How long does your oncologist have you on ADT?

For those of us who are stage 4 metastatic - forever. Even if, and I emphasis if you become castrate hormone resistant most doctors have you continue on your ADT shot and ARSI medications. Why? Because it is because these medication are still working on the cells that are not resistant. I said if to castrate resistance because not everyone become resistant. It is just not true that it is a matter of when. I do not know the percentage of men that remain castrate sensitive but men with stage 4 metastatic do remain castrate sensitive throughout their disease journey. This is why I believed in hitting the cancer as hard as possible upon being diagnosed. Radiation to the spin and ribs - keeps killing cancer cells 2+ years. 10 cycles of docetaxel chemotherapy. It took 33 weeks to finish chemo. That is a a lot of cellular death and DNA cell damage to the cancer cells. Cancer cells do die. They just do not die in the normal timely fashion. Cancer is killed in three ways - radiation, chemo, and starvation through ADT, ARSI's, and diet.

I agree--forever. My husband has been Stage 4 and castrate resistant for many years, and has stayed on Lupron the entire time. His local medical oncologist and the Pluvicto team and the Kwon team at Mayo all agree that it makes no sense to remove one of the weapons you are using to fight the cancer.

How long was your husband castrate sensitive. Or how long did it take for your husbands cancer to become resistant to ADT.

For those of us who are stage 4 metastatic - forever. Even if, and I emphasis if you become castrate hormone resistant most doctors have you continue on your ADT shot and ARSI medications. Why? Because it is because these medication are still working on the cells that are not resistant. I said if to castrate resistance because not everyone become resistant. It is just not true that it is a matter of when. I do not know the percentage of men that remain castrate sensitive but men with stage 4 metastatic do remain castrate sensitive throughout their disease journey. This is why I believed in hitting the cancer as hard as possible upon being diagnosed. Radiation to the spin and ribs - keeps killing cancer cells 2+ years. 10 cycles of docetaxel chemotherapy. It took 33 weeks to finish chemo. That is a a lot of cellular death and DNA cell damage to the cancer cells. Cancer cells do die. They just do not die in the normal timely fashion. Cancer is killed in three ways - radiation, chemo, and starvation through ADT, ARSI's, and diet.

Actually, you become castrate resistant and ADT no longer keeps your PSA down, Even though you are castrate resistant, not every cell is castrate resistant as you mentioned.

You then begin an ARSI Because they are capable of keeping the PSA down, even if castrate resistant.

I’ve been castrate resistant for six years, If I reduce my main ARSI drug, my PSA rises immediately. I was on Zytiga for 2 1/2 years. I tried reducing from four pills to three to see if it would help with the brain fog. My PSA went from .2 to 1 in 18 days because I had reduced the ARSI.

I stopped taking Orgovyx For eight months. Darolutamide Kept my PSA undetectable the whole time. That’s because Darolutamide works even if there is testosterone. (Other lutamides too).

I did not say every cell is castrate resistant. For many men who started their metastatic cancer treatment 6, 7, or even 8 years ago. The treatments was different. The medical community would start you on Casodex for 30 days and then start you on ADT. At some point resistance would set in and they would offer chemo. PSA would go down and then start to rise. Then they would start you on an ARSI like Xtandi and the ARSI would keep the cancer under control for many years - hopefully.

Now - triplet therapy has replaced doublet for high volume metastatic prostate cancer. You get all the treatments up front and they are hoping for longer deep remission.

I was told by my doctor if I ever started to become resistant they would not stop ADT or Darolutamide. I believe Darolutamide is a miracle drug and is superior to the other ARSI's.

I did not say every cell is castrate resistant. For many men who started their metastatic cancer treatment 6, 7, or even 8 years ago. The treatments was different. The medical community would start you on Casodex for 30 days and then start you on ADT. At some point resistance would set in and they would offer chemo. PSA would go down and then start to rise. Then they would start you on an ARSI like Xtandi and the ARSI would keep the cancer under control for many years - hopefully.

Now - triplet therapy has replaced doublet for high volume metastatic prostate cancer. You get all the treatments up front and they are hoping for longer deep remission.

I was told by my doctor if I ever started to become resistant they would not stop ADT or Darolutamide. I believe Darolutamide is a miracle drug and is superior to the other ARSI's.

Casodex is only required for two weeks before Lupron (etc.). Of course, if you start with Orgovyx you can skip Casodex.
They do not offer chemo if somebody is just castrate resistant. I have never been offered chemo because it is generally inappropriate if you don’t have metastasis. I have had PC for 15 years and castrate resistant for 6. My one spinal metastasis was zapped with SBRT, appeared 2 years ago.

I’ve heard from many people that have had triplet therapy and in almost every case it’s because they had multiple metastases found upon diagnosis or after a drug holiday. In cases where there are n five or fewer metastasis, they usually like to use SBRT rather than chemo right away.

When somebody becomes castrate resistant, they are almost always given an ARSI, NCCN calls for it.. Those include Zytiga, apalutamide, Enzalutamide, and Darolutamide.

I like Darolutamide a lot, It has worked quite well for me And many other people, I know.

Apalutamide has worked quite well for some people and is now involved in a study where people who are castrate sensitive stay on it, and it prevents them from becoming castrate resistant. It’s a study so no final results are available yet. Maybe Darolutamide works the same!

You said
‘I did not say every cell is castrate resistant.”

If you review what I said, you will see I said “ not every cell is castrate resistant as you mentioned.”

Actually, you become castrate resistant and ADT no longer keeps your PSA down, Even though you are castrate resistant, not every cell is castrate resistant as you mentioned.

You then begin an ARSI Because they are capable of keeping the PSA down, even if castrate resistant.

I’ve been castrate resistant for six years, If I reduce my main ARSI drug, my PSA rises immediately. I was on Zytiga for 2 1/2 years. I tried reducing from four pills to three to see if it would help with the brain fog. My PSA went from .2 to 1 in 18 days because I had reduced the ARSI.

I stopped taking Orgovyx For eight months. Darolutamide Kept my PSA undetectable the whole time. That’s because Darolutamide works even if there is testosterone. (Other lutamides too).

Your posts are very informative. You seem very knowledgeable. Is this from being an informed patient?