Is ADT ever used at reduced dosage to moderate side effects?

I really never see anybody saying their PSA is zero. Occasionally, you will see < .001 But that is not very common.

There isn’t really a way to reduce ADT dosage. The shots last a certain amount of time and give the same amount of the drug Each day. You could alternate Orgovyx, But you probably would end up with your testosterone down really low no matter what.

If your purposes is to not have your testosterone go down so low, you could get on a Lutamide Drug like Darolutamide Which can work even if testosterone is high.

After radiation, the PSA doesn’t go down immediately for a lot of people. And for most it doesn’t even go down to < .001 . Mine did go down to < .1 3.5 months after radiation, but I never had an ultra sensitive test to tell me if it was any lower. I do know that some people have taken up to three years before their PSA hit rock bottom after radiation.

ADT usage is based on other things. How high is the PSA?, Are there other aggressive features in the biopsy? Has there been a reoccurrence that requires radiation? Has the cancer spread beyond the prostate?

If someone had a very aggressive case of prostate cancer, they would generally put them on ADT before the PSA got down to the lowest level after radiation. Some people say no to ADT.

@jeffmarc “ You could alternate Orgovyx, But you probably would end up with your testosterone down really low no matter what.”

If the end result (low testosterone) was the same, could you reason that toxicity might be reduced?

Has anyone ever just taken the pill every second day? I presume some people have but haven’t heard any reporting on it.

@ozelli
I’ve never heard of anyone trying to do that. The half-life of Orgovyx Is only 25 hours so it would leave the system quickly, but it would suppress the testosterone every time it was taken, and that would just be cumulative. It would probably take longer for the testosterone to get down, but it would do the same thing over time I suspect.

If someone doesn’t want to mess with their testosterone, lutamides can work with it. I know quite a few people on Darolutamide alone and it keeps their PSA down.

@jeffmarc I would presume a lower dosage is possible, shots or pills.

My guess would be that this is not an unreasonable thing to do but that frequent monitoring and dose adjustment would be required and no provider wants to do that much work.

But it could at least be evaluated in studies.

(heck, start with rats, or whatever they use!)

I see ADT has been used for decades or longer, depending on what you count, and in all that time, no studies?

It might fail, but living with milder side-effects might be a winner at least for some, of course it depends on all the metrics I see people talking about and then actual monitoring and adjustment for each specific case.

My questions are colored by my experiences with other drugs for other conditions where the standard dosing has often turned out to be too high for me or the optional higher dosing has increased side-effects but not been any more effective.

I have been off adt ( Oorgovyx/zytiga) for 9 1/2 months. Testosterone gradually rising to 173 then 110. I have become accustomed to wimpy low T. I also wonder about adt lite to keep it low without full side effects of adt.At stage 4 Gleason 9-10 I really don t want to risk normal T levels for fear of reigniteing pc. One poster mentioned estrogen patch but growing a set of boobs is the downer in that idea.

@jeffmarc
Darolutamide sounds interesting ... but side-effect profile looks similar to Orgovyx. I guess not much point in having testosterone if it's blocked everywhere.

Are the side effects of ADT that you want to reduce, what YOU are experiencing, or what you have read OTHERS are experiencing?

I ask because side effects of ADT vary GREATLY from person to person. In my case, they were so mild that when my oncologist offered to take me off of ADT after 2.5 years, I initially declined, preferring the known over the unknown.

I finally changed my mind because I wanted to find out if the cancer had been reduced or eliminated. As it turns out, my PSA has now been stable at 0.09 for eight months. At the first sign of significant PSA values, I will have no problem going back on ADT.

Also, reputable medical studies consider dosages & side effects of medication versus efficacy. If you experiment with dosages that have not been considered in a reputable medical study, you are in effect creating your own one-man medical study without any controls. You may end up reducing side effects & efficacy, or reducing efficacy without a gain in side effects.

I would think you would be better off considering alternate medications that have been studied in a reputable environment, rather than experimenting on your own.

@carbcounter
The problem is that having a higher testosterone level is probably not going to help. People need to get it below 50 to be really effective in stopping the cancer from growing. You get below 150 and you’re going to get many of the symptoms Of low testosterone, like hot flashes, muscle, deterioration, bone deterioration And fatigue at least for some people. I know people that have stopped taking ADT and nine months to a year later when their PSA hits 150 they’re still getting hot flashes. It’s gotta go higher than that to really get the benefit of stopping ADT.

I don’t really think there is any happy midpoint, something you could discuss with a doctor.

I know the stampede trial says you need it below 50 in order to be beneficial.

@carbcounter
Side effects are not even close to similar. Darolutamide works without having to reduce your testosterone. It’s suppresses it from affecting the prostate cancer. I’ve been on it for almost 3 years and I’ve noticed no side effects at all from it. It doesn’t pass the blood brain barrier like Orgovyx So you don’t get brain fog with it.

So you get to keep your testosterone and all the side effects that Orgovyx Causes, by almost eliminating your testosterone.

@readandlearn thanks for your comments, I agree with all you said.

My questions here are not about myself, I'm fortunate enough so far to have avoided the whole issue but I'm asking about the case of a friend who is having sufficient side-effects at about the one-year point to need opiate pain killers. As I understand it he underwent radiation therapy a year ago so his case was that serious, but had not been seen to spread and was sort of a minimum radiation case. The frequency of these side effects seems to be pretty high though their intensity may vary. I'm also concerned that whatever mechanisms are involved, once the side effects are that severe they are likely to be doing real damage and get worse.

I think you have done exactly what I thought my friend should also try!

I thought he'd told me he was scheduled to try halting ADT in January, but now suddenly he's telling me it's been June all along. The serious pain only began a week or so ago. Actually maybe last January he told me June but I thought it was June 2025 and then it slid to January when he meant June 2026 all along and misspoke ... he doesn't really speak about it much but it has impacted his energy too from pretty early on, he has complained about that.

I have a friend who tried a new statin back some years ago and started complaining about the pain, and sure enough that statin was pulled from the market soon thereafter for rhabdomyolysis. So, I thought I should ask some of these questions.