ADT vacation: When do you start treatment again?

I know a lot of people that have been in your position and have taken a break. Get monthly blood tests and you can go until the PSA starts rising. One of this trials would continuously do the stop and start and would start again every time PSA hit .2. Some people like it to go a little higher so they can find something with a PSMA PET scan.

I think if I had a really aggressive case, I would want to go back on at .2. It totally depends what you feel is right for his long-term progression Free survival.

Yes, I'd make the same choice as @jeffmarc — if the LIBERTAS trial ends up showing that it's safe to take an ADT holiday with mCSPC as long as I'm still on Apalutamide — and I decide to do that — I'd probably resume ADT as soon as my PSA became detectable again (even 0.02); I wouldn't let it go all the way up to 10 before resuming, like the trial is doing.

Dr. Schellhammer, a prominent urologist, former president of the AUA, has used transdermal estradiol, a.k.a. tE2, for 18 years, instead of standard ADT drugs, after his disease became castration resistant.

He experienced a marked slowing of disease progression and a dramatic improvement in his overall well-being and performance after switching from standard ADT. He is using his credibility as a world renowned urologist to promote the use of tE2, especially for patients whose experience with standard ADT drugs leads them to need to take a break from the deteriorating quality of life associated with those drugs.

A short video by Schellhammer: https://www.youtube.com/watch

@climateguy It's a shame that estradiol is contra-indicated for anyone with a history of blood clots (as I just reconfirmed with my oncologist last week). That likely rules out a lot of us. 😟

@climate guy
Dr. Schellhammer Attends, almost all of the ancan.org Weekly advanced prostate cancer meetings. If you want to ask him some questions he is available there.

He actually hasn’t been on it for 18 years continuously. He talked about that at the meeting Tuesday. He went to ADT for a while for a particular trial he was involved in and then went back to Estradiol.

Richard Wassersug PhD, Who has been leading the creation of the Estradiolinitiative.org Has been on estradiol for over 22 years. An interesting thing is that the people on estradiol do not seem to become castrate resistant While on it.

Here is what I find about the study being done that the OP referenced: ( using AI)
"The A-DREAM study (Alliance A032101 / NCT05241860) is a phase 2 clinical trial testing whether patients with metastatic hormone-sensitive prostate cancer who respond exceptionally well to continuous hormonal therapy can safely take a break from treatment".....it goes on to say both ADT and ARPI will be stopped...and:
"Treatment is restarted if the PSA level rises to 5 ng/mL or higher, if scans show the cancer growing, or if symptoms return."....I am considering the protocol in the LIBERTAS trial, take a break from Orgovyx but continue Nubeqa and see what happens. The one thing I wonder about in my case is: I have had no surgery or radiation, just ADT and ARPI for 6 months. Will the nubeqa be effective enough to stop my (hopefully) returning testosterone that PSA rises slowly enough that I get 6 months before I go back on ADT....IDK.

@northoftheborder
I believe I read here on the forum that oral estradiol may cause blood clots but the patch (transdermal) does not (not sure if that is true). I take Eliquis but might have considered the "patch" ... when I asked the MO about estradiol it was obvious he did not know anything about it. So I think the first problem is getting it prescribed, at least from any Dr in my part of the woods. Then, if you can get it, frequent testing is required to get the optimal level right. More appointments? I need a break from appts AND a break from ADT......lol...it never ends!

@stage4lovolmetpc
This is a perfect question to get answered from the https://estradiolinitiative.org. You could contact them at their website and ask this question.

The patch version is supposed to get around these kinds of issues.

@northoftheborder The PATCH trial cited the exclusion criteria from a previous study: "We excluded patients with a previous history of major cardiovascular disease, defined as: cerebral ischaemia (eg, stroke or transient ischaemic attack) within 2 years of randomisation; history of deep vein thrombosis or pulmonary embolus confirmed radiologically or a known thrombophilic disorder; history of myocardial infarction or acute coronary syndrome within the past 6 months or more than 6 months with evidence of q-wave anterior infarct on electrocardiogram; unstable angina within the past year; angina that occurs on walking 100 m on the level or after climbing one flight of stairs at a normal pace and in normal condition, or angina that causes substantial limitation of ordinary physical activity or occurs at rest; New York Heart Association grade III or IV heart failure; and pulmonary oedema on chest radiography"

I'm not sure this means estradiol is contra-indicated for anyone with a history of blood clots.... Schellhammer or Wassersug would know more about this.

@stage4lovolmetpc
My husband did firmagon and zytiga and then chemo a year ago, no radiation either. We'll wait on the next scan and if it continues to look good (shrinking) then he might pause
I think he'd want PSA tests monthly and as soon as it goes up he'll go back on ADT but will that be a month or two or half a year and what about survival rate then?
Will it shave off years of his life? But doing ADT and having no testosterone isn't good either so....