Optimal Duration of Hormone Therapy

I'm in the opposite situation. For metastatic prostate cancer, the current expectation is that we're ADT "lifers."

Maybe that didn't matter up to just a few years ago, when life expectancy for metastatic prostate cancer was at best 3–5 years after diagnosis, but now that new treatments like doublet or triplet therapy, MDT, etc have many of us living far longer (possibly *decades* longer), we suddenly have to take a new look at the risks of long-term ADT.

I'm closely monitoring the LIBERTAS trial, which is reevaluating whether ADT holidays might also work for mCSPC now that we have doublet therapy (which didn't exist back in 2013, when the PR.7 and SWOG findings came out). The first survival and progression results are due out this fall. 🤞

You could take that risk of dying from something else to mean that ADT for a long period of time stops the prostate cancer so that somebody can get old and die from something else.

That seems to be what’s happening for me, Eight years on ADT, I get monthly blood tests and they are just fine. I’ve had surgery twice where they’ve had to put me under after 74 and I haven’t kicked the bucket yet. I check my blood pressure almost every day and it’s just fine, Maybe a little lower than normal.

I’m 78 and I’ve been undetectable for 28 months after four reoccurrences in the last 16 years. I can probably out run and out exercise most 78-year-olds even though I’ve been on ADT for so long. I can run a mile without stopping and without any heart issues and Not even breathing hard.

I guess time will tell, but it’s more likely the drugs will fail than I will die from them.

@oldgreenpaint Thank you, the summary was good enough. You're right that this study supports extending ADT past 12 months if you have localised prostate cancer classified as NCCN "very high risk" and treated with radiation.

Highlights:

- this was a meta-analysis (reviewing existing patient data), so they couldn't set ground rules, interview patients, ensure consistent approaches, etc.; it's much less reliable than a clinical trial, but also far less expensive, and still helpful.

- it limited to localised prostate-cancer cases (as you mentioned), treated with radiation

- the median age of patients whose case files were reviewed was 70

- the risk from ADT side effects over time was linear, e.g. 2× as high after 2 years as it was after 1 year

- the benefit from ADT was non-linear, e.g. less than 2× as high after 2 years as it was after 1 year

The estimated cross-over points (where ADT risks outweighed benefits) — and thus, optimal ADT treatment lengths — for localised PCa after radiation were as follow, based on the cancer's risk factors:

1 intermediate risk factor: 0 months

2 or more intermediate risk factors: 6 months

NCCN high risk: 12 months

NCCN very high risk: undefined (i.e. no point was found where ADT risks started to outweigh the benefits)

Note: the specific benefit measure was the chance of preventing a distant metastasis within the next 10 years.

Cheers!

I'm in the opposite situation. For metastatic prostate cancer, the current expectation is that we're ADT "lifers."

Maybe that didn't matter up to just a few years ago, when life expectancy for metastatic prostate cancer was at best 3–5 years after diagnosis, but now that new treatments like doublet or triplet therapy, MDT, etc have many of us living far longer (possibly *decades* longer), we suddenly have to take a new look at the risks of long-term ADT.

I'm closely monitoring the LIBERTAS trial, which is reevaluating whether ADT holidays might also work for mCSPC now that we have doublet therapy (which didn't exist back in 2013, when the PR.7 and SWOG findings came out). The first survival and progression results are due out this fall. 🤞

This adds more evidence to those trials. I should also clarify that this is *just* determining the appropriate time of efficacy from ADT under certain circumstances. That does NOT mean that I am cured. I understand this is the beginning of the journey, not the end.

I was literally on the verge of ending ADT and it hit me bigtime. I think for others in prostate confined cancer and wtih none or some certain defined risk factors (no palpable prostate lump, psa < 10,, no seminal vesicle invasion) that now can re-exame what they want to do. As the video says, you can bring the study to your oncologist and discuss it.

@jeffmarc what’s your height and weight old timer. ? I m curious. You remember me I m sure. Still < .01 over 2 years with mushrooms as my med.

@northoftheborder

Thank you sir for the copy paste. Since I am a newbie here, I was not sure that I should have done so, so did not. Are there any ground rules for this forum? I hit the high risk mark with 3 out of 15 core at G8. I had a psa of 6, no palpable lump(lesion was 10mm in front part, so really would prob never have been detected with dre) and in first consult with oncologist, he said ADT from 6-18 months. After doing my studies even before this JAMA study was published, wife and I talked through it and settled on stopping after 5 months of Firmagon. At that time I had psa undetectable using Ultrasensitive psa. I have cardiovascular disease, osteoporosis, and dementia in my mother’s side of family. I did and continue to do 6 hrs in fitness center each week.

@northoftheborder Well, if you couple that with Dr Weisserug’s (sp?) recent work on ADT, it seems now that being on ADT long term - or even being a lifer - does not lead to castrate resistance, one of the main reasons for these controversial holidays.
As @jeffmarc points out, being on ADT is hard work; there’s the lure of saying “screw it, I’m gonna die anyway so let’s eat, drink and be merry” and I totally get that mindset.
On the other hand, the disciplined approach of controlling blood pressure/diabetes with daily exercise and diet WILL keep you alive for many years.
It’s really a choice made early on and the results speak for themselves. My brief stint of 6 months on ADT gave me no ill effects because I watched what I ate religiously and I exercised like a madman. Could I do that for the rest of my life?? I don’t know if I could and I hope I never have to find out. Best,
Phil

@oldgreenpaint Thank you, the summary was good enough. You're right that this study supports extending ADT past 12 months if you have localised prostate cancer classified as NCCN "very high risk" and treated with radiation.

Highlights:

- this was a meta-analysis (reviewing existing patient data), so they couldn't set ground rules, interview patients, ensure consistent approaches, etc.; it's much less reliable than a clinical trial, but also far less expensive, and still helpful.

- it limited to localised prostate-cancer cases (as you mentioned), treated with radiation

- the median age of patients whose case files were reviewed was 70

- the risk from ADT side effects over time was linear, e.g. 2× as high after 2 years as it was after 1 year

- the benefit from ADT was non-linear, e.g. less than 2× as high after 2 years as it was after 1 year

The estimated cross-over points (where ADT risks outweighed benefits) — and thus, optimal ADT treatment lengths — for localised PCa after radiation were as follow, based on the cancer's risk factors:

1 intermediate risk factor: 0 months

2 or more intermediate risk factors: 6 months

NCCN high risk: 12 months

NCCN very high risk: undefined (i.e. no point was found where ADT risks started to outweigh the benefits)

Note: the specific benefit measure was the chance of preventing a distant metastasis within the next 10 years.

Cheers!