When to stop adt treatment

Starting PSA? Damage level? How many metastases were there and where?

When you stop Zytiga, make sure that you taper our prednisone off over at least two months. If you don’t do this, you will find that you have major fatigue in the afternoon because your cortisol does not return quickly enough and you need the prednisone to keep it at minimum level Until your body can start producing it fully again.

This was discussed a lot at the ancan.org Advanced prostate cancer online meeting a few months ago. Many people in the meeting had had major fatigue because they cut their Prednisone own too quickly. Why Taber it off over a month and still had major fatigue in the afternoon and had to sleep.

Just Yesterday during an Online meeting with CSC (Cancel Support community) One of the guys who had been on Zytiga for five years, had stopped his 10 mg of prednisone very quickly and Ended up in the hospital twice because of the low cortisol problem. Had to get injections of a steroid to restore his cortisol. He will now be taping it off Over a few months.

If your PSA has been undetectable for a year to 18 months, it definitely would make sense to stop ADT as well, to see how you react. Many people have been able to go for years without their PSA rising more than just a little bit. You can always go back on ADT. It does take 9 months or more before your testosterone gets up to a decent level and you start feeling better.

You are a Gleason eight even though one core showed a seven. I know people with Gleason 8 that have gone decades without having a reoccurrence.

"When to stop adt treatment..."

I would suggest that's the central question of prostate-cancer research in the 2020s

There are many trials and studies underway for different cancer situations (there's no one-size-fits-all, obviously). The main game-changer is the arrival of second-generation ARSIs — the lutamides — which *may* end up being sufficient on their own in some cases, even for stage-4 prostate cancer.

The other big change is the discovery that for high risk, early stage (non-metastatic) prostate cancer, it's often safe to take ADT holidays, and then resume treatment once PSA starts rising again.

what is your PSA now compared to what it was when you started ADT ? that is prob biggest question. If your PSA is and has remained less than .2, then you prob have a great argument for stopping now. DID you have a PET Scan ? what is your age ? etc.

You do have a say in the matter and after 24 months, I would say a break is in order.

@xahnegrey40

Is the extent of the lesion (number of metastases) not important?

Billfarm here. I am following a protocol from an md anderson study on intermitent adt. Bcr up to 2.8. Orgovux/zytiga for 20 months. Fatigue overwhelming. Off drugs since march 2025. Psa hovering near undectacle since. Testosterone 63 . Psa tests monthly petscans each 6 months. Someone on here can cite the exact md anderson study showing imtermittent adt not inferior to constant adt outcomes. Be well!

@denis76 well they say number of lymph nodes and bone metasis do matter. However, I also believe how well you respond to treatment is very important. How quickly your PSA went down and what is the NADIR point. Did you have PSMA PET scan ? What did it sow? and what are the time frames. Of course it all matters to a degree but each person's cancer is unique and how quickly it is suppressed ( dropping PSA number) etc is very strong prognostic indicator. AS Jeff Marchi is fond of saying, in most cases of advanced PC today, it is more of a chronic disease than fatal. When it flares up, lots of tools nowdays to suppress it back into remission.

Instead of concluding you are suffering from "all the usual problems with ADT" you might want to consider thinking you are suffering from "all the usual problems with the particular ADT drug you have been prescribed".

Dr. Paul Schellhammer, former president of AUA, has been using an alternate drug, trans-dermal estradiol, a.k.a. tE2, for 20 or so years. Estradiol has the same effect on testosterone as the more traditional drugs used for ADT.

Most of the "usual problems with ADT" are eliminated. The main drawback is that compared to the fairly low 3 - 15% rate of breast development or breast pain in patients on Lupron, up to 85% of patients experience these problems while on tE2. See the attached photo of Paul Wassersug displaying what happens to most of these 85%..

Schellhammer was interviewed by Mark Moyad of P.C.R.I. recently. Starting at minute 51:30 in this video the discussion turned to tE2. https://www.youtube.com/watch

UCSF is putting on a webinar August 20 moderated by Dr. Matthew Cooperberg "Transdermal estradiol vs traditional ADT – what’s best for you?" https://meded.ucsf.edu/events/6th-urotoday-journal-club-prostate-cancer-patients

The reason new attention is focused on tE2 is the publication of the groundbreaking study recently published in the New England Journal of Medicine comparing traditional ADT (Lupron, Orgovyx, Firmagon, etc.) with Transdermal Estradiol therapy. https://www.nejm.org/doi/full/10.1056/NEJMoa2511781

@climateguy
Dr. Paul Schellhammer Works with Richard Wassersug PhD (Wrote a book on ADT) On the estradiolinitiative.org. Richard Wassersug Has been on estradiol for over 22 year. Has not become cast resistance, and it is kept his cancer under control.

Definitely worth considering, The biggest problem is many doctors will not prescribe it.

Dr. Paul Schellhammer Comes to almost all of the ancan.org Weekly online advanced prostate cancer meetings. If someone has questions, they could show up at one of those meetings and ask him.

@denis76 well somewhat- it doctates what kind of treatment you recieve and for how long..Gleason score, metasis ( where and hom much) status and PSA. Then I would say your PSA after 6 mos and 1 yr are pertinent. AS I said, your response to therapy is a prognostic indicator of long term survival etc. Again everyone is different and landscape of PC world is littered with noteable long term survival of guys who started with many metasis and Gleason 9- 10.