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← Return to Doublet Therapy Holiday - Option for Oligorecurrent Prostate Cancer?
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Doublet Therapy Holiday - Option for Oligorecurrent Prostate Cancer?
Prostate Cancer | Last Active: Oct 13, 2025 | Replies (13)Comment receiving replies
You ask..."Anyone take a break from hormone therapy despite being oligometastatic?"
In formulating responses, more clinical data may be useful.
You say:
Surgery in December 2019, pathology report?
IMRT - implies BCR to me, if so, again, what was the clinical data, his PSA tests after surgery...what were the dates of his SRT, did it include the pelvic lymph nodes, did they add short term ADT...
Over the course of the next few years his PSA began to rise at the start of 2024, what was it at the start of his SRT, at the end, and since.
He was treated a year ago for oligorecurrent prostate cancer (2 small spots on his spine) after his PSA reached 0.5 with SBRT. He has been on Eligard and Nubeqa for almost a year now as well and was tolerating it well enough with his PSA being below 0.1 for the last 10-11 months..what did his medical team recommend, a defined period such as 24-26 months or continuous?
There are other clinical data which can assist the forum in responding, age, overall health, any other co-morbidities, imaging result...
There is debate about intermittent vs continuous ADT for advanced PCa. In some clinical trials, EMBARK for example, treatment is discontinued if participants reach a n undetectable PSA in the first 3-9 months., That may be clinical data that points to a "longer" progression free survival period when stopping treatment.
My experience, clinical history attached, it has been possible for me to come off treatment based on my clinical response and enter an "active monitoring" phase with labs and consults every three months. We have decision criteria about when to resume treatment, three or more consecutive increases and PSA between .5-1 which supports a statistically better chance of imaging informing the treatment decision.
So, yes, it is possible" for your father to come off treatment, there are many variables in thatv decision, a discussion with his medical team.
Kevin"
Replies to "You ask..."Anyone take a break from hormone therapy despite being oligometastatic?" In formulating responses, more clinical..."
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@kujhawk1978 I appreciate the prompt response and not making a completely out of pocket comment that contributed nothing to the conversation as the first person decided to do.
For more specifics (didn't want to get too long winded in my initial post), my Dad was initially diagnosed as Gleason 8 (4+4) in December 2019. His RP was in March 2020 and the pathology report downgraded the Gleason score to (4+3) with a Tertiary pattern of 5.
His PSA was below 0.1 from May 2020 till April 2021 where it increased to 0.3, then 0.5 in July 2021, and finally 0.7 in September 2021. He underwent IMRT to the post surgical bed from January 2022 to February for 28 sessions. In July 2022 he had a double bypass procedure performed. Afterwards his PSA remained below 0.1 from this time till April 2024 where it was 0.2, then 0.5 in August 2024. A PSMA-PET done in early September 2024 confirmed the 2 metastatic lesions (C2 and L5 on his spine).
He received his first Eligard shot in September 2024 and underwent spot radiation for the 2 metastatic lesions between October-November 2024. A PSA test was done in October 2024 with a result of 0.23, then in November 2024 (also started Nubeqa at this time) where it was below 0.1 and has remained ever since (undetectable level threshold from the lab used is below 0.1/not an ultrasensitive reading).
He underwent genetic testing in March 2025 and had a result of No Clinically Significant Variants Detected (ATM, BARD1, BRCA1/2, CDH1, CHEK2, NF1, PALPB2, PTEN, RAD51C, RAD51D, STK11, and TP53 all tested). This same month, a CT scan for his heart was done that determined he had severe calcifications of the aortic valve that confirmed severe aortic stenosis.
A successful TAVR procedure was done in April 2025 and improved the chest pains/angina he was feeling when exerting himself for prolonged periods which would radiate down to his arm. However, he recently has been feeling aches/pains in his chest at times when exercising and exerting himself. This leads to my post concerning a possible holiday or if a cardio-oncologist will be able to steer us in the right direction. I wish I had a specific answer as to the recommended duration for the doublet therapy as his radiology oncologist stated he could delay being on it after having the SBRT performed but his medical oncologist wanted him on it for at least 18-24 months. This is the frustrating part to me as there is never a consensus for the duration or if he truly needs to be on indefinitely as I am starting to believe. I am trying to encourage him to get a second opinion from Cleveland Clinic as our team is currently a part of University Hospitals.