ADT Holiday

Our experiences may not be yours, for example, my first ADT break after 18 months of Lupron was almost four years. The last Lupron shot was in May 2018, so 90- days from then, August "began my ADT holiday, then in August 2022, my PSA began rising to where in April 2023, we did SBRT and 12 months of Orgovyx. However, that was part of triplet therapy, six cycles chemotherapy and WPLN radiation.

The 2nd time is now, I am coming up on 14 months since the SBRT and 12 months of Orgovyx.

For the first year, we had labs and consults every three months. At our recent consult, my oncologist and I agreed to stretch it to four...

Mine is high risk, GG4, GS 8, rapid PSADT (< 4) and PSAV, short time to BCR.

If you come off, determine frequency of labs and consults, and decision criteria for wat constitutes clinical data to go back on treatment - in my case, that's three or more consecutive increases spaced three months apart, PSA between .5-1.0, image and then decide.

Treatment choices may depend on your clinical data, importantly, imaging. As others have said, possibly MDT only as there is some data indicating it may delay the need for onset of systemic therapy. You may also do MDT in conjunction with systemic therapy, doublet such as ADT + ARI, or triplet, throwing chemotherapy or MDT in with the doublet.

If you take the break, consider some type of fitness program, diet, exercise, managing stress. Why, there is some data that it can aid in T recovery and strengthening the immune system, thus potentially extending the holiday.

Depending on which agent you were on, your baseline T, and age, it may time some time for your T to recover to where you feel "better." In both my cases, it was three months. Yours, as others have indicated, may be different.

Kevin

Thank you for the great response!

No problem, that's what this forum is for, share our experience and understanding!

Greetings. I attended a webinar, yesterday hosted by the Prostate Cancer Foundation on this very subject. They discussed all ADT, namely a host of new drugs in two categories, ones like Firmagon and others that surprises the receptor cells. The two doctors, a radiologist oncologist and surgeon both agreed, it seems to be standard protocol to take a break from ADT. The consensus was to monitor and restart if needed. Also that recovery can take as long as the ADT regime. And that some could have resistance to the adt and others could never see their testosterone ever return and may need replacement. They also agreed that any of the treatments are better than none and to mix drugs. Also that the cancer isn’t gone just retarded and once on any form of ADT, that one will probably be on them again. There was also a discussion on side effects, more than I’ve heard before, the same outcomes. Not exactly what I was told at onset of treatment. I received, two years ago, two Firmigon and one Eligard with Proton radiation. I’m still feeling the effects and my testosterone is still low. I was stage 1, intermediate Gleason 4+3/7. To date my psa is at .29 and the Docs are happy, myself I’m indifferent. Always been skeptical and the webinar only confirmed my doubts.
Go to the PCF website and check their webinars, it’s supposed to be posted there. The news, while good is still a rough road to travel.
Stay strong my Brothers

I was disappointed that they didn’t mention that people who were on Orgovyx recovered their testosterone a lot quicker than other ADT drugs.

I've been on a break for 3 and 1/2 years. My last PSA (after minor ups) is now down to 0.07. I take Turkey Tail mushroom tea daily which can kill prostate cancer stem cells. I started with a PSA of 54, local metastasis in the pelvic cavity, and a Gleason of 8.

What treatment did you have?

42 sessions of IMRT ending in March 2021. (no surgery) I had one year of various ADT injections and oral meds (Orgovyx). I could not have Space OAR due to the location of one of the suspect metastasis. My urologist tells me he is surprised that I am doing as well as I am!

My husband has had vacations on and off for over 2 years. He started on a 6 month shot of Lupron along with Xtandi. He is now on Orgovyx and Xtandi. After 6 months his PSA was under 2.0 - he was off all drugs. Every 6 weeks he gets a blood draw - under 2,0 off meds until PSA goes over 2.0 then back on meds. So far so good.