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One year PO and now it seems I'm Stage 4 :-(
Prostate Cancer | Last Active: 4 days ago | Replies (17)Comment receiving replies
@northoftheborder pretty much nailed it.
@jeffmarc as usual, has use thioughts.
You may want to delve further into those choices with your medical team...
There is some data which may point to MDT by itself pushing back the need for systemic therapy.
The data also generally indicates there may be longer PFS, RPFS if using systemic therapy with MDT, so...
Do they see systemic therapy as continuous or for a definitive period, aka, intermittent...?
How long would I be on systemic therapy...? It may range from 6-36 months though with your clinical data, more likely on the right side of that range.
Depending on that answer and their reasoning, the discussion may turn to what clinical criteria constitutes a decision to de-intensify treatment...?
Which ADT agent, say Lupron vs Orgovyx, there is a difference in the side effects and recovery when coming off treatment. Same for the ARI.
Chemotherapy from what literature I've reviewed has more effectivenss in high versus low volume cases
Kevin
Replies to "@northoftheborder pretty much nailed it. @jeffmarc as usual, has use thioughts. You may want to delve..."
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@kujhawk1978 For long-term systemic therapy with metastatic castrate-sensitive prostate cancer (mCSPC), an important trial to watch is LIBERTAS:
https://clinicaltrials.gov/study/NCT05884398
Previous studies have shown that intermittent ADT results in worse outcomes with mCSPC (unlike with non-metastatic cancer), so current standard of practice with mCSPC is to stay on ADT for life. However, most of the data for those studies was collected before the widespread introduction of ARSIs like the -lutamides or (previous-generation) Abiraterone in doublet therapy for mCSPC.
The phase III LIBERTAS trial is looking at whether exceptional responders to doublet therapy — showing a rapid and stable PSA decline after starting ADT+Apalutamide — can safely drop the ADT and use *just* Apalutamide (Erleada) for long-term maintenance. That would allow testosterone to return to support bone/heart/muscle/endocrine health, but still block any stray dormant prostate-cancer cells from receiving the T signal to start reproducing.
The preliminary results are expected this fall, and final results at the end of 2027. I'm on Orgovyx + Erleada, so my oncologist and I are obviously monitoring this trial closely. If it's successful, I'll expect that the results will be similar with the other -lutamides.