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

Had not seen this post when I replied to your other post.
ADT may be a management tool for you (I am not a MD).
I can forsee ADT management for me; hopefully a number of years down the road.
My Orgovyx side effects were significant, but not overwhelming.
However, after 4 mos of Orgovyx, it took a good 3 - 4 mos to feel like myself again.
I think of it as "intermittent ADT therapy", not a "holiday", but as being months off of therapy.
And restarting when PSA rises "significantly ", whatever that means for me in the future.
Again, best wishes in your decision making and results.

Excellent area to explore! I am on orgovyx/zytiga/prednisone post surgery 12/15/22. Do we experiment with holiday? Would that prolong the efficacy of adt or hasten the resistance? Stage4 will not likely be cured by local radiation therapy so I am hoping to extend usefulness of adt. How long can a person survive on adt if resistance doesn’t occur?

How long can a person survive on ADT if resistance doesn't occur? --- This is a great question and without the ability to give an answer (because it depends on many factors), I would offer encouragement and self-education by checking out the PCF webinar from last month (October 17, 2023: Advanced Prostate Cancer Series: Metastatic Hormone-Sensitive Disease) and also watching the upcoming webinar (November 29, 2023: Advanced Prostate Cancer Series: Metastatic Castration-Resistant Disease), both are available within this link: https://www.pcf.org/pcf-webinar-series/

For myself, I have heard stories that ADT efficacy can last from months to years to decade plus. Some folks stay on ADT for a long-time, others become resistant and have to enhance their treatment package.

Thanks for the video link. My medical oncologist thinks 24-30 months will be the limit of this combination therapy then another that lasts a year then another that lasts 6months then predicts cancer will explode. Worth noting Zytiga/orgovyx combo first talked about in literature in Jan of 22. No long term results are yet possible as the combination is new. Psa undetectable scans show tumor remnants non-existent no enlarged lymph nodes testosterone 15-20. Wouldn’t mind staying on this course.

Without knowing your specifics, those estimates provided by your health team seem like "averages" and while it "might" be correct, I would suggest to confirm the information so that you are aware of the ranges for each treatment option and understand where & why you fit into each. Also and always keep in mind that new treatments and combinations are coming out at a brisk pace. Keep The Faith.

Here's my clinical history...

As I've said before, if you come off treatment, have decision criteria to do so.

Once you do, actively monitor through labs and consults while off treatment.

Have decision criteria to go back on.

Our decision criteria to go back on treatment after triplet therapy ended in May 18 with the last 90 day Lupron shot was three or more consecutive increases, 2-4 months apart, PSA between .5-1.0 and imaging. That decision criteria was met in March this year, roughly 4-1/2 years off treatment.

Our treatment plan was SBRT and 12 months Orgovyx, with Xtandi if needed. My PSA at six weeks dropped significant, and three months to undetectable. T went from 600+ to < 9. Given that clinical data, oncologist and I felt no need to add Xtandi. We'll do labs and consults at the end of January and again in April next year. If PSA remains undetectable and T castrate, we'll stop treatment in April and actively monitor, probably same decision criteria,

My T did recover as you can see from my chart, 135, then 400+ and finally at 600+ just before we went back on treatment. Why, I don't know. I do exercise quite a lot, may have been a factor.

Kevin

At first my onco team told me 5 years average survival starting with Firmagon + Erleada (maybe a couple extra because I'm relatively young and strong), but by the time I hit 18 months still with undetectable PSA and only trace testosterone, they tossed out 10+ years as a possibility.

As time goes on, the odds change because things have or haven't already happened. Now that I've gone 25 months not only tolerating Firmagon + Erleada well, but showing no hint of progression in tests (most recently a cystoscopy), symptoms, or bloodwork, my odds have shifted a bit.

That said, I know things can change really fast. I saw that happen to a friend last spring and summer — his lymphoma had been responding well to treatment, them suddenly it wasn't. We have to learn to live with uncertainty, and that's a big emotional and spiritual challenge.

That is right. It is possible that these stats come from trials where their cut off is PSA 0.5. There studies, as well as the experience of oncologists that when the PSA goes below 0.2 or even 0.1, it is very much different. The scientific explanation is that at that level, very few malignant cells remain, if at all. The important point is it stays stable at that level. So regular monitoring is needed to make sure. I hope that helps.
Dont mind me. I am just another layman trying to make some sense of the hole thing.

Thanks for sharing your experience. You are correct about the uncertainty of life after diagnosis. The videos are more about relief from side effects. I may come to need that in the future. @72 your 10-12yr tolerance of adt would do me a lot of good. Thanks bill

I had not heard that. My PSA got down to 0.1 but the next PSA after a 2 month holiday (Orgovyx only.. no radiation or surgery precedes).. was 3.0 so now I'm taking Orgo. again and will do a PET and PSA in 3 months so I guess that would be interesting . I was on Orgo for over a year preceding, and just could not take the ADT (typical) side effects anymore; so did a holiday on my own recognizance without asking permission. And yes the side effects progressively eased; but 3.0 might infer rebound of PC?