HealingWell
Search Close Search
☰

When is Int. HT NOT an option

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 12/13/2016 7:28 PM (GMT 0)
Howdy. A general query.

Sometimes patients are told that they have to go on HT with no HT vacation in sight. Others have a shot at intermittant HT, like me.

What factors go into that decision?

Is it identifiable bone Mets to start with (ie: identified before starting HT)?

Mel
Posted 12/13/2016 7:42 PM (GMT 0)
When it doesn't work. HT is strong treatment and shouldn't be overdone. Many of the studies have tried to find the least amount that can be used with good effect. This is what intermittent does.

For some that are already advanced they just have so much cancer that a vacation doesn't work. Think about Todd as an example. You started your treatment with much less cancer and the intermittent use has managed it so far.

But until you become hormone refractory the intermittent may work and keep you in a state of remission. Here is hoping your vacation lasts a long time.
Posted 12/13/2016 8:08 PM (GMT 0)
JNF:

This time, it's not about me!

I am talking about INITIAL HT tx.

When I started HT, I was told by Dr. Lam that if I got lucky and the HT worked really really well, I could go on the great HT VACATION. I got lucky (sad definition of lucky in this PC World).

Yet, I thought I've heard of folks who, when they start on HT, are told to expect to have to be on it indefinitely with no vacation. I thought that if it works real well, one can take a vacation. So, which is it? Is the non-vacation situation due to a high initial G-score, or Mets, or both, or...??

In other words, when STARTING HT, under what circumstances is the possibility of a future HT vacation off the table.

Mel
Posted 12/13/2016 8:31 PM (GMT 0)
I observe that it those who are advanced metastatic at diagnosis That are relegated to continuous HT as long as it works.

The high risk, but less advanced like you and get to try the vacations. I have been on one for nearly three years now. If my PSA starts going up then I will go back on HT. Will have to wait until then to see if it is intermittent or continuous.
Posted 12/13/2016 9:04 PM (GMT 0)
This is a good question Compiler! I have wondered about this too. But with a rising PSA while on Lupron, IHT may never be an option for husband.
Posted 12/13/2016 9:08 PM (GMT 0)
I've had mets before HT, Gleason 9, and am on IHT.
Posted 12/13/2016 9:44 PM (GMT 0)
This is a good question. I remember hearing a presentation once in which there was some evidence that not only did IHT work better than continuous HT, but that it might have even worked better. (Better = a longer time.) I'm not fully sure if I remember that right, but if so it would seem that IHT would be the plan for most everyone.
Posted 12/13/2016 10:02 PM (GMT 0)
In Maha Hussain's landmark study, all patients in the study had to demonstrate an initial good response to HT and they were all M1. Continuous did better than intermittent, but not by a statistically significant amount. They could not rule out the possibility that intermittent might be inferior.

In the NCIC-CTG PR.7 RCT, all patients had a recurrence after initial radiation, but were not diagnosed with distant metastases. patients getting iADT and cADT had similar survival. A Finnish RCT that included both advanced and metastatic PC also showed no significant difference. A southern European RCT had similar findings.

I think there's pretty universal agreement that if the patient is symptomatic (i.e., pain), iADT is a poor choice.

This remains a judgment call. Among the factors assessed:
• presence, number and location of detectable distant mets
• symptoms
• response to ADT/ nadir PSA
• degree of castration resistance
• assessment of whether breaks improve QOL
• whether T levels come back during breaks
Posted 12/13/2016 10:10 PM (GMT 0)
Makes sense that someone with pain would not be a good candidate for IHT.
Posted 12/13/2016 10:39 PM (GMT 0)
IAD and CAD demonstrated similar efficacy, tolerability, and QoL in men with nonmetastatic PCa. The principal benefit of IAD compared with CAD is a potential cost reduction with comparable OS rates. There are no apparent QoL benefits.

according to

Intermittent Versus Continuous Androgen Deprivation Therapy in Patients with Relapsing or Locally Advanced Prostate Cancer: A Phase 3b Randomised Study
Posted 12/13/2016 10:53 PM (GMT 0)
Gemlin:

This is very weird.
First of all, being on IHT, I can tell you that there is an ENORMOUS difference in QOL in on vs off periods. The whole reason for IADT is to increase QOL.

I looked at the report (very quickly/superficially). Indeed, it does claim no difference in QOL based on some scale. But it also says "Nausea, vomiting, and appetite loss were the most distressing symptoms reported."

Huh? These are generally not major symptoms with HT.

So, something is askew

Mel
Posted 12/13/2016 11:19 PM (GMT 0)
I've been fortunate in that when I am on HT, it's not that bad. However, I prefer my testosterone to be normal and I enjoy the HT vacations.
✚ New Topic ✚ Reply