1. < Prostate Cancer

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

Posted by seer @seer, Nov 3, 2023

I wish there was more info. on 'drug holidays' or 'intermittent use of ADT', with or without concurrent or prior surgery or radiation; especially as may relate to ADT 'orally alone' emphasizing Quality of Life, which may be a consideration particularly in order (over 75) men. I see plenty of discussion about side effects (common between ADT regimens it seems, whether injections or pills, which have lower long QT heart risk); but I see nothing dedicated to 'Orgovyx alone without any other treatment; and then 'if' one stops; and restarts... meaning is there an 'end point' of the course'; and then a patient does nothing more.

Maybe I saw one study in Japan; but not U.S. .. Again no discussion on say an older guy (over 75) taking Orgovyx … as ADT alone… without surgery or radiation. IE: QOL concern given it seems longevity is about the same (statistics don't help much; as once someone hits 80, longevity won't vary much regardless of treatment). So I'm wondering if 'ADT alone.. mono therapy' is a wise course. Also, is there info. on after successful year of treatment with Orgovyx and then PSA pops up a bit (say from .1 to 3. ..) will another few months restarted treatment be sufficient, and then 'do nothing' beyond. Or just skip it after going through a year of Orgovyx with the usual side effects (hot flashes etc.. )

May not be what supports clinics; but wonder if it's a quite reasonable choice (for 'localized' PC, Gleason Score 8; not metastasized). I have conflicting views from doctors; one for 'radiation' despite pacemaker; another: 'just pause the Orgo. and restart'; to lastly another doc: 'you had a course of Orgo; let things stabilize; enjoy life and don't think about it".

I realize there's no perfect answer; would appreciate reflections on this topic…especially if you did Orgovyx alone and stop and restarted or not. Thanks! I appreciate Coleen's efforts to help this group! (Lurking so far; my first post here ever.)

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

ecurb | @ecurb | May 25 3:05pm
In reply to @glabelle "For those of you who have been on an initial round of ADT for 6, 12..." + (show)
@glabelle

For those of you who have been on an initial round of ADT for 6, 12 or 18 months (or whatever time period), and have then taken a break, how long were you able to stay off ADT before your PSA rose to the point where you had to resume ADT? I am Stage IV oligometastatic and my oncologist wants me to take a break from ADT after six months. Have also been through SBRT. Thank you in advance!

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One year vacation is nice, Hope I get that lucky. ADT side effects are no fun. On my 5 th month of no ADT- all is well so far.

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glabelle | @glabelle | May 25 4:42pm
In reply to @glabelle "For those of you who have been on an initial round of ADT for 6, 12..." + (show)
@glabelle

For those of you who have been on an initial round of ADT for 6, 12 or 18 months (or whatever time period), and have then taken a break, how long were you able to stay off ADT before your PSA rose to the point where you had to resume ADT? I am Stage IV oligometastatic and my oncologist wants me to take a break from ADT after six months. Have also been through SBRT. Thank you in advance!

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That’s great!

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web265 | @web265 | May 26 6:32am
In reply to @glabelle "For those of you who have been on an initial round of ADT for 6, 12..." + (show)
@glabelle

For those of you who have been on an initial round of ADT for 6, 12 or 18 months (or whatever time period), and have then taken a break, how long were you able to stay off ADT before your PSA rose to the point where you had to resume ADT? I am Stage IV oligometastatic and my oncologist wants me to take a break from ADT after six months. Have also been through SBRT. Thank you in advance!

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I was on Orgovyx for two full years, started with my salvage radiation treatment. For the last 18+ mos of that time my PSA was < 0.006, been on "holiday" for almost a year now (knocks wood) still < 0.006 at last blood test.
Best of Luck to you!

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1 reply
firespooks | @firespooks | May 26 7:14am
In reply to @jeffmarc "I know a lot of people that have done this and there is no one answer...." + (show)
@jeffmarc

I know a lot of people that have done this and there is no one answer. Has your PSA been below .1 For a long time? If that’s true, then taking a holiday can make a lot of sense.

I know a few people that have taken more than one holiday. A couple of them have ended up with a few metastasis after the second time, but it’s been manageable for them. Some people don’t have to come back for many years, others have their PSA rise too much within nine months to a year and then have to get back on ADT.

Because you were metastatic You could have your cancer come back, but if you worked with Doctor Scholz, seen at PCRI, He would just zap whatever came back and send you on your way. He feels that Zapping whatever comes up is the best solution. Check out the last hour and a half of the most recent PCR I conference on YouTube and hear him talk about it.

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How many radiation zaps do you typically need for a lesion ?

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1 reply
ecurb | @ecurb | May 26 9:20am
In reply to @web265 "I was on Orgovyx for two full years, started with my salvage radiation treatment. For the..." + (show)
@web265

I was on Orgovyx for two full years, started with my salvage radiation treatment. For the last 18+ mos of that time my PSA was < 0.006, been on "holiday" for almost a year now (knocks wood) still < 0.006 at last blood test.
Best of Luck to you!

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On Holiday- a treat from the Almighty!!!

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jeff Marchi | @jeffmarc | May 26 10:41am
In reply to @firespooks "How many radiation zaps do you typically need for a lesion ?" + (show)
@firespooks

How many radiation zaps do you typically need for a lesion ?

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They zapped me three times for a lesion on my L4 in the spine. They could’ve done it with one, but they wanted to use a little less radiation because of how it was wrapped around the L4.

So the number of zaps does vary, dependent on the lesion size and location.

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firespooks | @firespooks | May 26 12:29pm
In reply to @glabelle "For those of you who have been on an initial round of ADT for 6, 12..." + (show)
@glabelle

For those of you who have been on an initial round of ADT for 6, 12 or 18 months (or whatever time period), and have then taken a break, how long were you able to stay off ADT before your PSA rose to the point where you had to resume ADT? I am Stage IV oligometastatic and my oncologist wants me to take a break from ADT after six months. Have also been through SBRT. Thank you in advance!

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Good to know. Did your PSA drop after the radiation?

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billfarm | @billfarm | May 26 11:04pm
In reply to @jeffmarc "I know a lot of people that have done this and there is no one answer...." + (show)
@jeffmarc

I know a lot of people that have done this and there is no one answer. Has your PSA been below .1 For a long time? If that’s true, then taking a holiday can make a lot of sense.

I know a few people that have taken more than one holiday. A couple of them have ended up with a few metastasis after the second time, but it’s been manageable for them. Some people don’t have to come back for many years, others have their PSA rise too much within nine months to a year and then have to get back on ADT.

Because you were metastatic You could have your cancer come back, but if you worked with Doctor Scholz, seen at PCRI, He would just zap whatever came back and send you on your way. He feels that Zapping whatever comes up is the best solution. Check out the last hour and a half of the most recent PCR I conference on YouTube and hear him talk about it.

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23 months Oorgovyx/abi undetectable psa after 45 days. Taking holiday 2 months now had devised a plan to get pet scan if and when psa rose and identify and zap Mets if possible. I have been alone in this course of treatment. Glad to hear others have this thought also

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kujhawk1978 | @kujhawk1978 | May 27 6:59am
In reply to @glabelle "For those of you who have been on an initial round of ADT for 6, 12..." + (show)
@glabelle

For those of you who have been on an initial round of ADT for 6, 12 or 18 months (or whatever time period), and have then taken a break, how long were you able to stay off ADT before your PSA rose to the point where you had to resume ADT? I am Stage IV oligometastatic and my oncologist wants me to take a break from ADT after six months. Have also been through SBRT. Thank you in advance!

Jump to this post

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
REPLY
1 reply
glabelle | @glabelle | May 27 8:05am
In reply to @kujhawk1978 "Our experiences may not be yours, for example, my first ADT break after 18 months of..." + (show)
@kujhawk1978

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

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Thank you for the great response!

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