Optimal Duration of Hormone Therapy

Of course, if the prostate cancer doesn't return, you have a 100% chance of dying of something else (some day). 🙂

More seriously, I don't have the patience to watch many videos (someone taking 10 min to say what I could read in 30 sec), but I expect it was discussing attempts to find the point where the line of decreased risk of dying from PCa crosses the line of increased risk of dying from ADT side-effects like heart disease, diabetes, kidney disease, etc.

That crossing point must vary wildly by person and type/severity of cancer. It's one reason we ADT "lifers" get so much extra bloodwork beyond just PSA tests in our 3- or 6-month labs, as well as periodic scans like DEXA, so that they can spot the first early-warning signs of strain on vital organs or bones.

You could take that risk of dying from something else to mean that ADT for a long period of time stops the prostate cancer so that somebody can get old and die from something else.

That seems to be what’s happening for me, Eight years on ADT, I get monthly blood tests and they are just fine. I’ve had surgery twice where they’ve had to put me under after 74 and I haven’t kicked the bucket yet. I check my blood pressure almost every day and it’s just fine, Maybe a little lower than normal.

I’m 78 and I’ve been undetectable for 28 months after four reoccurrences in the last 16 years. I can probably out run and out exercise most 78-year-olds even though I’ve been on ADT for so long. I can run a mile without stopping and without any heart issues and Not even breathing hard.

I guess time will tell, but it’s more likely the drugs will fail than I will die from them.

Dear @northoftheborder, you should view this video. It is to the point and well worth your time. It is not discussing attempts to find that intersection. It is 40 well-known oncologists looking at 1000 patients and setting very clear lines for intermediate and high-risk PC. It does NOT talk about metastatic cancer. This is cancer confined to the prostate considering 3 risk factors that modify that timing. It also clearly suggests (although doesn’t explain why) going beyond that increase mortality risk.

Hi @jeffmarc, unfortunately it doesn’t cover metastatic cancer. Only PC confined to the prostate and discusses 3 risk factors (palpable DRE, PSA > 10, and invasive vessicles). Unfortunately, my friend, it also says that continuing beyond the suggested time frame is not just living long enough to die from something else, but increased mortality from use.
As always, my hope is for you to be well and live a long life. I’m 74 also.

Well, I guess I have some more to say about this video.

Doctor Scholz Did specifically say during the video that if somebody had weight gain and their blood sugar was higher as a result of being ADT that the shorter period is a time would be very beneficial. For those that did not have those issues it probably would not make a difference. I’ve had neither of those issues.

The other thing that he specifically said was that advanced issues like intraductal, cribriform, Seminal vesicle invasion, EPE or ECE would change the recommendation of a shorter period of time on ADT. I would imagine a genetic problem would also fit in this.

There are a lot of people in here that have those situations and should realize that a longer period of ADT is legitimate.

@robertov Thanks! I have metastasic cancer, so it's not applicable to my situation, but we've known since the PR.7 and SWOG trials in 2013 that ADT holidays are often beneficial for non-metastatic prostate cancer (stop ADT once PSA is very low, and don't start again unless/until it rises again past a certain point).

That's probably where you'd find the core explanation that's not included in the video. Great that those researchers are working to refine the criteria more. Cheers!

This adds more evidence to those trials. I should also clarify that this is *just* determining the appropriate time of efficacy from ADT under certain circumstances. That does NOT mean that I am cured. I understand this is the beginning of the journey, not the end.

I was literally on the verge of ending ADT and it hit me bigtime. I think for others in prostate confined cancer and wtih none or some certain defined risk factors (no palpable prostate lump, psa < 10,, no seminal vesicle invasion) that now can re-exame what they want to do. As the video says, you can bring the study to your oncologist and discuss it.

I'm in the opposite situation. For metastatic prostate cancer, the current expectation is that we're ADT "lifers."

Maybe that didn't matter up to just a few years ago, when life expectancy for metastatic prostate cancer was at best 3–5 years after diagnosis, but now that new treatments like doublet or triplet therapy, MDT, etc have many of us living far longer (possibly *decades* longer), we suddenly have to take a new look at the risks of long-term ADT.

I'm closely monitoring the LIBERTAS trial, which is reevaluating whether ADT holidays might also work for mCSPC now that we have doublet therapy (which didn't exist back in 2013, when the PR.7 and SWOG findings came out). The first survival and progression results are due out this fall. 🤞

Here is the link to the JAMA study, highly condensed version. I didn’t want to sign up and create yet another account. Full study, I think you would be reading a lot longer than a few minutes. This study deals with Intermediate and High risk localized cancer.
https://jamanetwork.com/journals/jamaoncology/article-abstract/2841671

@oldgreenpaint Thank you, the summary was good enough. You're right that this study supports extending ADT past 12 months if you have localised prostate cancer classified as NCCN "very high risk" and treated with radiation.

Highlights:

- this was a meta-analysis (reviewing existing patient data), so they couldn't set ground rules, interview patients, ensure consistent approaches, etc.; it's much less reliable than a clinical trial, but also far less expensive, and still helpful.

- it limited to localised prostate-cancer cases (as you mentioned), treated with radiation

- the median age of patients whose case files were reviewed was 70

- the risk from ADT side effects over time was linear, e.g. 2× as high after 2 years as it was after 1 year

- the benefit from ADT was non-linear, e.g. less than 2× as high after 2 years as it was after 1 year

The estimated cross-over points (where ADT risks outweighed benefits) — and thus, optimal ADT treatment lengths — for localised PCa after radiation were as follow, based on the cancer's risk factors:

1 intermediate risk factor: 0 months

2 or more intermediate risk factors: 6 months

NCCN high risk: 12 months

NCCN very high risk: undefined (i.e. no point was found where ADT risks started to outweigh the benefits)

Note: the specific benefit measure was the chance of preventing a distant metastasis within the next 10 years.

Cheers!