Our experiences may not be yours, for example, my first ADT break after 18 months of Lupron was almost four years. The last Lupron shot was in May 2018, so 90- days from then, August "began my ADT holiday, then in August 2022, my PSA began rising to where in April 2023, we did SBRT and 12 months of Orgovyx. However, that was part of triplet therapy, six cycles chemotherapy and WPLN radiation.

The 2nd time is now, I am coming up on 14 months since the SBRT and 12 months of Orgovyx.

For the first year, we had labs and consults every three months. At our recent consult, my oncologist and I agreed to stretch it to four...

Mine is high risk, GG4, GS 8, rapid PSADT (< 4) and PSAV, short time to BCR.

If you come off, determine frequency of labs and consults, and decision criteria for wat constitutes clinical data to go back on treatment - in my case, that's three or more consecutive increases spaced three months apart, PSA between .5-1.0, image and then decide.

Treatment choices may depend on your clinical data, importantly, imaging. As others have said, possibly MDT only as there is some data indicating it may delay the need for onset of systemic therapy. You may also do MDT in conjunction with systemic therapy, doublet such as ADT + ARI, or triplet, throwing chemotherapy or MDT in with the doublet.

If you take the break, consider some type of fitness program, diet, exercise, managing stress. Why, there is some data that it can aid in T recovery and strengthening the immune system, thus potentially extending the holiday.

Depending on which agent you were on, your baseline T, and age, it may time some time for your T to recover to where you feel "better." In both my cases, it was three months. Yours, as others have indicated, may be different.

Kevin