Quick ADT Question

From my understanding, the longer you stay castrate-sensitive on ADT, the longer it's likely to last. One stat I saw (but don't remember where) suggested that if you made it 5 years castrate sensitive, you had only a 10% of developing castrate resistance in the next 5.

Take my unsourced stat for what it's worth (close to zero, unless someone finds the ref), but you're already halfway to 5 years and you're past the highest-risk zone for developing castrate resistance (18–24 months after starting ADT). No guarantees, but there's starting to be even more reason to hope.

And even if you do eventually develop castrate resistance, that's just the start of a lot of other good treatments, not an end.

Oh, and personally, I've been castrate-sensitive on ADT + Apalutamide for 3 years 8½ months. My PSA is < 0.01, and 5 years is starting to become visible on the horizon ... 🤞

I started Lupron in April 2017 and my PSA started rising, even though I was on it, in July 2019. That’s the definition of castrate resistant. At that point, my oncologist had me start Biclutamide. It kept my PSA from rising very quickly and in 15 months more I started on Zytiga. It kept my PSA bouncing around between .2 to .7 most of the time for 2.5 years. Stopped it because of the 3rd afib event. Had Metastasis in my spine zapped with 3 SBRT sessions. Went on Darolutamide and switched to Orgovyx. After 21 months on Darolutamide I have been undetectable for the last 19. I am a Gleason 4+3.

So it’s been six years since I became castrate resistant. I have been on ADT over 8 years. The only problems I have are the side effects from ADT. I have another drug I can take after Darolutamide, I have BRCA2 so I can use a PARP inhibitor. This all started in 2010 with an RP.

When will you become castrate resistant?? There’s no way to know, but it almost definitely will happen if you stay on the drugs long enough. There is a Study using apalutamide Along with ADT to see if that can extend the time to castrate resistance.

It is just another step in our prostate cancer journey. Fortunately, people can live decades with the treatments available now. There are new drugs all the time, we are all just waiting for the cure.

At one of the weekly advanced prostate cancer Ancan.org online meetings I went to a couple of months ago, one guy showed up who had started to have his PSA rise 30 years after surgery.. He was a Gleason nine.

Here’s a more technical answer. From Healthunlocked and Mayo Clinic

The duration of castration sensitivity varies widely. Some patients remain castrate sensitive for several years—sometimes 5 years or more—especially if they have less aggressive disease or respond well to treatment. In clinical studies and real-world experience, it is common for patients to remain castrate sensitive for 2–3 years, but many have exceeded this, with some reporting castrate sensitivity for up to 9 years or more

And to add to that, recent changes in preferred treatment for castrate-sensitive oligometastatic PCa, such as treating both the prostate and metastases with high "curative" doses of radiation — and adding an ARSI (like a -lutamide) at the beginning instead of waiting for castrate-resistance — have extended the period of castrate-sensitivity considerably for many patients (often for many years). The old numbers were based largely on treating advanced-cancer patients with ADT alone.

They told my husband to expect a year or 18 months on ADT before the PSA doubles (meaning even from 1 to 2 or from 3 to 6) because we were talking about Pluvicto already but in the US, my husband doesn't qualify yet and it's a very expensive drug, he would probably qualify in other countries maybe, because it's metastasized and high Gleason.....I don't know, we thought about going overseas for it, but it seems like a lot, my thought was if it would be effective yet if it's NOT castration resistant YET? would it be like giving antibiotics to a cold virus vs bacteria?
we'll see, time will tell.
We talked about it because my husband was against Chemo and Pluvicto just removed that requirement recently, but now he started Chemo, so it doesn't really matter I guess.

OMG, 30 years later???

I'm currently at about 8 months in on a 18 month plan with Eligard. My PSA is at .01 right now. The side effects of it are a bit crazy!! haha

I know this must be frustrating, But your husband probably made the best solution. If he’s got multiple metastasis all over chemo is a good option. He can always do Pluvicto if he needs further treatment.