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What if this prevents cancer from becoming resistant?
I saw a thread about half-dose medications.
Guys, what do you think about whether resistance can be avoided? Read below.
Another option is to use different combinations of ADT and lutamide. For example, one month is ADT without lutamide, the second month is ADT with lutamide, the third month is lutamide without ADT, the fourth month is neither ADT nor lutamide, and then the cycle starts over again, so as not to repeat the previous cycle (the combinations would be reversed).
I had this thought, perhaps it's naive, but for some reason my intuition told me exactly this. What do you think?
In other words, varying the medications is necessary to avoid resistance. I've heard of guys who are still alive for 30 years; maybe they did exactly this?
I voiced this thought to my oncologist, and he said it wouldn't work with high Glyson levels.
At that moment, I thought about resistance as cancer adapting to low testosterone levels. The cells change and no longer respond to low testosterone.
And if you really want to "let the cancer swing," you can try to keep testosterone levels fluctuating rather than staying steady, and change the ADT + Lutamide combination depending on PSA growth. For example, if PSA growth is significant, ADT + Lutamide is taken for a month; if PSA growth is moderate, Lutamide alone is taken; if PSA growth is low, ADT alone is taken; and if PSA growth is not observed, the duration of Lutamide-only treatment is extended (2 months instead of 1 month). In any case, the method is based on the fact that we don't "create" a wall for the cancer, but rather a swing when it doesn't have time to adapt (testosterone levels fluctuate, but we don't allow it to fully utilize them with the help of lutamide).
I want to try this on myself, but fear holds me back. But who knows, maybe this method works.
Why do I think this method might work for those with a PSA level of almost 0 and whose cells have not yet become resistant to cancer?
Argument 1: If cells are still dependent on testosterone, they will respond to ADT and lutamide when drug therapy is resumed.
Argument 2: By changing combinations and increasing testosterone levels, we prevent cancer from becoming resistant because we are changing the "rules of the game" and not dealing with cells that are no longer responsive to ADT and lutamide.
Argument 3: By repeating combinations in a cycle (ADT and lutamide, ADT only, lutamide only), we maintain a basic level of protection by closely monitoring PSA levels, which is an indicator that resistance is not developing.
Argument 4: Cancer has little time to "start firing." A new combination will either lower testosterone (ADT) or dampen the ignition.
Argument 5: It's no secret that they're making money off us, and the higher the stage, the more money they make. But they can make much more money if resistance develops (medicine is a business), and perhaps that's why ADT and lutamide inevitably lead to the development of resistance! What if we take our luck by the balls and say no to a society in which someone profits by keeping silent about the easy way out (when registration doesn't occur)
And finally, if the cancer becomes resistant, then we're done for, and we need to avoid it at all costs to keep the cells sensitive to hormones.
What do you think, guys? Is it risky?
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If you go on ADT for a month, it could take three or four months before your testosterone returns so the benefit you are thinking you’re getting from doing it every other month is not going be there. When I stopped taking ADT My testosterone went from under 5 to 5 in the first month, Second months it went to seven. If you’re on Orgovyx , it might come back a little faster But alternating at every other month is not gonna give you much higher testosterone, Definitely not gonna alleviate the side effects.
A drug like Darolutamide (Nubeqa) Has almost no side effects for most people. I’ve been on it for three years and have noticed no side effects. One benefit of lutamide drugs is that they suppress the ability of testosterone to allow your cancer cells to grow. So even if you have testosterone, you can stay undetectable. I know people that are on this drug all by itself because it keeps their cancer under control. If you have real high testosterone, that might be a problem. I know a couple of dozen people on this drug and they just don’t have side effects problems. I’m not saying side effects are impossible, but they are very infrequent.
The other lutamides do have more side effects So alternating them may help. You would have to see what your PSA test shows.
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7 ReactionsTwo things can be true at once:
1. Researchers discover meds that are genuinely helpful and extend our lives (Apalutime originated at UCLA, for example).
2. Big pharmaceutical corporations overcharge for those meds (especially in the U.S., where they can cost 2–10× as much as they do in other countries).
#2 is ugly, but it doesn't cancel out #1. These really are miracle drugs.
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2 Reactions@jeffmarc
Thanks, Jeff.
What if we repeat the combination for 2 or 3 months? And add an additional variation.
Look at this
Cycle 1
2 months - ADT only (decrease testosterone)
2 months - ADT + lutamide (decrease testosterone and reduce "ignition")
3 months - lutamide only (reduce "ignition" increase testosterone)
1 month - no ADT no lutamide ( "let cancer think that wall is no exist ")
Cycle 2
2 months - ADT + lutamide (decrease testosterone and reduce "ignition")
3 months - ADT only (decrease testosterone)
1 month - no ADT no lutamide ( "let cancer think is wall no exist ")
1 month - no ADT no lutamide ( "let cancer think that wall is no exist ") 2 months - lutamide only (reduce "ignition" increase testosterone)
Cycle 3
2 months - ADT + lutamide (decrease testosterone)
1 month - no ADT no lutamide ( "let cancer think that wall is no exist ")
2 months - lutamide only (reduce "ignition" increase testosterone)
3 months - ADT only (decrease testosterone)
....
Cycle 4 (New combination)
Each line can be linked to a PSA increase. As I already mentioned, if the increase is small, the lines are swapped; if the increase is significant, we increase "protection" by using both components over a longer period.
In other words, combinations should not be repeated.
You can consider varying the duration (2-3 months) depending on the Gleason level and PSA increase, and try to find a correlation. It's clear it will be nonlinear. For example, for those with a high Gleason level, they should not go without a moderate level of protection for 3 months (level = duration and combination of ADT and lutamide).
These aren't puzzles you can just solve in your head, unfortunately. There have been and (continue to be) major trials trying to figure out if, when, and for how long it's safe to pause ADT with various cancer situations.
So far, ARSIs (especially the -lutamides, mentioned in the OP) have proven very effective at postponing or preventing castrate-resistance for metastatic prostate cancer, to the point that trials like LIBERTAS are now looking at if/when it might be safe to pause ADT for mCSPC and rely *just* on the ARSI.
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3 Reactions@denis76
If you’re on ADT for a month or two, your PSA is gonna drop a lot but your testosterone is gonna drop even more unless something is wrong. That testosterone doesn’t come back for a while. Stopping and starting, it isn’t going to help the way you feel.
Stopping and starting a lutamide May or may not make any difference at all. If you have a very serious case and are castrate resistant, then it can raise your PSA a lot, very quickly. If you have a mild case, ADT alone will take care of it and the fact that you’re stopping and starting it won’t matter since the testosterone is not going to rise much.
I don’t think you’re going to get anywhere with these techniques. And then there’s what @northoftheborder has to say, another valid issue You need to consider.
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2 ReactionsSad to say but men caught in the ADT trap have no clean out. Using ADT as the sole weapon will naturally induce over time, castrate resistant cancer cells. ADT holidays have been shown to work. If anything, I would use Orgovyx as the rise time for testosterone is much faster than with Lupron.
If you live close to CA, there is a study underway at UCLA that uses PSMA ligand radioisotopes in conjunction with SBRT. I think this approach will yield fruit. Using ADT drugs alone will guide you into the box canyon called castrate resistant.
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1 ReactionAll very good comments and suggestions.
However, of necessity, they are all isolated cases and suggestions/ideas; good ones to boot.
But by definition they are all anecdotes; single observations. And the studies mentioned, though also good news, only cover a limited scope of the topic.
What's needed, IMneverHO, is a very large (or multiple) study/s to evaluate all the variables. Plus a coordinated design so powerful multi-variable analyses can be used to tie them together. This of course would take years to complete.
Are there some ideas that we, as PC patients, can use to influence such a large and coordinated study????
For one, I'd be all in to help. And the participation of younger PC fighters would be most helpful due to the long term needs of such a study program.
Let's keep praying and pushing and asking our PC doctors for such rigorous approaches.
@grandpun Two of the longer-term, multifaceted studies currently underway are IRONMAN and STAMPEDE, in case you're interested in taking a look.
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1 ReactionI did not want to stay on ADT for extended period of time due to side effects but also to reduce the chance of castrate resistant PC. I quit after one year to go on a vacation. I have been on this "vacation" for 4 years now. If I had it to do over, I would have quit at 9 months.
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1 Reaction@ededed
Gleason? Starting PSA? Metastases?