Are castration sensitive prostate cancer patients being over treated?

The meeting was the most encouraging news with regard to my PC journey that I have ever heard. Not because they say that they can cure me but because they offer a better quality of life with fewer side effects. The Doctors at NIU are involved in a number of Prostate Cancer trials. Many of those trials are ongoing some, just starting. I have contacted NIU already to see if I would qualify for the study discussed. Even if I am not eligible for one of their studies just knowing about this particular field of study is extremely encouraging. The video of the meeting is over an hour and a half and I encourage everyone with PC to take the time to watch it. It could change your life.

Yes, this is true for the typical "slow growing" prostates cancers, but it is not for aggressive ones. That's why Decipher and genetic tests are so important. Gotta know what you have. Taking your time with a aggressiv PCa is an error imo.

Seems like they are treating BCR in the same way they view AS…wait and see if something clearly shows on PSMA…or if PSA doubling time (velocity) > 6 months.
Again, we’re back to the old question of micrometastases not showing on PSMA; and a slow doubling time…don’t know if I personally could handle the anxiety…
Some, however, might jump at the chance to forestall treatment for any reason.
I did not listen to the whole presentation, but my gut tells me that if you were excluded by virtue of visible PSMA or higher PSA velocity, you could probably delay any treatment by a year or more since your cancer was not that aggressive to begin with. Thanks for the info!
Phil

On a different (but related) note, the last research I saw suggested that ADT holidays were safe for earlier-stage aggressive prostate cancer, but not for stage 4, where outcomes were still a little worse after "holidays".

I'm hoping additional research will refine that a bit, and that maybe they'll discover that holidays are safe for *some* stage-4 situations as well (I don't mean just one isolated study, but major, reproduceable findings).

I'd love an ADT holiday, but with my mCSPC perfectly controlled by ADT+Apalutamide for nearly 4½ years now (and me tolerating the side-effects surprisingly well), I'm nervous about prodding the sleeping bear. If my cancer is happy staying in full hibernation with the current regimen, I want a lot more medical evidence before I risk disturbing it.

Of course, if I weren't tolerating ADT+Apalutamide well — if I were showing a serious risk of kidney, liver, or heart disease, for example — that might be enough to tip the scales towards an ADT holiday: there's no point surving cancer just to die of liver failure. But very fortunately, I'm not experiencing any of that (at least, not yet) — just the normal, non-life-threatening side-effects.

@northoftheborder Wrestling with this as well. Heart rhythm got a little whacky last month, maybe or maybe not ADT related. Echo showed function is slightly diminished but still OK, however, Cardio-Oncology stepped in with more frequent testing but hasn't nixed cancer meds yet. We'll see...pretty sure I'd rather drop from heart failure than lay around with end stage cancer. Crystal ball would be nice to see which one's coming when.

@northoftheborder
This is true. The more aggressive the original prostate cancer case the less likely waiting for it to get worse makes sense. If you have an aggressive case, you probably need aggressive treatment.

That’s one reason castrate resistant cases were not included in this discussion.

Thanks, Jeff, for sharing these two links. The entire webinar was thought provoking for me, a gleason 9 with EPE and cribriform, NCCN very high risk, treated with proton RT and two years of lupron + abiraterone). Particularly the following at (1:25:21): "The gleason score and all that stuff is very relevant about is it going to leave the prostate or not. Once it's left the prostate...the proof is in the pudding and and the pudding, at that point, is your PSA doubling time and what's going on with your PSMA."

If ongoing research continues to support this concept, quality of life and, potentially, overall survival can be improved for months/years through delaying the start of ADT for BCR and kicking the can of castrate resistance and treatments of last resort further down the road. I consider forestalling the need for treatments like chemo and Pluvicto a major extension of good quality of life.

The webinar underscores the need for patients to advocate for their care. Delaying treatment for BCR based on doubling time is likely to cause additional 3 or 6 month PSA test angst. The panel suggested that it would not be unreasonable to adopt a more frequent PSA test schedule, even as short as monthly, as a solution.

Definately an important perspective on BCR treatment to monitor as research continues.

Bill

I watched this,..

As I've said, the decision to treat is a complicated one...we would all love for science to simply say, if this, do this, black and white. Alas, it's not that simple.

Guidelines...AUA, NCN
Clinical Trials finding their way into mainstream clinical practice.
One's own clinical data.
Other...

When my PSA started rising in 2022 and it got to .4+ my radiologist said it was close enough to our trigger of .5 to image. My urologist (who I have since fired when his ego and wallet got in the way of supporting me) said we could wait another three months. I waited and the next one was .7+
That is some fast doubling time!

I am high risk. GS. GG, time to BCR...

The key factor in my decision making since the failure of SRT has not been just the GS, GG...,.rather it is my PSADT and PSAV, always less than four months. That speaks volumes...

That piece of the clinical data puzzle leads my medical team and I to treat sooner rather than later.

So, I intuitively, albeit as a layman, understood the rationale behind their argument.

As I've said before, my "horizon" is 3-5 years, will this treatment likely provide 3-5 years of PFS and RPFS, yes, ok, let's go...

I do not use OS in my decision calculation, not sure it is pertinent with my horizon.

I do see many on this forum hit the panic button when their PSA goes from say .03 to .05...this presentation speaks to them!

I do agree that USPSA is a blessing and a curse. My radiologist laughed when I described it as the prostate specific anxiety test...

Could I let my PSA rise above the .5-1.0 range before treating? I suspect I could...but given that PSADT and PSAV, not going to and my takeaway from this presentation is that is not a "bad" decision.

Keep in mind that while I experience the usual side effects of treatment, they don't make a difference in living my life, just how I feel doing so...and, they are for defined periods, not indefinite, have brought off treatment times of almost five years and working on two this time.

I do think this opens the discussion of those who are in the middle, not GS 6 but not 8-10 either, PSADT and PSAV tween say 6-12 months, PSA 3+4...the "gray zone!"

Just to muddy the waters...https://www.urotoday.com/conference-highlights/suo-2025/suo-2025-prostate-cancer/165219-suo-2025-clinically-significant-prostate-cancer-not-all-pattern-4-prostate-cancer-is-the-same.html

Study of one.

Kevin

Where do I go to find all the accornyms and how to understand what is going on with you. I have had a prostatectomy and radiation. My PSA keeps creeping up and I have done androgen therapy twice. I would like to see and understanding what others are doing.

Anyone have experiences from the use of AI?