who is a good candidate for Intermittent ADT?

Generally speaking, if you’ve been undetectable, after being on Orgovyx for over a year, then stopping at may make sense, If you have a low Gleason score, below 8. If you’re above a seven then 24 months undetectable is usually the number of months that is the safest.

If you’ve got a number of metastasis, you should get them zapped before considering it.

Come to an Ancan.org meeting to get advice from people that have been helping people with prostate cancer for 15 years and really know what works best for stopping treatment.

The last research I read said that ADT holidays produced slightly better outcomes for non-metastatic prostate cancer, but worse outcomes for metastatic.

Of course, the devil is in the details: if you have serious comorbidities that are exacerbated by the ADT (e.g. heart disease), that might flip the needle. You need to talk to your oncology team about your specific situation.

For me, the concern is that my stage 4 castrate-sensitive prostate cancer might come back as castrate-resistant after a "holiday."

I was gleason 7, RALP then SRT with two years of ADT. PSA has been undectable for two years so I went off it for now.....we'll see!
(knocks wood, scratches a stay, turns three times) Movie reference ? Anyone?

I ll be in your shoes in two months, no more ADT, I m sorta worried that this may not work in the long run, but due to my age-76- testosterone return will be very very slow= PSA remains undetectable for ? years, this is like Gambling at the casino.

Yes, there's no default safe choice with prostate cancer, just different sets of risks to choose from.

If I were 76 with non-metastatic prostate cancer and low PSA, I think I'd opt for an ADT holiday as well. The health benefits in preserving bone and muscle density and heart health (as well as the reduced diabetes risk) may well outweigh any dangers from faster cancer progression.

Best of luck!

But it was in two pelvic lymph nodes too, did radiation get them- 28 x. I guess I ll find out and let ya know. Lol

Replying to myself....does this mean I'm talking to myself....

Forgot to mention, over the last six months, Total Testosterone went from 3 to 82.

I don't know that there is a definitive answer for that...

There have been some on my medical team during my 10+ years who have argued given my clinical history GS 8, GG 4, 18 months to BCR, PSADT and PSAV, I am not. Yet, I chose to.

My medical team and I have had clear criteria in doing so - PSA undetectable within the first three to six months, stays there throughout the duration of treatment, that when we come off treatment we actively monitor, labs and consults every three months (I see my oncologist in about 1-1/2 hours this morning) and criteria as to when to go back on - three or more consecutive increases in PSA, a PSA between .5-1.0 which triggers imaging with a PSMA PET and then decide based on both my historical clinical data and the most recent.

It has worked so far, but I am fortunate in that no bone or organ involvement nor castrate resistance. Those would be game changers.

For me, a study of one, my rationale and criteria for intermittent has been:

No bone or organ involvement
No castrate resistance
PSA decline when initiating treatment to undetectable within first 3-6 months, stays that way.
PSA stays undetectable throughout the duration of treatment
When coming off treatment, actively monitor and have decision criteria when to resume informed by clinical data.

I certainly feel better off treatment though honestly the side effects of treatment have been more annoying , not life changing and, in my mind, and those on my medical team, may be delaying or avoiding castrate resistance (so far...)

Keep in mind, a layman, not a medically trained, educated a licensed professional and the heterogeneity of this cancer.

Kevin

My husband does a 6 week PSA blood draw. If it's below 2.0 he's on vacation from Xtandi & Orgovyx above he's back on meds. He has done this for 1 1/2 years.

Yes, "non-mestastic" was probably too broad a brush. Let's say "non-metastatic or local spread". It's advanced prostate cancer with distant metastases where there's not evidence yet to support ADT holidays (as far as I know, and that could change tomorrow if a new study publishes its results).