ADT for 18 months vs 24 months

12/29/2021 diagnosis (G8 but upgraded to G9 on 2nd opinion from J Hopkin;, PSA ~ 9.5)
PMSA indicated spread to one LN and to seminal vessels
03/14/2022 started 44 PRT (ended 05/14/2022) at WashU/Siteman Cancer Ctr in St Louis
03/14/2022 started Eligard (6 mo) injections
06/xx/2022 started Zytiga in additional to Eligard
PSA and testosterone both undetectable on first blood work following PRT (but so is my libido -- zilch)
03/01/2023 Mild stroke and Zytiiga discontinued due to concern it may have had some bearing on the stroke

So I will have been on Eligard for 18 months by my next appt with the MO & CO
While I feel incredible better after discontinuing the Zytiga, I still feel like crap most of the time. The emotional roller coaster may be as much psychological as physiological. I was on Lexapro for a couple months which just made things worse (total apathy vs "depression").

My question concerns if there has been anything published concerning the advantage of being on ADT for 24 months vs 18 months? Obviously I do not want to compromise the success of the treatment, but the ADT is also a process of "slow kill". The "good" thing about Zytiga is that I slept A LOT (12+ hrs/day) and I lost weight. Loss of appetite and loss of hours awake to eat. Lost 25 lbs which I've now re-gained. I think the Lexapro caused compulsive eating (think of the munchies from pot).

It's scary to think of quitting the ADT and then having to wait to see if my testosterone rebounds (doubtful since I was on TRT for over 20 years prior to my dx) and watching the blood tests for a rise in PSA. I imagine it's like sitting on a time bomb. BUT if there is anything that shows 18 mo to be equally effective as 24 mo (on G8/G9), I think I'd like to end it and see if I improve.

Thanks!

IsIt Serious
I'll let you know next week. I get my 6th shot of Leuprolide (every 3 mths). That will bring me to 18 mths when done. I meet with my MSK RO to discuss if that will be it or if I get another 2 shots (24 mths). Initially, my RO said 24 mths when I started. When we spoke last, he changed his mind and felt that 18 mths will be enough given the test results. I'm leaning towards and hopeful that 18 mths will be it and I can hopefully get my body and mind back. I haven't had anything debilitating but some side effects have definitely been more bothersome than others. My RO was also concerned with lingering effects of ED if I stay on ADT for the full 24 mths. I also was able to speak with Dr Mulhall at MSK and he too felt like it would be better for me to get off ADT sooner than later. I'm like you still too young to be sexless and without sexual thoughts. The sidenafil pills don't work too well when you've got zero testosterone flowing through you.......
My next questions to my RO and this group will be:
1. How soon can I expect my T levels to bounce back?
2. How quickly can I build back my muscle mass?
3. Will the brain fog thing clear up as soon as the leuprolide leave the body?
4. As for the other side effects (e.g. minor muscle & joint aches, hot flashes/sweats, fatigue,...etc) when will they begin to dissipate?

Lots of things to look forward to getting better. I'm still optimistic that salvage radiation and ADT will have cured me. That is still the goal according to my surgeon and RO.

Thank you Google (for what it's worth):

https://www.pcf.org/news/18-month-adt-optimal-for-locally-advanced-prostate-cancer/

https://www.cancernetwork.com/view/reducing-adt-18-months-may-be-sufficient-high-risk-prostate-cancer

https://www.europeanurology.com/article/S0302-2838(18)30443-3/fulltext

IIS - You can find studies to back up almost any position one wants to take. One key item to look at are dates of studies as the ones you referenced appear to be from 2018. Here is reporting of a recent UCLA study:

https://www.insideprecisionmedicine.com/topics/oncology/optimal-high-risk-prostate-cancer-adt-duration-may-be-radiotherapy-dependent/

"Further analysis revealed that, to have optimal benefit for metastasis prevention, the ideal ADT durations were 26.3 months for patients receiving EBRT without brachytherapy and 12.0 months for those given EBRT with a brachytherapy boost.

The problem with all these studies is they have nothing to with you specifically and are general observations based on the limitations of study. Many are studies of studies. This is where study and discussion with your doctor about articles you find is about all one can do. At some point, you flip a coin and move on.

When I was treated, the best studies for high risk recommended 36 months, which is what I did. I was fine with it as I wanted to be as aggressive as possible. A few years later some studies reduced the durations for most, but still went to 24 months for the very high risk guys.

My attitude is you get but one shot at your initial treatment and if you can tough out a few more months, why not. It may or may not make any difference and you may never know, but psychologically you can clearly believe you gave it your all for a cure. On the other hand, stop at 18 months and if a few years from now you have to treat again you may be saying “if only I would have had one more shot, might have worked better”. Under-treatment regret.

If it were me, I would have another shot. But you have to be you and make your own decision. Do what makes you most comfortable and confident. Best wishes.

ok, so my RO (Dr Shasha - MSK) and I just discussed whether I should stay on Lupron (Leuprolide) for 24 mths or stop now at 18 mths. He said there's no curable benefit from staying on Lupron for an additional 6 mths, but there's actually more long term impact from the side effects the longer that I stay on it. His direct comment to me was, "We will assume that you are cured until we are proven otherwise. Focus on living your life and not worrying about the cancer and its treatment like you've been for the last 3.5 yrs." He believes the combination of the surgery, radiation and hormone treatment, that over time, it will prove out that I am cured (I mean, what else would you expect him to say....).
While I have not had any debilitating side effects they have been bothersome and lately more of a nuisance. For perspective, here's what I've experienced:
1. Hot Flashes/Sweats - I get them for 3-5 mins about 6-10 times a day
2. Fatigue/Restlessness - When I stop doing things my body wants to rest. I usually got to bed by 9:30-10pm if I'm not doing things. There are times when I'm exhausted but can't sleep because of the restlessness. Spent many a night going downstairs at 3 or 4 am to watch TV and try to fall back asleep. Previously I would be up until 11:30/midnight during the week and on weekends and still get up for work at 6 am.
3. Minor muscle and joint aches - When I stand up after sitting for longer than 15 mins, the first 10 steps are slightly painful like you've run a marathon or had a real long workout. The good news is that the aches go away after the first 10 steps.....just more of a nuisance than any thing else.
4. Brain Fog - I've noticed over the last few months that it has become a bit more difficult to concentrate and remained focused at work. My mind wanders and I forget minor details that I never did before.
5. Muscle Loss - I've always had a fairly toned body, certainly not like when I was younger, but had some definition. I've lifted weights and exercised each day since I started on Lupron. It's grown more and more difficult over the months. I've seen my chest, arms and legs atrophy and lose their muscle mass.
6. ED - Never had a problem with ED before surgery. I was using sildenafil post surgery with success but since the hormone treatment and radiation, I haven't had a sexual thought or urge. It's difficult to get an erection even with taking sildenafil every day. Oh, and my testicles have shrunk since they haven't been producing testosterone.

Long winded story, but I figured that I would give people interested my backstory (sorry to bore anyone). I also have an appointment with Dr Mulhall - MSK in September. I met with him last Sep shortly after I started Lupron and right after I finished radiation. He's interested to hear how I'm doing with the sexual side of things.

I'm looking forward to November when the Lupron should be out of my system and I will hopefully begin to see the side effects dissipate and my testosterone levels bounce back. At that point, I'll be interested to see what sexual feelings come back, whether I can get my body back into shape and whether the brain fog goes away.

Feel free to comment on anything written above. I'm curious what some of you think having been down a similar path before me.

I'm way late in responding.
After 24 months I went on ADT, PSA started going up after 12 months. After that we'd wait until PSA stabilized at my lowest for a couple tests, then go take another vacation. This lasted 8 years until became castrate resistant. I guess I took longer than average, 5 years was supposed to have been the avg to CR. Blessed I made it to 8.