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Androgen deprivation therapy (ADT) for short or long-term?

Posted by zonanaa @zonanaa, Jul 16 8:03pm

I am 66 yrs old, highest PSA before prostatectomy wss 9 ng_mL.
I had radical prostatectomy, Gleason score of 4+3 and posiive surgery margins with Gleason 3. PET scan m1T2m miNo miMo
Post-surgery PSA of 0.48 ng/mL
Actually salvage radiotherapy 20 of 35 sessions and ADT, Goserelin, first trimestral dosis.
My concetn is the use of ADT short-term (4-6 months) or long-term (24 months) ? Thank you for comnents
Abraham

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adoptedtomato | @adoptedtomato | Jul 17 6:27pm
In reply to @jeffmarc "@adoptedtomato Actually, here’s more information on this exact subject from 2024 This information is from Dr...." + (show)
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@adoptedtomato
Actually, here’s more information on this exact subject from 2024

This information is from Dr. Eleni Efstathiou, One of the top GU oncologists in the country. She recently moved from Houston to Portland.

Adjuvant radiation
Dr. Efstathiou concluded as follows
* Early salvage radiotherapy is favored over adjuvant radiotherapy in most patients
* Consider adjuvant radiotherapy in otherwise fit, motivated, very high-risk patients with ≥2 of the following risk factors:
* pT3b-4
* Gleason score 8-10
* pN+ Lymph node Metz
* Decipher score >0.6
* In high-risk patients, use lower thresholds to initiate ‘ultra-early salvage or adjuvant-plus’ radiotherapy
* If giving adjuvant radiotherapy, it implies high-risk disease. Thus, Dr. Efstathiou would recommend treating the prostate bed and pelvic lymph nodes, in addition to short-term versus long-term ADT, depending on risk factors
* May consider genomic classifiers or artificial intelligence tools to help with informed decision-making
* The goal is to avoid (or delay) radiotherapy in those who we can, without missing a window to cure patients who are guaranteed to recur

Here is a link to the article supplied by @surftohealth88 originally
https://www.urotoday.com/conference-highlights/apccc-2024/151546-apccc-2024-debate-how-to-best-manage-a-fit-patient-with-high-risk-localised-and-locally-advanced-prostate-cancer-how-to-select-patients-for-adjuvant-therapy-after-radical-prostatectomy-and-how-to-treat-them.html

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@jeffmarc thanks !!!

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Jeff Marchi | @jeffmarc | Jul 17 6:32pm
In reply to @wheel1 "@jeffmarc Jeff, is their any information on percentage of prostate cancer metastasis found at BCR with..." + (show)
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@jeffmarc
Jeff, is their any information on percentage of prostate cancer metastasis found at BCR with PSA .2?

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@wheel1
Since everybody is different, there is no way to know this. A PSA of .2 is a little low to do a PSMA pet scan, but sometimes they will do it. That would only tell you if any metastasis were found, There’s no percentage.

BCR is just the biochemical recurrence of Prostate cancer. It could be you have mini metastasis. There could actually be a tumor.

Not sure exactly what you’re thinking, I think you used the wrong word when you wrote percentage and meant something else.

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isrexpo | @isrexpo | Jul 18 4:21am

My post surgery results were similar.PSA starting gradually rising
After 2years i went onto abirateron pills which prevented spread of cancer
I took a break after 18 months and PSMa pet scans show cessation of spread Its 8 years since the surgery
I chose a few more years even the ADT treatment has obvious down side

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pesquallie | @pesquallie | Jul 18 8:42am
In reply to @wheel1 "It sounds like even only 4 to 6 months of ADT would be sufficient in such..." + (show)
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It sounds like even only 4 to 6 months of ADT would be sufficient in such a case. This study is huge as in the past it was 24 months for everybody then maybe 18, then some 12. The concern they state with giving ADT is the long term effects. It is terrific news for patients going forward and also how oncologists have struggled as some began reducing ADT length of time based on anecdotal evidence obtained through networking at cancer conferences regardless of NCCN cancer guidelines

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@wheel1

New studies now indicate that low testosterone may worsen cancer and major medical research institutions like John Hopkins, Duke, Mayo, and NIH are entertaining the use of TRT (Testosterone Recovery Treatment) after successful initial treatments. Tuesday, I visit my urologist and will attempt to get him to approve TRT for me since my side effects are so bad and my PSA is undetectable after a year.

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amota | @amota | Jul 18 9:47am

Wow!
This is 90% my own case. My PSA rose to 0.14 after 14 months of the surgery. I was given 40 radiation sessions and began a 6 years on Lupron. My testosterone came as low a 8, normally it is 521. The side effects of the hormone therapy make the quality of life miserable. Every case is different, but for the last 3 years I have been without medication, my choice.
Good luck.

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ucla2025 | @ucla2025 | Jul 18 10:38am
In reply to @amota "Wow! This is 90% my own case. My PSA rose to 0.14 after 14 months of..." + (show)
Profile picture for amota @amota

Wow!
This is 90% my own case. My PSA rose to 0.14 after 14 months of the surgery. I was given 40 radiation sessions and began a 6 years on Lupron. My testosterone came as low a 8, normally it is 521. The side effects of the hormone therapy make the quality of life miserable. Every case is different, but for the last 3 years I have been without medication, my choice.
Good luck.

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@amota I am curious, what is your PSA now?

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surftohealth88 | @surftohealth88 | Jul 18 10:52am
In reply to @wheel1 "@jeffmarc Jeff, is their any information on percentage of prostate cancer metastasis found at BCR with..." + (show)
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@jeffmarc
Jeff, is their any information on percentage of prostate cancer metastasis found at BCR with PSA .2?

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@wheel1
Do you mean "true metastasis" like having a distant lesion in thoracic region or on the spine etc. for example, or are you thinking of a cancer found in local nodes and similar ?

I am asking since anything in the local area is not considered metastasis but I catch myself sometimes thinking about those in "metastatic" terms although they are not.

On the other hand there are so- called micro mets that can be anywhere and not produce PSA since they are dormant.

I do not think that it is possible to know any exact % for any scenario just by looking at PSA at those small levels. BUT, if you look at PSMA study results and according to Dr. Kwan 1/3 of cases will find actually that PC is in a distant place.

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Jeff Marchi | @jeffmarc | Jul 18 10:59am
In reply to @pesquallie "@wheel1 New studies now indicate that low testosterone may worsen cancer and major medical research institutions..." + (show)
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@wheel1

New studies now indicate that low testosterone may worsen cancer and major medical research institutions like John Hopkins, Duke, Mayo, and NIH are entertaining the use of TRT (Testosterone Recovery Treatment) after successful initial treatments. Tuesday, I visit my urologist and will attempt to get him to approve TRT for me since my side effects are so bad and my PSA is undetectable after a year.

Jump to this post

@pesquallie
Low testosterone can worsen cancer when it has become castrate resistant. When that happens, not all of the cells are susceptible to testosterone, but some still are.

If you were just beginning with a low Level case of prostate cancer, then testosterone really does help stopping it in its tracks.

Even people with more serious prostate cancer who wanted to delay doing anything benefit from having ADT while they delay it.

There’s no real specific answer to when testosterone will help, But it’s more likely to do it in an advanced case.

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wheel1 | @wheel1 | Jul 18 11:08am
In reply to @jeffmarc "@pesquallie Low testosterone can worsen cancer when it has become castrate resistant. When that happens, not..." + (show)
Profile picture for Jeff Marchi @jeffmarc

@pesquallie
Low testosterone can worsen cancer when it has become castrate resistant. When that happens, not all of the cells are susceptible to testosterone, but some still are.

If you were just beginning with a low Level case of prostate cancer, then testosterone really does help stopping it in its tracks.

Even people with more serious prostate cancer who wanted to delay doing anything benefit from having ADT while they delay it.

There’s no real specific answer to when testosterone will help, But it’s more likely to do it in an advanced case.

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@jeffmarc
I am just learning my DEXA scan had a right neck femoral at -2.6, which the cutoff from osteopenia to osteoporosis is -2.5 and testosterone plays a part on your bones. My testosterone has never been tested and I have also been on omeprazole for 8 years which I knew had an impact. I guess it probably means more pills. Two years ago I only had two, my omeprazole and one for cholesterol. Then added after the blood clot after surgery to three. Just last week my cardiologist added another cholesterol one for four. If i have to add more now I get concerned about my nightly 🍷. Do you think getting the testosterone checked for the osteoporosis should be done?

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