GG3), and 18-36 months for high risk (GG4 and 5). Actually, the footnote suggests ADT + abiraterone for T3b with lymph node involvement.
The meta-analysis suggests:
* 0 months for 1 intermediate factor (PSA 10-20, GG2 or 3, T2b-c)
* 6 months for 2 or more intermediate factors (PSA 10-20, GG2 or 3, T2b-c)
* 12 months for NCCN high risk (PSA >20, GG4 or 5, T3 or 4)
* undefined for NCCN very high risk (2 or more PSA >40, GG4 or 5, T3 or 4)

@pfj0650 Hey man, just commenting here on your situation.
A Gleason 4+3 with a Decipher of .88 is a fairly aggressive case; though not technically aggressive, since it’s not G8, the unfavorable aspect in conjunction with a high Decipher score certainly makes it damn close.
What was your RO’s reasoning for not radiating full pelvis (bed and nodes)? That just doesn’t make sense to me; even without ECE and other visible pathologies in your biopsy, the Decipher score is telling you clearly that this particular cancer has a higher rate of recurrence.
My own case was a very dense content of G4+3 unfavorable (some cores 90%). But there was no decipher score 7 yrs ago and I did not have the knowledge to ask about cribriform cells and intraductal carcinoma. I elected surgery because of increased chance of recurrence.
Got 5 yrs out of that and then had SRT INCLUDING PELVIC NODES and 6 mos ADT.
Don’t think more than 6 months ADT is gonna have a great impact on you at this point.
My only advice (humbly and given in comradeship), is to monitor your PSA closely after it hits its nadir (which could take 6 months to a year) and to be more pro-active in getting treatment if you see your PSA trending upward 3 consecutive times.
Don’t WAIT just because any doctor tells you so; find another one because it’s YOUR life hanging in the balance, not theirs!
Best,
Phil

Well, it's a factor...

The EMBARK trial allowed participants who achieved an undetectable PSA within the first seven months to come off treatment.

There are other clinical data which may play in a decision.

GS
Grade Group
PSADT
PSAV
Genetic Testing
Pathology Report

My radiologist says that at the tumor review boards are all over the map when presenting the time, agent(s) for systemic therapy and their reasoning.

The question about coming off treatment center around:

What is the clinical data supporting doing so?

What is the monitoring plan, frequency of labs, imaging and consults?

What clinical data would constitute going back on treatment?

How long will your "vacation" be? Nobody knows. More and more OS is not a measure, PFS and RPFS are.

The length of the vacation is one factor, so us the quality. If the length is short, say 6-12 months and you were on Lupron for 18-24 months then the rate of T recovery may make the vacation mute in terms of quality.

I've taken two vacations, after triplet therapy I completed in May 17 and doublet therapy I completed in April 24.

The first vacation lasted almost five years, the send is at 20 months....

I'm high risk, GS 8, GG4, rapid PSADT and PSAV, only 18 months to BCR after surgery....

Some would say I should be on continuous not intermittent. Maybe, but I chose not to and my medical team has worked with me to support my choices.

We do have criteria for resuming treatment and when off, we do labs and consults every 2-4 months, image when the clinical data supports doing so.

Perhaps,, no way of knowing, but my genetic testing has shown no mutations, so, maybe that's why my clinical history is the way it is.

So, can you take a "vacation!?" That's a discussion and decision for you and your medical team.

Kevin