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ADT and Castrate Resistance

Posted by ga73ds @ga73ds, 7 hours ago

Diagnosed Nov 2021. Gleason 9, Decipher .99, stage 4a (spread to seminal vesticles and 1 of 12 lymph nodes tested). I had prostatectomy in January 2022. There was some positive margin. I started ADT (Orgovyx) a year later in January 2023, a few months prior to pelvic radiation in March-May 2023.

So, I've been on ADT (Orgovyx) for 2 1/2 years total-- 2 years since radiation. Since radiation and while on ADT, for over 2 years now, my PSA has remained undetectable at < 0.01. I am very pleased.

My question-- is castrate resistance more likely the longer you stay on ADT? If CR develops, I read that the prognosis is not good.

My doctors want me to come off the ADT. I'm not convinced I understand why. I'm reluctant. I've so far had no serious side effects from the ADT (Orgovyx).

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northoftheborder | @northoftheborder | 6 hours ago

It's a hard call. Castrate resistance isn't likely to emerge if you still have a lot of castrate-sensitive prostate cancer, but you want *no* active cancer. For earlier-stage prostate cancer, there's good evidence now that benefits to other areas of your health (heart, bones, muscles, endocrine system) from "ADT holidays" outweigh the additional risk of prostate-cancer progression for overall survival, but the biggest trial to date for intermittent therapy for metastatic prostate cancer — the phrase III SWOG trial — still showed a clear overall survival benefit for continuous ADT over intermittent: https://pubmed.ncbi.nlm.nih.gov/24395278/

Of course, that may change, especially as they collect more data from people getting the latest therapies. But if you're concerned, it's worth bringing up SWOG with your oncologist. Best of luck, whatever, you decide!

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hbp | @hbp | 5 hours ago

I am also G9 CR stage 4a I was on Lupron and Erleada for 6 months then surgery then 6 more months of drugs That started 41 months ago and my PSA has been undetectable since surgery in June of 2022. My UCLA urologist has advised me that my event free status is the result of the experimental treatment that I received. Look into androgen restrictive drugs such as Erleada Good luck

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1 reply
ga73ds | @ga73ds | 4 hours ago
In reply to @hbp "I am also G9 CR stage 4a I was on Lupron and Erleada for 6 months..." + (show)
@hbp

I am also G9 CR stage 4a I was on Lupron and Erleada for 6 months then surgery then 6 more months of drugs That started 41 months ago and my PSA has been undetectable since surgery in June of 2022. My UCLA urologist has advised me that my event free status is the result of the experimental treatment that I received. Look into androgen restrictive drugs such as Erleada Good luck

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I am diabetic type 2 and also have reduced kidney function eGFR about 40. So, something like what you suggest might not work good for me.

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jeff Marchi | @jeffmarc | 3 hours ago

I think you are worrying about the wrong thing. I’ve had PC for 15 years and I’ve Been castrate resistant for six years. I’ve had four reoccurrences but have not had one for four years. I’ve been undetectable for the last 19 months.

I know a lot of other people who are castrate resistant and have been around for decades.

The longer you stay on ADT the more likely it is that you will become castrate resistant. The average is 2 to 3 years, but some people can go up to nine years.

You have been undetectable a long time,I have heard from doctors who recommended others stop ADT In similar situations. If you decide to follow your doctors Advice you could get PSA tests every month to make sure that if your PSA starts rising, you can immediately get back on ADT. There are an awful lot of people who do this. Over at the weekly advanced prostate cancer meeting at Ancan.org There are a few people that have done that With cases similar to yours.

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