Anyone take a Treatment Holiday? Intermittent use of ADT (hormone Tx)

Is anyone on intermittent ADT Therapy following external radiation and brachy therapy? I would like more information on this and or research for using intermittent ADT? Thanks

My situation is not exactly what you asked about, but it’s close enough that I thought I would respond. I had RP 2 years ago at age 59. My PSA was 23, Gleason 4+4=8, stage 3 with seminal vesicle involvement. 60 days post RP, my PSA declined to 7. I started intermittent Bicalutamide in dosages between 50-150 milligrams per day. Got my PSA down to 0.23 in 6 months. Then stopped for 2-3 months until PSA rose above 2.0. Now I will be on the bicalutamide for 2-3 months then off for 2-3 months depending on how quickly the PSA rises and falls. I am being treated by a Dr in Mexico City. I go once a year for a PET/PSMA scan and I have two tumors in the prostate bed but no metastasis. My Mexican Dr says I can go on indefinitely like this, but I’m going to see an RO at Miami Cancer Institute in December who uses the MRIdian equipment to see if a cure is still possible. If the RO thinks there is a decent chance, I will go for it. I think the intermittent ADT is better for quality of life than constant ADT, but it’s still bad enough that if there is a reasonable chance of getting off it through RT, I will try it.

Thank you and good luck.

Greetings;
My take would to have a short course of ADT first then have the radiation because the ADT weakens the cancer then the radiation finishes it off easily.
I don't totally agree with the doctor's opinion that you can go on ADT indefinitely because of the side effects.
Given that after RP the psa only dropped to 7 means that it is still out there and after the ADT it went from .23 to 2 in 2-3 months means that you have to get on it ASAP.
I researched the MRIdian and it is impressive.
Please keep us in the loop.
Best wishes

Dr. Scholoz on Utube has many helpful videos on your situation. He would advise to get on Lupron since the cancer is in the bed of where the prostate was. I have a friend who got his removed 7 years ago and he had a similar Gleason 7 and PSA around 7 like me. He gets blood work done and if it bumps up from .1, he get a Lupron and he gets one about once a year. A 3 month one, I had no cancer per CT and Bone S. I had it removed 2.4 months ago. I go back on Nov. 16 for my first blood work. If the PSA is above 0, I get a PMSA Pet Scan and that identifies any spots. If a spot is detected where the prostate was, I get on Lupron. If a spot is outside of where the prostate was, I have the spot pinpointed and then targeted Beam Radiaition will poison the little bastard. I am 70 just now. I do the Kelgel and Pelvic exercises and now am working out hard again and doing Core exercises, 1,000 Crunches a day. I am on some pill for pee control but I swear to all of you, I pee 200 a day. I put up with it because I am so happy to be alive.

Valid question, here is video that might be of interest...
https://www.urotoday.com/video-lectures/nccn-prostate-cancer-guidelines-review/video/2295-intermittent-vs-continuous-adt-for-patients-a-review-of-the-nccn-guidelines-christopher-wallis-and-zachary-klaassen.html
When reading about Orgovyx...

Advise patients to take a missed dose of ORGOVYX as soon as they remember. If the dose was missed by more than 12 hours, patients should not take the missed dose and resume with the next scheduled dose. | If treatment with ORGOVYX is interrupted for greater than 7 days, restart ORGOVYX with a loading dose of 360 mg on the first day, and continue with a dose of 120 mg once daily. (https://www.drugs.com/dosage/orgovyx.html)

I am on ADT (Eligard + Zytiga) and there is no practical way to take a holiday from the drugs. The Eligard is a 3-month injection and the Zytiga can easily be skipped and would just make a small improvement in QOL. For me personally, managing the side effects through the holidays equates to getting plenty of sleep, exercising daily, and avoiding sugary foods. The brain fog from these drugs is my biggest QOL issue, and eliminating sugar has done wonders to reduce the fog.

Last but not least, always enjoy holiday and family traditions. Those are memories and experiences that are meant to be cherished and enjoyed. I will eat a peperoni pizza and chocolate cake with my family even if it shortens my life, the smiles and warmth of family and friends is why we are here.

If a "vacation" isn't possible, there are ways to live with the ADT side-effects:

Bone fragility: take calcium supplements and do light resistance training (weights, therabands, etc) to slow or reverse bone-mass loss.

Sexual relations: my doctors have told me that it's OK to use ED meds or a vacuum pump (I haven't tried yet, due to other mobility issues from my spinal compression).

Hot flushes: dress in layers, so that you can peel off the outer layers when you feel one coming on.

Gynecomastia: wear loose shirts, or heck, if you feel confident, just wear tight shirts and own it. We can learn from the younger generation about not getting caught up in stereotypes about what a man is supposed to look like. If you identify as a man and you have enlarged breasts, then you're a man with enlarged breasts, period. (Ditto for loss of body hair; I used to be a hairy guy, and now, while I still need to shave, I have the body hair of a 12-year-old. So be it.)

Weight gain: I haven't quite figured this one out yet. I am managing to hold it steady with exercises and moderate portions (not restriction) in eating, but after months of barely being able to eat post-surgery due to an prolonged ileus and other complications, I'm not willing to go on appetite-suppressants or harsh diets now that I have the precious gift of a good appetite again.

Be careful with 'calcium' supplements. I took them for a long time and got calcified aortic valve probably thusly. Your points are good .. a 'vacation' is possible; concerned about what duration of a restart.. I guess until PSA is again knocked down... rinse & repeat?

I appreciate your post greatly; as that video gave me the most information (more than three docs and two radiation oncologists); only one of which would even acknowledge the topic of 'drug holidays' or intermittent. In my case I've had a pacemaker installed and probably didn't need it, as the irregular heartbeat (bracycardia) might have been triggered by too long ADT.

I was on Orgo. for 15 months and never was it mentioned as a 'course of treatment you stop' at a point or IF there are side effects. I had many of the side effects and stopped taking it on my own and almost all normalized. BUT, the PSA popped back up so starting it again and we'll test in 3 months.. even another PET scan. Due to cardio-drugs I didn't think brain fog was a factor, but now that you mention it, maybe I can attribute the 'fog' to the ADT treatment not Blood Pressure treatment or statins.

I knew about the re-loading to restart and followed that (thanks); but mostly for that video; 2 years old and far more informative than any information I've encountered on this topic. Cheers and good luck to you too!

Thanks for the caveat. My calcium supplement is just one extra-strength Tums every day (with my medical team's approval). Agreed that you'd want to be careful with anything stronger.