ADT vacation

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.

@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....

@jeffmarc

The unanswered question here (& other threads) is once back on ADT/etc., how long do you stay on it before trying another vacation???

During my prior "vacation" after 2.5 years on Lupron + Abiraterone, my PSA remained undetectable for a year, & it took another year to climb to 0.14. My oncologist recommended waiting until my PSA got to 0.2, but I chickened out early. 🙂

When I went back on Orgovyx + Nubeqa, my PSA went from 0.14 to 0.02 in twelve days. Lupron is slow to recover from; I imagine Orgovyx is not.

One can imagine a protocol where one starts another "vacation" in a couple months (eg, after PSA & Testosterone have hit the floor), but I'm not that brave. Are there any studies on this?

@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.

@readandlearn
I know one guy that has gone on five holidays. Each time he’s done it it is lasted less time and the last couple of times it took longer for the ADT to get his PSA down.

He’s still going to keep Stopping and starting.

I know a lot of other people that have done it but none with as many reoccurrences. Sometimes the PSA start rising soon and sometimes it doesn’t rise for many years.