Is ADT ever used at reduced dosage to moderate side effects?

Posted by carbcounter @carbcounter, Dec 13 4:32pm

After radiation and PSA of zero, is ADT ever used at a reduced dosage so that side effects are moderated?

I mean, is it always applied as all or nothing?

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

Profile picture for jeff Marchi @jeffmarc

@carbcounter
Side effects are not even close to similar. Darolutamide works without having to reduce your testosterone. It’s suppresses it from affecting the prostate cancer. I’ve been on it for almost 3 years and I’ve noticed no side effects at all from it. It doesn’t pass the blood brain barrier like Orgovyx So you don’t get brain fog with it.

So you get to keep your testosterone and all the side effects that Orgovyx Causes, by almost eliminating your testosterone.

Jump to this post

@jeffmarc said, "Side effects are not even close to similar."

Just reporting what I read online. And if it blocks the receptor for one thing I could understand it blocking the receptors everywhere.

Are drugs like Darolutamide becoming preferable to the total blockers?

REPLY
Profile picture for carbcounter @carbcounter

@jeffmarc said, "Side effects are not even close to similar."

Just reporting what I read online. And if it blocks the receptor for one thing I could understand it blocking the receptors everywhere.

Are drugs like Darolutamide becoming preferable to the total blockers?

Jump to this post

@carbcounter
I know a number of people over at the ancan.org Advanced prostate cancer group that are only on Darolutamide and it’s working quite well for them. They love the fact that they feel no side effects from it.

I stopped taking ADT for eight months while I was on Darolutamide. My PSA stayed undetectable the whole time. My testosterone just hit 50 at the very end, My oncologist said I needed to go back on ADT because of that. When I was on Lupron and Zytiga, I cut the Zytiga pills back from four pills to three for 18 days. My PSA went from .2 to 1 in those 18 days. I Thought I might have a similar problem, stopping ADT while on Darolutamide but it didn’t happen.

REPLY

You might want to research the use of intermittent ADT. In my case I had 6 month dose given in a 2020 IMRT for recurrent lymph node prostate cancer. Haven't had any since and I'm now in a clinical trial that uses Enzalutamide (an ARPI) in which a 3 month dose dropped my PSA from 3.47 to undectable. Many Docs today are looking for ways to avoid or reduce the use of ADT in treatments, eg, using it intermittently. There's lots of info and studies on it.

You might check this out by Dr Sean P Collins who treated me at Georgetown Medstar


Also suggest Googling Dr Ravi Madan of the NCI who is running clinical trials trying to ascertain which patients can avoid or minimize ADT.
Good luck!!

REPLY
Profile picture for icorps @icorps

You might want to research the use of intermittent ADT. In my case I had 6 month dose given in a 2020 IMRT for recurrent lymph node prostate cancer. Haven't had any since and I'm now in a clinical trial that uses Enzalutamide (an ARPI) in which a 3 month dose dropped my PSA from 3.47 to undectable. Many Docs today are looking for ways to avoid or reduce the use of ADT in treatments, eg, using it intermittently. There's lots of info and studies on it.

You might check this out by Dr Sean P Collins who treated me at Georgetown Medstar


Also suggest Googling Dr Ravi Madan of the NCI who is running clinical trials trying to ascertain which patients can avoid or minimize ADT.
Good luck!!

Jump to this post

@icorps good video, thanks.
FWIW my friend and I are in Los Angeles.

My friend's specific set of physicians could probably be improved, by the sound of things, and certainly enough advertising by the major local health systems pop up the moment you start Googling the topics! But his current Medicare plan may be pretty limiting on that.

REPLY
Profile picture for jeff Marchi @jeffmarc

I really never see anybody saying their PSA is zero. Occasionally, you will see < .001 But that is not very common.

There isn’t really a way to reduce ADT dosage. The shots last a certain amount of time and give the same amount of the drug Each day. You could alternate Orgovyx, But you probably would end up with your testosterone down really low no matter what.

If your purposes is to not have your testosterone go down so low, you could get on a Lutamide Drug like Darolutamide Which can work even if testosterone is high.

After radiation, the PSA doesn’t go down immediately for a lot of people. And for most it doesn’t even go down to < .001 . Mine did go down to < .1 3.5 months after radiation, but I never had an ultra sensitive test to tell me if it was any lower. I do know that some people have taken up to three years before their PSA hit rock bottom after radiation.

ADT usage is based on other things. How high is the PSA?, Are there other aggressive features in the biopsy? Has there been a reoccurrence that requires radiation? Has the cancer spread beyond the prostate?

If someone had a very aggressive case of prostate cancer, they would generally put them on ADT before the PSA got down to the lowest level after radiation. Some people say no to ADT.

Jump to this post

@jeffmarc

I do not see how a PSA < 0.001 is even possible since men with no tentacles will be higher than < 0.1 since there are other organs that produce small amounts of testosterone.

REPLY
Profile picture for pesquallie @pesquallie

@jeffmarc

I do not see how a PSA < 0.001 is even possible since men with no tentacles will be higher than < 0.1 since there are other organs that produce small amounts of testosterone.

Jump to this post

Lupron takes care of the testicles.

Abiraterone / Zytiga takes care of the androgen sources. Hence "ANDROGEN Deprivation Therapy" (ADT)

REPLY
Profile picture for pesquallie @pesquallie

@jeffmarc

I do not see how a PSA < 0.001 is even possible since men with no tentacles will be higher than < 0.1 since there are other organs that produce small amounts of testosterone.

Jump to this post

@pesquallie
@readandlearn replied with exactly what I was going to make a point about.

I have heard from people that have < .001, Not sure if they were on Zytiga at the time, but it has been reported.

I’ve also heard from people that have been getting < .006 Which is the minimum some machines can reach.

REPLY
Profile picture for jeff Marchi @jeffmarc

@pesquallie
@readandlearn replied with exactly what I was going to make a point about.

I have heard from people that have < .001, Not sure if they were on Zytiga at the time, but it has been reported.

I’ve also heard from people that have been getting < .006 Which is the minimum some machines can reach.

Jump to this post

@jeffmarc
My friend told me zero. Maybe his doctor told him zero. Maybe it was really 0.01 or 0.1. At what point does it matter?

REPLY

I began with the full dose of 1000mg of Zytiga plus prednisone (5mg) and my liver enzymes went through the roof. My oncologist scaled it back to 750 mg plus prednisone (5mg) and my PSA has consistently been at 0.0. I also take Lipton every 6 months. I feel confident in his approach. Best of all to you on your journey…

REPLY
Profile picture for Sicetnon3 @sicernon3

I began with the full dose of 1000mg of Zytiga plus prednisone (5mg) and my liver enzymes went through the roof. My oncologist scaled it back to 750 mg plus prednisone (5mg) and my PSA has consistently been at 0.0. I also take Lipton every 6 months. I feel confident in his approach. Best of all to you on your journey…

Jump to this post

“Lipton” should be “Lupron”, but I also drink green tea with Kombucha…

REPLY
Please sign in or register to post a reply.