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That's an area of active research. Right now, standard practice is to stay on ADT (and often, ARSI) indefinitely with stage 4 prostate cancer, but they're still doing studies to see if there's a safe way to take "holidays," the way people can with earlier stages of prostate cancer.
The danger is that castrate-sensitive cancer could come back as castrate-resistant — that's why I wouldn't consider an ADT holiday for myself until there's strong evidence for a safe way to do it. I haven't fought my way this far to risk losing it all just for a 6-month break from hot flushes. 😕
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My MO stopped my ADT in January if 2025, Trelstar was used on my butt for 28 months. Psa been less than .01 for that long. I was Gleason 9 stage 4 metastices to two pelvic lymphoma nodes. Will keep y informed if PSA goes up. I take mushroom powder in my hot tea every morning. Can’t hurt- white button ground up into powder. I ll be glad when some of the side effects go away from my ADT shots. Naps all the time. Take care everybody.
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@northoftheborder, I've also seen (apologies, I don't have the reference) a competing thought: that uninterrupted ADT (Lupron/leuprolide) may promote resistance, as cancer cells find alternate sources for their survival, and that intermittent ADT may prevent this.