What is the current position on the length of hormone treatment?

Thank you for your reply.

Regarding "complete faith", I said "I choose my physicians wisely and have complete faith in them". The key here choosing wisely. Having been in the medical profession for over 40 years, I can attest that physicians are no different than people in any other field or endeavor in life. Some are brilliant, experienced, dedicated and highly skilled. Others not so much. No different in some ways than auto mechanics. I have had some that diagnosed and fixed my problem without difficulty and charges a reasonable fee. Others were more interested in making money than in solving the problem.

I have read some of your posts and you appear to be the exception. You are obviously intelligent and highly invested in your care. You have extensively researched the disease, treatments and physicians. This is not the norm. Most people don't have the understanding to go to the literature and make sense of this complicated disease. This is not a criticism of them. If I tried to go research patent law I would end up confused and likely make the wrong assumptions.

My expert MO at JH and RO at Emory are both highly experienced, knowledgeable and have done extensive research on the topic of prostate cancer. There is no way I could read literature and understand the disease and treatment to the degree that they do. That doesn't mean I don't ask questions or am not involved with my care. My MO at Hopkins, after my chemo, gave me 5 options going forward. He said at this time they is no true SOC with the rapidly changing landscape. One of the options he said he would not recommend. I asked him what he would recommend/do given the risk/benefit. He told me and I followed his advise.

I have always thought that if you don't want to follow your doctor's advice you probably picked the wrong physician. Just my opinion.

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Thank you for your reply.

Regarding "complete faith", I said "I choose my physicians wisely and have complete faith in them". The key here choosing wisely. Having been in the medical profession for over 40 years, I can attest that physicians are no different than people in any other field or endeavor in life. Some are brilliant, experienced, dedicated and highly skilled. Others not so much. No different in some ways than auto mechanics. I have had some that diagnosed and fixed my problem without difficulty and charges a reasonable fee. Others were more interested in making money than in solving the problem.

I have read some of your posts and you appear to be the exception. You are obviously intelligent and highly invested in your care. You have extensively researched the disease, treatments and physicians. This is not the norm. Most people don't have the understanding to go to the literature and make sense of this complicated disease. This is not a criticism of them. If I tried to go research patent law I would end up confused and likely make the wrong assumptions.

My expert MO at JH and RO at Emory are both highly experienced, knowledgeable and have done extensive research on the topic of prostate cancer. There is no way I could read literature and understand the disease and treatment to the degree that they do. That doesn't mean I don't ask questions or am not involved with my care. My MO at Hopkins, after my chemo, gave me 5 options going forward. He said at this time they is no true SOC with the rapidly changing landscape. One of the options he said he would not recommend. I asked him what he would recommend/do given the risk/benefit. He told me and I followed his advise.

I have always thought that if you don't want to follow your doctor's advice you probably picked the wrong physician. Just my opinion.

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Just a follow up to your reply. I asked my MO at JH and his very experienced NP (Dr. Pienta and Diana Reyes NP) what the next steps would be. They said that from their experience treating men in a subgroup like me (high grade cancer G9, very limited spread, excellent response to initial triple therapy with undetectable PSA) that about 70% remain undetectable after about 3 years (I don't think they have reliable data further out) and 30% will see PSA rise as testosterone rises. If PSA goes up they will wait until it hits 0.5 and then repeat the PSMA PET. If the PET shows another site of spread they will use SBRT to obliterate the cancer +/_ short 3 month course of Lupron.
I don't believe there are set-in-stone protocols for men in my position at this time due to the rapid evolution of treatment and the large number of trials ongoing. For me, that is why I went to someone with extensive experience, heavily involved in research, treats almost exclusively prostate cancer, and treats patients individually based on their circumstances rather than following set protocols (Standard of Care-which lags the curve of latest trials etc).

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Thank you for your reply.

Regarding "complete faith", I said "I choose my physicians wisely and have complete faith in them". The key here choosing wisely. Having been in the medical profession for over 40 years, I can attest that physicians are no different than people in any other field or endeavor in life. Some are brilliant, experienced, dedicated and highly skilled. Others not so much. No different in some ways than auto mechanics. I have had some that diagnosed and fixed my problem without difficulty and charges a reasonable fee. Others were more interested in making money than in solving the problem.

I have read some of your posts and you appear to be the exception. You are obviously intelligent and highly invested in your care. You have extensively researched the disease, treatments and physicians. This is not the norm. Most people don't have the understanding to go to the literature and make sense of this complicated disease. This is not a criticism of them. If I tried to go research patent law I would end up confused and likely make the wrong assumptions.

My expert MO at JH and RO at Emory are both highly experienced, knowledgeable and have done extensive research on the topic of prostate cancer. There is no way I could read literature and understand the disease and treatment to the degree that they do. That doesn't mean I don't ask questions or am not involved with my care. My MO at Hopkins, after my chemo, gave me 5 options going forward. He said at this time they is no true SOC with the rapidly changing landscape. One of the options he said he would not recommend. I asked him what he would recommend/do given the risk/benefit. He told me and I followed his advise.

I have always thought that if you don't want to follow your doctor's advice you probably picked the wrong physician. Just my opinion.

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For those that had treatment that follows the ARSENS trial (i.e., ADT, Darolutamide, and 6 Cycles of Docetaxel). The newest data released by the ARSENS trial.

Overall Survival - Still Not Reached (NR)
Time to Castrate Resistance - Still Not Reached (NR)

It has been 5+ years now. This is promising news.

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Where did you see that? My MO at JH was essentially following the ARASENS trial but he believes there is no supporting data that 6 cycles of Docetaxel is any better than 4. My Darolutamide was discontinued after the chemo (PSA was undetectable). He strongly suggested pelvic radiation as I had a positive node on PSMA PET prior to beginning the triple therapy. My Lupron was discontinued after year with PSA still undetectable.
Was this similar to your treatment? I don't believe there is a set in stone protocol for the triple therapy at this time and trials are underway to assess the best exact protocol.

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I wanted to add this caveat as there are multiple men replying who are in a similar situation. There is no one right treatment. There are many excellent, well trained, experienced MO/RO/Urologists around the world that treat prostate cancer differently. The reason there are different approaches is that there not yet an established treatment protocol for every phase of this disease that is so complex. There are options for initial treatment of the prostate (surgery, radiation, seed implantation (brachytherapy), and direct ablation using heating/freezing and US. Add to that the vast number of drugs and the complexity of patient presentation/stage of disease/G score/patient age, co morbidities, patient preference etc etc and it is no wonder that there is no one set treatment. As I have read extensively on various support boards I have occasionally encountered individuals that definitively state that this treatment is best or yo shouldn't have surgery etc. These are only opinions, usually from lay people that have read articles and done "research". This is not helpful as making definitive statements about treatment plants seeds of doubt in the minds of those who choose a different treatment and causes anxiety. Sharing my experience and how I was treated is fine and maybe it will help someone else. But none of us should tell others what to do or their treatment is wrong. My daughter, who is an Infectious Disease specialist at a major Medical Center, was given a coffee cup by one of her colleagues which reads "Don't confuse your Google search with my Medical Degree". I thought it was funny and not meant to be pompous. Even myself, with an MD, 5 years post med school training/Fellowship and 40+ years of practice (including major medical center) do not fully understand the complexity of this disease and the treatments. The real experts, MO, RO and urologist, know much more than I. I choose my treating physicians wisely and have complete faith in them. I ask questions but don't try to direct my own care. I remember the old adage I have heard many times "He who acts as his own doctor has a fool for a patient".

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The information is a compilation of multiple sources including expert webinars and publications. Researchers deterined that 10 cycles is the sweet spot. Researchers then began subtracting cycles to see how many cycles they could reduce to avoid side effects - they agreed on 6 cycles.

All PC is different for each person. I was diagnosed Stage 4 De Novo. The PC went to my bones (i.e., spine, ribs, and pelvis). My doctor thinks a lot like Dr. Kwon. Hit the hell out of the PC up front with triplet therapy. I first was given 10 treatment of radiation to my spin and then 5 to the ribs. I started ADT and Darolutamide and then Chemotherapy. I finished 6 cycles and asked if I could have more. Because I had zero side effect to chemo and my blood was other worldly, and my PSA was dropping too slowly I did 10 cycles. After completing all 10 cycles my PSA dropped to 0.238. My PSA continued to drop post Chemo and is undetectable. For me, I wanted to kill as many micro metastases as possible. That was my choice and my journey. If my doctor would have let me have more cycles I probably would have done 12 cycles in total. I probably will have to continue on ADT and Darolutamide indefinitely. I am determined to live with this cancer and not die of it. I also eat a 70% plant based diet. I work every day and exercise.

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