Stopping ADT

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. 😕

It seems we are far enough down the line with the advances in PCa, that testing for androgen sensitivity (prior to trial) should/could be an important step. I am a wee bit flummoxed that we have had 2 liquid biopsies, 2 mets tissue biopsies and there is no 'knowing' about the cancer's reliance on Testosterone - its an assumption that it is, versus a fact. Is is true for all who are ADT virgins? just assume the cancer depends on T? Being rhetorical...

@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.

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.

I think that might be overstating the problem a bit. There's no test for individual cancer cells loose in the body, period — they can't detect them until they start forming tumors — so there would be no way with current tech to detect if some of those cells are evolving castrate resistance.

But they can measure by impact. Prostate cancer cells express PSA when they're multiplying, so if ADT brings your PSA down, then at least a lot of your cancer is castrate sensitive; if it doesn't, then at least a significant portion of it is evolving castrate resistance.

The studies I've seen are a little more nuanced: it's not that prolonged ADT promotes castrate resistance, but that overall mortality can fall with ADT holidays for earlier-stage cancers, because the risk from side-effects like heart disease and diabetes are reduced.

Unfortunately, they have not found that (yet) for stage 4. Our life expectancy used to be in the low single digits (there's a good chance I'd have been dead by now); things are much better with new treatments over the past few years, but our bodies are *not* evolving any "natural resistance" to prostate cancer at stage 4. We just have to keep hitting it hard and knocking it back. ARSIs like the -lutamides are massively extending the period of castrate-sensitivity for many of us now in the 2020s, so it's no longer the old story of just ADT, either — any data collected more than a few years ago is seriously out of date

One also needs to consider age and general health — if you're very old and/or very sick, then yes, the side effects from ADT might be more dangerous to you than the cancer itself.

Agreed…. I think the universal assumption that all PCa initially is hormone dependent is the quickest, EASIEST path forward for the patient.
Although no one likes the SE’s of ADT, it works quickly - (can anyone cite ONE case where PSA went UP or stayed the same after initiating ADT?) and has far fewer side effects than the treatments used for castrate resistance.
But of course we all want to think “ours is different”. Best
Phil

May i ask hoe long have yoy been diagnosed

I should have been more clear - I meant testing the biopsies for mutations and anomalies - we just got ‘adenocarcinoma of prostate origin’ from the lung Mets - I mean, isn’t there more information in that cluster?

I see what you mean. As far as I understand (not a molecular biologist), all your cancer cells aren't exactly the same — tiny mutations are happening all the time. So even if they could determine castrate sensitivity for the tiny sampling of cells in your biopsy, they wouldn't know if there are others that are on the verge of evolving castrate resistance, or whether they're dormant or active.

That's why it makes the most sense to monitor systemically, to see what your millions or billions of cancer cells are doing together. If your PSA is falling, then ADT is working to hold back the flood, regardless of how any individual cancer cell is responding.

I hope that makes sense.