When to resume intermittent hormone therapy?

Posted by bluegill @bluegill, Feb 28 4:39pm

How do I know when I should re-start ADT? My urologist doesn't seem to be sure. Here's an interesting recent video on the subject, but this doctor is also very vague. He says ADT should be resumed "at a certain threshold" that could be "around 2 to 5."

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Thank you for sharing this video.i am currently on a 7 month holiday from Lupron and Casadex after 24 months of continuous treatment.
I wonder too what the playbook will be for me if my psa begins to rise and I experience biochemical recurrence.
Science is evolving all the time … a good video that provides useful information on your options….if you are on Lupron…WATCH THE VIDEO……

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Xlnt video by a well-respected doctor & institution.

And it's a new video -- released on youtube in the last few days -- so I expect the facts & opinions are based on the most recent info.

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Very informative video. I am in my 7th month of an 18 month regimen, so to be determined!

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I am not sure you'll find a definitive answer.

You can read through the NCCN guidelines.

Here's an article, - https://www.dovepress.com/evolution-of-androgen-deprivation-therapy-adt-and-its-new-emerging-mod-peer-reviewed-fulltext-article-RRU

Chapter 4 discusses early versus delayed ADT.
Chapter 5 talk about intermittent versus continuous.

Part of your answer may lay in your clinical history. In my case, an aggressive PCa so I have tighter criteria for resuming ADT. For me, that is three consecutive increases spaced three months apart, PSA between .5-1.0 which is where I image, then, based on clinical history and data from the scan, decide on treatment. As you can see from my attached clinical history, that criteria was met last March, we did a Plarify scan, showed a single PLN, we did SBRT and am a month away from completing my 12 months of Orgovyx which we'll stop on 4 April if my labs on 2 April stay the same, PSA undetectable, T at castrate level.

I have seen some published papers which seemed to indicate you can delay ADT until the onset of symptoms and that could be up to 8 years. That would not be me but someone with a "favorable" risk category, clinical data such as slow PSADT, PSAV, older...maybe?

Kevin

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Wow…….there’s a lot to consider here on a case by case basis including current overall status, past results and the monitoring of all negative results etc. As you know, Prostate Cancer is the thread that connects us all. However, there are so many variables, outcomes and results vs. expectations that it’s far too easy to over generalize without intending to do so. All of us just wants to assist one another in any way we can while keeping the information accurate and accountable. Speaking for myself any my own experience, I had my RALP performed on 10/25/22. I had been in “TRT” for about 13 years prior to my initial PC diagnosis. I discontinued “TRT” for a period of 5 months prior to and following my surgery. As I also suffer from debilitating symptoms of CHRONIC FATIGUE SYNDROME & FIBROMYALGIA for the past 13 years, it was imperative that I resume my “TRT” ASAP in order to regain some kind of quality of life or ability minimally function. Thankfully, 5 months following my RALP
I resumed my “TRT!” Within one month, I was starting to feel normal again and able to function as expected. Every patient is different in addition to their needs and expectations following their initial and ongoing cancer treatments.
Thankfully, my PSA was < 0.014, (undetectable), the day following my surgery and has remained exactly the same since then. As with all patients and therapies, there’s no one protocol that’s the best and most effective for everybody. All we can do is remain vigilant and make sure we keep our doctors up to date and notified regarding any measurable changes taking place through our own observations.
Best wishes always,
Phil

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Thanks for all the replies. My PSA is steadily rising, but still low (about 0.2), so I have some time to try to educate myself.

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