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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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Jeff Marchi | @jeffmarc | Jul 18 11:25am
In reply to @wheel1 "@jeffmarc I am just learning my DEXA scan had a right neck femoral at -2.6, which..." + (show)
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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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@wheel1
Low Testosterone is a direct cause of the bone deterioration that gives you osteoporosis. Getting it tested every three months, may be more than enough if on ADT. If you are on ADT Then using an estradiol patch can help restore some of your bone strength. It sounds like you’re not on anything that will reduce your testosterone so get it tested yearly maybe, since it doesn’t change a lot over time.

Switching to estradiol instead of ADT can actually reverse osteoporosis.

I’ve been on Omeprazole For at least 8 years, Don’t think it makes that big a difference because I’ve taken calcium daily for all that time. I’ve fallen a number of times and have not broken anything. I’m being much more careful about that now, The balance problems caused by the drugs we’re taking have to be offset by watchful walking.

I have been on a bone straighteners that whole time as well so that may be why I haven’t had any issues.

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wheel1 | @wheel1 | Jul 18 1:07pm
In reply to @jeffmarc "@wheel1 Low Testosterone is a direct cause of the bone deterioration that gives you osteoporosis. Getting..." + (show)
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@wheel1
Low Testosterone is a direct cause of the bone deterioration that gives you osteoporosis. Getting it tested every three months, may be more than enough if on ADT. If you are on ADT Then using an estradiol patch can help restore some of your bone strength. It sounds like you’re not on anything that will reduce your testosterone so get it tested yearly maybe, since it doesn’t change a lot over time.

Switching to estradiol instead of ADT can actually reverse osteoporosis.

I’ve been on Omeprazole For at least 8 years, Don’t think it makes that big a difference because I’ve taken calcium daily for all that time. I’ve fallen a number of times and have not broken anything. I’m being much more careful about that now, The balance problems caused by the drugs we’re taking have to be offset by watchful walking.

I have been on a bone straighteners that whole time as well so that may be why I haven’t had any issues.

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@jeffmarc
Not on ADT, i see my non Hodgkin’s lymphoma oncologist next week to go over all his blood work and CT scan he ordered. I am going to ask him about my osteoporosis.

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Jeff Marchi | @jeffmarc | Jul 18 4:00pm
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
After thinking over your question, I realized you might’ve meant what is the chance of a PSMA PET scan finding a metastasis if the PSA was only .2.

This is the closest I could come to an answer,

At a PSA level of 0.2 ng/mL, a PSMA PET scan detects metastatic disease in about 34% to 38% of patients.

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wheel1 | @wheel1 | Jul 18 5:08pm
In reply to @jeffmarc "@wheel1 After thinking over your question, I realized you might’ve meant what is the chance of..." + (show)
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@wheel1
After thinking over your question, I realized you might’ve meant what is the chance of a PSMA PET scan finding a metastasis if the PSA was only .2.

This is the closest I could come to an answer,

At a PSA level of 0.2 ng/mL, a PSMA PET scan detects metastatic disease in about 34% to 38% of patients.

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@jeffmarc
Do you have idea where the metastatic disease is found. Is the prostate bed considered metastatic disease at BCR,

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Jeff Marchi | @jeffmarc | Jul 18 5:45pm
In reply to @wheel1 "@jeffmarc Do you have idea where the metastatic disease is found. Is the prostate bed considered..." + (show)
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@jeffmarc
Do you have idea where the metastatic disease is found. Is the prostate bed considered metastatic disease at BCR,

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@wheel1
Because the Technology, PSMA pet, Is unable to see metastasis smaller than around 2 mm and in some cases even 5 mm, they frequently cannot find a metastasis when somebody has BCR.

We frequently hear that a pet scan is done and nothing could be found.

In that case, the most likely place for a metastasis is in the prostate bed. It is not always right, But that location is the best bet they have at this time.

The reason that location is most likely is because the prostate is near there and if the cancer gets out of the prostate, that is the closest spot to get to.

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wheel1 | @wheel1 | Jul 18 8:24pm

I just wasn’t sure the prostate bed was considered metastatic for prostate cancer. I always thought that meant it had gone to lymph nodes or bone or elsewhere

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Jeff Marchi | @jeffmarc | Jul 18 9:38pm
In reply to @wheel1 "I just wasn’t sure the prostate bed was considered metastatic for prostate cancer. I always thought..." + (show)
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I just wasn’t sure the prostate bed was considered metastatic for prostate cancer. I always thought that meant it had gone to lymph nodes or bone or elsewhere

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@wheel1
It is not considered metastatic, It’s a large area, which could have a metastasis here and/or there in it, or it may not have any And one or more metastasis are in the lymph nodes.

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joecontheroad | @joecontheroad | Jul 19 10:49am
In reply to @adoptedtomato "If you had immediately radiation after RP then I think that's called Adjuvent, not Salvage treatment..." + (show)
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If you had immediately radiation after RP then I think that's called Adjuvent, not Salvage treatment (salvage is later when confirmed returned).

Not sure semanitcs makes a diff. My my RO kept correcting me. I had adjuvent. And they said 6 months ADT during IMRT was sufficient.

Said the goal is to see if radiation worked - and "save your ADT bullets" for later if you need them. I understand metaphor but not sure if it applies.

I keep questioning it. Researched extensively. Got more confused.

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@adoptedtomato
"I keep questioning it. Researched extensively. Got more confused." Don't feel like The Lone Ranger! 🥴

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