PC spread to some lymph nodes; radiation, ADT. intermittent ADT

My husband had RP and he unfortunately had BCR 9 months later. His PC was found in several lymph nodes. He just finished RT and was prescribed Orgovyx and Nubeqa which he is supposed to take from 18 to 24 mos. and than stop.

I am pretty new to this phase of PC treatment but I never heard (so far) that patients are put on ADT indefinitely without being with distant metastasis. I might be wrong and I hope that @jeffmarc and the rest of ADT veterans will jump in here soon and share their wisdom.

Wishing you all the best and I am glad that you found this place and are trying to find good way forward for your husband. <3

@surftohealth88
This sounds like a pretty normal treatment. You’ve got a very advanced prostate cancer case. This is not a 3+4 that has no aggressive issues and after BCR really doesn’t need to go on the drugs for more than about six months after salvage radiation. That was a 4+3 and just had ADT for 6 months after that.

This is an advanced case which requires the drugs be prescribed for up to two years. Adding the ARPI is supposed to reduce the incidents of castrate resistance And extend the time before reoccurrence.

If you’d like to have this confirmed for you, come to the Ancan.Org Meeting tomorrow at 5 PM Pacific. Get there 10 minutes early. Make sure you have goto meeting on your computer or device And put in answercancer for the meeting name. You will get very specific information from them that will confirm this prescription.

@jeffmarc

Hey Jeff : ))), I was trying to answer to @gkgdawg original post in this thread.

I shared the fact that we got 18 mos of ADT and yes, that is standard treatment in our case.

HER question is however different and I hoped that you might know the answer for her husband's case. He was advised to take ADT INDEFINITLEY and she is confused since he has NO cancer visible on any of the scans, and his PSA after RT is less than 0.1

He had SBRT as primary treatment to gland and some nodes.

She is wondering why he needs to be on ADT indefinitely when all is pointing to very successful primary treatment.

Please if possible give some insight to @gkgdawg

Thanks so much in advance : )))

@surftohealth88 thank you very much for your response. I watch the videos from PCRI and they seem to indicate that ADT indefinitely isn't something which is done anymore. They seem to encourage going off the ADT and monitoring the PSA. This oncologist is not our original doctor. Our first doctor is on maternity leave. I found it difficult to understand that she had never taken a prostate patient off ADT. She seemed to assume that it is a forever thing.

@jeffmarc Unfortunately I am not available at that time tomorrow. Are these meetings regular occurrences? I would really appreciate the information and discussion.

@surftohealth88 Thank you. You explained our situation very succinctly.

Glenda

Intermittent ADT may not be what you really want. When you stop ADT, it takes 6 to 9 months to get back to some testosterone level. It can take many more months to get to a normal level.

There has to be some reason that the oncologist feels this case is so aggressive he can’t get off ADT..

Unfortunately, you don’t mention His Gleason score, Or whether he had any other things found in the biopsy.

Were any of these things found in the biopsy intraductal, ductal, large cribriform, Seminal vesicle invasion, EPE or ECE. (Extraprostatic extensions extra capsular extensions). They can make the cancer much more aggressive.

Were hereditary genetic test done to see if there’s a genetic issue? What was the result?

I’ve been on ADT for nine years, I’m on it because I have BRCA2 and stopping drugs can cause of my PSA to start rising quickly. I just wonder if something in your husband’s cancer diagnosis causes a similar need.

If he has no aggressive issues, then stopping drugs is a good idea after no more than a couple of years. And then testing to see if the cancer comes back. So your desire makes sense.

If none of the questions I’m asking, bring up aggressive issues then you need to go back to the oncologist and ask specifically, why they feel the ADT cannot be stopped. I know with my oncologist. I can ask just about anything and she can answer with quite useful information. You have to be proactive with doctors and make sure you are working toward your own best interest.

Another thing occurred to me.

You probably have never had a decipher test for him.

That test would tell how aggressive his cancer is and whether he needs to stay on ADT for an extended period.

If no aggressive issues are Obvious, that Decipher test Can make sense, If there are aggressive issues already then doing the test may not make sense.

@gkgdawg

You are very welcome 🌺.

I hope that you will get clear answer from your husband's original MO and please do not hesitate to ask for second opinion by Zoom consultations with MO from some other hospital or even better with an MO from Cancer Center of Excellence such as Mayo or MD Andersnn etc. , or local university hospital.

I am not a doctor, nor am I here for long time but so far my understanding is that continuous ADT is reserved for patients with stage 4 cancers and/or patients whose PSA rises as soon as one is taken off ADT and who have very aggressive cancers that were not put under control with either surgery or radiation in combination with short or long (up to 24 mos) term ADT.

Wishing you all the best and keep us posted if you find time 🍀.

@gkgdawg FYI-was on ADT 28 months, off ADT-21 months now. PSA<.02 still, testosterone up to 99 now. I m still functional as I visit the ANYTIME FITNESS joint 3x/week.