Optimal Duration of Hormone Therapy

@heavyphil Yes, doublet therapy (adding an ARSI) significantly postposes castrate-resistance.

I don't quite get the "longer-term ADT leads to castrate resistance" fear.

If I had two fires in my house, a big one blazing away (castrate-sensitive cancer) and a little one smouldering somewhere I couldn't get to (a few cells that have started to develop castrate-resistance), I wouldn't tell firefighters to let the big fire burn the house down now to prevent the little one from possibly spreading in a few years. 😕

@northoftheborder There have been many posts during my time here, claiming - or at least suggesting - that the longer the duration of ADT, the greater the chance that the cells will become castrate resistant.
But @jeffmarc posted a communication just last week I believe, in which Dr. Wasserug said that his research shows that the earlier you are on ADT, the more successful you will be in avoiding castrate resistance.
It seems that the more PCa cells are allowed to proliferate, the more some can mutate into the resistant form.
Jeff, if you are seeing this post maybe you can chime in and straighten out the mess of an explanation I am trying to give?
I tried searching for that thread but was unsuccessful. Thanks!
Phil

@northoftheborder There have been many posts during my time here, claiming - or at least suggesting - that the longer the duration of ADT, the greater the chance that the cells will become castrate resistant.
But @jeffmarc posted a communication just last week I believe, in which Dr. Wasserug said that his research shows that the earlier you are on ADT, the more successful you will be in avoiding castrate resistance.
It seems that the more PCa cells are allowed to proliferate, the more some can mutate into the resistant form.
Jeff, if you are seeing this post maybe you can chime in and straighten out the mess of an explanation I am trying to give?
I tried searching for that thread but was unsuccessful. Thanks!
Phil

@robertov PC seems so personal: I had no palpable lump, PSA 6.x, Gleason 7 but PSMA PET showed lesions in prostate and adjacent lymph nodes. My treatment includes 44 IMRT treatments and 18 months on Orgovyx. @jeffmarc and I have had such extremely different outcomes from treatment: he continues to endure ADT like an athlete and I have been through all the known side effects. I was pre-diabetic (glucose 111) but lost 40 pounds during Covid, pre-diagnosis making all my indicators "normal". Unfortunately, since diagnosis, I've gained back 30 and am pre-diabetic again, and diabetes and stroke are my major fears. I think it's providential that I lost weight earlier. Had I gained 30 with no prior loss, I would definitely be diabetic. ADT has my Testosterone < 10, and life is so different. I had an hour of physical therapy yesterday followed by 2-3 hours of yard work, and I am still "crashed" today. The video doesn't apply to me, but other studies have shown that 18 months ADT is typically as effective as 24 or even 36, so we'll see! I am scheduled to complete ADT at the end of June and am anxious to see whether and how much testosterone returns afterward.

Hi @jime51, I know, Jeff is a model to us all. You made a power move to lose those 40 lbs. That is a major accomplishment and kudos to you. I am not sure if the results apply to you. But I think it is still worth reading and then discussing with your oncologist what the best duration is for you. I’m not convinced there isn’t something in the study that pertains to you.

I was never a ‘gym’ guy. But I rode my bicycle and swam for my exercise. The swimming would definitely help you as it helped me.

I didn’t have the strength in me to keep my exercise routine going and the effects accumulated until I really felt awful. Since I fit the pattern and I was taking my grandkids traveling, I decided to end the ADT as I was past the optimum efficacy according to the study. That does not mean I am cured. I will have to walk thru that journey yet.

@robertov Thanks! I hate walking past my bike hanging from the garage ceiling and hope to be back on it. I was three months past left knee replacement two years ago when I test rode an elliptical bike at the suggestion of my PT. I lost my balance, had a perfect fall on a concrete walk, and broke my hip. The hip replacement went well but somehow I lost balance on that side. I'm practicing mounting my stationary bike from the right side with the intent to do the same on my road bike. I'm concerned enough about falls that I am naturally hesitant. I have 60-90 min. weekday exercise plans that hopefully will help me avoid the typical muscle loss while on ADT. Just 3-1/2 more months....

Hi @jime51, I know, Jeff is a model to us all. You made a power move to lose those 40 lbs. That is a major accomplishment and kudos to you. I am not sure if the results apply to you. But I think it is still worth reading and then discussing with your oncologist what the best duration is for you. I’m not convinced there isn’t something in the study that pertains to you.

I was never a ‘gym’ guy. But I rode my bicycle and swam for my exercise. The swimming would definitely help you as it helped me.

I didn’t have the strength in me to keep my exercise routine going and the effects accumulated until I really felt awful. Since I fit the pattern and I was taking my grandkids traveling, I decided to end the ADT as I was past the optimum efficacy according to the study. That does not mean I am cured. I will have to walk thru that journey yet.

@jime51

Have you had a DEXA scan to see how well your bones are doing?. Breaking a hip like that seems to have been a little bit too easy. If you get a DEXA scan, it gives you a percentage chance of your breaking a hip? Being on ADT really messes that up but I don’t think you’ve been on ADT long enough to really have serious bone loss due to it.

I know in my case four years after I started taking ADT my chance of a hip fracture was 2.9% according to a DEXA scan. I’m having another one in the next six months. I’m really interested in seeing what’s going on..

I have fallen a few times in the last couple of years, but have never broken anything. Had really sore muscles for three or four weeks in a couple of cases, but nothing broke, And they were all falls on hard surfaces. One time it was right on my hip. I have been taking bone strengtheners for the last seven years, Really an important thing when it comes to being on ADT for a long time.

@heavyphil
What you are saying is what Richard Wassersug Has said repeatedly. If you have your cancer under control, then the cells don’t grow into large groups. When they do get into large groups, they can be affected by cosmic rays, which can convert them to castrate resistant cells.

So essentially if you could be on ADT and or an ARPI continuously, And it keeps your cancer undetectable, You are less likely to become castrate resistant.

In his own case, he has been on estradiol for 22 years and has never become castrate resistant because it has kept his cancer from growing.
https://connect.mayoclinic.org/discussion/a-note-from-richard-wassersug-phd-about-the-use-of-estradiol-over-adt/