“Anyone take a Treatment Holiday? Intermittent use of ADT like Orgovy

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.

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.