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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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With the addition of ARSIs like the -lutamides, castrate-resistance is postponed indefinitely for some patients; it just depends on the idiosyncrasies of each person's cancer.
And — not a doctor — but I think that the oncology community's thinking is changing from "ADT causes castrate-resistance" to "ADT unmasks castrate-resistance".
If a tiny percentage of your cancer is already castrate-resistant, you won't notice it if you let the castrate-sensitive cancer spread unchecked, just like you won't notice dry rot if your house is on fire. It's only when you put out the fire that the dry rot becomes a problem.
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1 Reaction@northoftheborder
Another words, We have not choice?
How define type of cancer? And when We have time to this test?
How some guys live with this on 20-30 years
You're talking about uncontrolled spread, but isn't the PSA level an indicator? As soon as the PSA level rises, we fire the ADT cannon again. Shouldn't that work, since cells depend on hormones?
You've been taking lutamide and ADT for 3-4 years now, and at any moment you could reach a point where they're useless. Aren't you afraid? What's scarier: not having a gun or having a gun but taking it at risk (by refusing ADT)? Are there really no statistics on this?
@denis76 Of course I worry about castrate resistance, but the alternative — letting the (castrate-sensitive) prostate cancer run rampant — isn't very appealing.
And we do have some control. For mCSPC, multiple trials have shown that taking an ARSI (like Apalutamide) with ADT significant postpones, and in some cases, may even prevent castrate-resistant cancer cells from waking up and taking over, because it also inhibits their own internal signalling.
Meanwhile, trials continue to test whether its ok to discontinue ADT and go on with just ARSI for people with mCSPC who are exceptional responders.
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2 Reactions@denis76
After being on ADT for seven years, I stopped taking it while I was on Nubeqa. I was 77. My Testosterone rose at a pretty good rate hitting 50 in eight months. The second and third month it went up over 75% a month. When it hit 50 it was going up 25% a month for the last four months. My oncologist wanted me to go back on because of my BRCA2, So I never found long-term results. My PSA stayed undetectable the whole time.
Some people don’t have T come back at all.
Waiting one year, undetectable, is what a lot of doctors recommend. It can depend on your Gleason score and other aggressive problems, however. If you are a Gleason nine or 10, you might want to wait 18 months. At least that’s the recommendation that Rick Davis over at ancan.org Gives to people. He’s been helping people for 17 years and has found that those that have more severe cases have it come back sooner. The doctors in the meetings agree with him.
You would expect the PSA to drop to undetectable < .1 Within three or four months of starting ADT. If that didn’t happen then waiting longer to stop ADT may make sense. Did you have radiation as your primary treatment? That can be a factor in PSA, not dropping since it takes a long time for the cells to die for some people. It still should not take that long for the PSA to become undetectable, definitely unusual.
How often you should monitor you PSA depends on your prostate cancer case. If it was very aggressive, you probably want to continue it for at least six months to a year. If it’s not as aggressive, maybe three months of monthly and then three month tests. Since your PSA took so long to become undetectable, I would want PSA test monthly for at least six months.
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3 Reactions@jeffmarc
Yes, Jeff, I've been reading your words ever since, and I've been in awe of your wisdom.
Regarding radiation therapy, I didn't have it. My PSA was 530, with 3 metastases in my bones and numerous lymph nodes.
My PSA dropped to 0 within a year and a half. And I think this long period is due to the fact that Erleada was added later.
After 8 sessions of docytaxel and ADT (my PSA dropped to 6), the PET/CT report (January 2025) stated that most metastases (their SUV) were not detectable in my bones, and the size of the lymph node metastases had decreased and remained. And most importantly, please help me figure this out. The report stated that the SUV of my prostate tumor had barely changed. It only dropped by 10%. In other words, ADT and chemotherapy failed to suppress the cancer.
I was preparing for death back then because my PSA hadn't dropped. And after a very good doctor recommended that I start taking Erleada, and I did, my PSA dropped from 6 to 0 in about six months.
You asked about the aggressiveness of the cancer. How is it determined? By the number of metastases, or by the Gleason score? I have an ATM mutation. Could that make the cancer aggressive?
I've been reading all your messages very carefully. If I understand you correctly, in my case, I should wait until my PSA remains at 0 for at least two years and then try to stop all medications, right?
Please explain to me what it means when report say "my prostate tumor's SUV has remained almost unchanged after chemotherapy."
Bless you and thank you!
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1 Reaction@northoftheborder
Ye, Bro, thanks for reply and your Glison Level? Please remind me.
@denis76 It would have been 8 or 9 since it metastasised, but I never got a Gleason score because we discover the cancer first through biopsy of a tumour on my spine (originally of unknown origin) rather than a prostate biopsy. A prostate biopsy would have been pointless by then.
@denis76 Yes, Erleada (Apalutamide) has been a magic drug for me, too.
Granted, it's distributed by a big evil Pharma multinational (Johnson & Johnson), but so are Xtandi (Pfizer) and Nubeqa (Bayer), so not much to choose from there. 🤷
As I mentioned earlier, I'm waiting to see the results of the big phase 3 LIBERTAS trial to see if it's safe for exceptional responders with mCSPC (like you and me) to drop ADT and stay on just the Erleada.
The EMBARK trial that you mentioned ended with a negative result for Xtandi, another -lutamide, but it's 8 years later now, and a lot of other things have changed in prostate-cancer treatment and detection, so 🤞
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3 Reactions@denis76
The fact that ADT alone could not get your PSA to undetectable, would usually mean you are castrate resistant or hormone resistant. Did your doctors ever mention that to you? You might want to ask if they consider you castrate sensitive or castrate resistant.
When my PSA started rising while I was only on ADT, they put me on abiraterone And that brought my PSA down again. I was castrate resistant they said because ADT alone failed and was unable to keep my PSA undetectable.
Either the fact that you became metastatic before you were diagnosed, And that it was spread in multiple places, More than five, Usually results in triplet therapy, which is exactly what you appear to have gotten eventually. You started off double with just ADT and chemo. I’m really surprised your doctors waited so long to add the ARPI (Erleada). The standard of care calls for triplet therapy with what you had originally so waiting so long for Erleada Was a little late.
You say you think you should wait two years undetectable, 1 1/2 years may be sufficient. I know people that had serious cases like you have and didn’t wait two years. The true test is, when you stop taking the drugs. Does your PSA rise real soon or does it take a while. You could very well get a year or two with no rise
The SUV is how disease progression is measured. The fact that the SUV stays the same or goes down is a good indicator that it’s not spreading anymore in that area. The higher the SUV number, the more aggressive the cancer is in that particular area.
The aggressiveness of your cancer is measured by all of the things you mentioned. The Gleason score and the number of metastasis are a big indicator. The fact that you went directly to chemo is an indicator that it’s very aggressive.
As for ATM, It does add to the aggressiveness. @dinu This is one of the participants in this forum. He has ATM and has had problems getting his testosterone down with just Lupron, He just had a prostatectomy because they caught it early, but his cancer is aggressive. I’m including him here because you two should probably talk to each other about it. There’s at least one other person in this forum with ATM. Ancan.Org Has a quarterly meeting with people that have genetic problems. You might want to attend one and ask questions about How ATM affects your prostate cancer?
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1 Reaction@jeffmarc
Yes, Jeff, thank you!
I wasn't prescribed Erleada because it's not listed in clinical guidelines in our country. I had to see a very good oncologist, who saw that my PSA hadn't dropped to 0 (it was around 6) after seven months of ADT and chemotherapy.
\\You say you think you should wait two years undetectable, 1 1/2 years may be sufficient. I know people that had serious cases like you have and didn’t wait two years.
I'm a little confused. When should I start counting time? From the start of ADT (2 years have passed since then)? From the moment my PSA dropped to 0 (1/2 years have passed since then)? Could you please tell me what you meant?