When to stop hormone therapy?

So, here I am, two years after the start of treatment. It began with Firmagon injections every 28 days, then 24 external beam treatments, then HDR Brachy therapy. Details of my diagnosis are in my signature section.

My relatively young radiation oncologist says the latest study claims there is almost no benefit to continuing hormone therapy after two years. My much older urologist says the evidence is inconclusive - some evidence supports two years, some three ... no studies are available for longer than that.

I detest what this therapy has done to me ... but going for one more year is not impossible. The other treatments had no detectable side effects, thankfully (unless the occasional flashback to the grip n' rip to end the HDR Brachy counts).

As far as I can tell, any choice I might make is basically arbitrary. There is no way to know which is better.

Am I wrong? Is there some objective way to decide?

Thanks for reading this, and I hope you are doing well!

Mark

My original uro said probably three years, my RO said one year would be okay. So I could have stopped with the second six month shot that I got just before starting ART.

Both docs were sixty-ish, but recent research I had read here and elsewhere online showed that 18 months was just as good as two or three years.

But now here I am one year after my final six month shot and my testosterone is still only eleven. My current uro says it can take 18 months to kick in. So there's a good chance that if you stop now, your body could still have another year of hormone suppression.

I realize that having only primary radiation makes your PSA a not-so-reliable indication of progression, but with residual ADT you/we really have no idea whether the treatments have done their job until after everything wears off. I've been telling people that I am NED until 2020, rather than using the word remission.

Wow wished I had a magic crystal ball cause I think most of us guys on ADT and the guys that are contemplating ADT have this question how long and do I need to start. I will only speak from my experience my team at Mayo told me 2 yrs and when I asked about 18 months they kinda told me in a nice way that if I stopped at 18 months well maybe I should look for a different facility, They have had very good results with 2 yr treatments and that's what they are sticking with, so I agreed after all they are the experts and have a history to back up 2 yr treatment. I am looking forward to my last one in May hopefully the last one for me. The side effects for me haven't been very nice,

Larry

I did three due to my high risk. At the time that was the norm from the BOLLA study. A few years ago another study showed 18 months effective for all but high risk. That you have been on two years I would be comfortable stopping based on your dx. Remember there is enough residual drug to suppress your T for about a year after stopping. Stop now and you will effectively have about three years of ADT effectiveness.

My uneducated gut feeling is that 2vyears is probably fine, since it will take time before your T rises. Also, I’m not sure if it’s a valid thought, but I’d rather not use another year before becoming castrate resistant, in other words, save the bullets for when you need them.

Unfortunately, so much of treatment decisions is, as you said , “arbitrary” in this disease. There’s a lot we know, but so much that we still don’t know.

P.S. since it’s so arbitrary, maybe you should be considering quality of life in your decision making process as well. You deserve a break.

I don't know how good this 2018 study is, but I'm passing it on. Maybe others who have expertise in evaluating studies can comment. Also, the men didn't have the exact treatment you've had.

https://www.practiceupdate.com/journalscan/48238/67/11?elsca1=emc_enews_weekinreview&elsca2=email&elsca3=practiceupdate_advancedprostatecancer&elsca4=advancedprostatecancer&elsca5=newsletter&rid=MzQzMzY2NTY4OTM0S0&lid=10332481

TAKE-HOME MESSAGE
• This trial evaluated outcomes of radiotherapy (RT) combined with 36 vs 18 months of androgen-deprivation therapy (ADT) in men with localized high-risk prostate cancer. A total of 630 patients were randomized, 310 to pelvic and prostate RT combined with 36 months (long arm) of ADT and 320 to the same RT with 18 months (short arm) of ADT. The 5-year overall survival rates were 91% for the long-arm group and 86% for short-arm group, which were not statistically different. In quality-of-life analysis, there was a significant difference favoring the short-arm group.
• There does not appear to be a difference in survival between receiving 18 months of ADT and 36 months of ADT, with those receiving 18 months experiencing a better quality of life. Short-term ADT appears to be a legitimate option in the management of men with high-risk prostate cancer undergoing radiation.

tough call. i'd split the difference and go 2.5. whatever you choose I wish the very best for you!

Need to emphasize that this patient (IdeaSave) has been diagnosed as stage T3c. Almost all of the comments so far apply to less serious cases. In fact, the (2018) Nabid et al study mentioned by spouse 21 really doesn't apply because it had patients with localized (!) prostate cancer.
Considering this issue, I must conclude, unfortunately, that a longer course of ADT should be considered.

Good point, Rob. My initial diagnosis was T3c, but a couple of years ago they decided to consolidate the Dx into a and b rather than a,b and c.

I convey my little cancer as stage 3 & 7/8 nowadays.

RobLee said...

Just to point out that both Trailguy and myself have SVI, which is the highest stage of stage 3 PCa. The OP states that as of his biopsy in Jan 2017 he was stage "T3c"... I don't know where or when the stage 3c was used or when it came into existence or went out of use, but AFAIK SVI is staged as T3b.

Yes, I should have been more careful in my comment. I just wanted to emphasize though that T3c is, IMHO, quite a bit more serious than T2b cases and that studies on patients with confined prostate cancer may not apply.
I also agree that T3c is not used anymore for staging and that such cases are now classified as T3b. More about 'staging':
https://prostatecancerinfolink.net/treatment/staging-grading/clinical-staging/

PS: Three years of ADT in the following study:
https://www.ncbi.nlm.nih.gov/pubmed/28905446

Post Edited (Sr Sailor) : 3/4/2019 5:48:27 PM (GMT-7)

I’m assuming that everyone on this thread has localized PC? I had bone and lymph Mets at dx and though they’ve been virtually eliminated after chemo lupron zytega, I’ve been told I’ll be on ADT until it no longer works. None of my 3 docs have ever said anything about an end to adt.

Thanks RobLee. I’m blessed to have had great success thus far with my treatments. Everything has worked to eliminate virtually all mets for now. Just opened my seventh bottle of zytega. With a small spot left on my hip, I’m doing radiation to zap that. 7 sessions down, three to go. Then another scan this fall. PSAs been 0.4 for 4 months, and though we’d hoped it would be even lower, it’s the lowest it’s ever been, so I’m feeling mighty blessed. Thanks to you and all the bros for your continued support. Steve