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Is off-period possible in ADT3 when you had extensive bone metastases ?

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Posted 4/4/2010 1:12 PM (GMT 0)
End of June '09 I experienced pain in my left leg when I walked up a staircase. End of July my PSA was measured: 575 !.
Biopsy Sept 1: 3 out of 6 positive cores, Gleason 4+3. Bone scan revealed metastases everywhere.

Now I am on Zoladex + 150mg Casodex, so-called ADT2, and after 3 months my PSA was down to 0.3, and now it is <0.1, and I am feeling excellent. Little side-effects anymore.

My questions are: should I go for ADT3, that is add Proscar ?
And could I then, even with those extensive metastases, have an off-period, say after another 9 months on ADT3 ?
Here in the Netherlands ADT2 seems just being accepted, ADT1 had been the norm.
Posted 4/4/2010 1:20 PM (GMT 0)
Arno:  It might not be a bad idea to pick up Dr. Meyer's book about HT.  It really gives some good info on more advanced guys.  I believe in his book he suggests that if your PSA has dropped to less than 0.01 and stayed there for a year while on HT you can try a period with no HT.  As for the Proscar/Avodart, it is considered to be an integral part of the puzzle.  The proscar works to shut off the dihydrotestosterone which is much stronger than just the testosterone when dealing with prostate cancer.  Also I believe proscar has been shown to be a great support vehicle while trying an off period of HT.  I don't have the book in front of me right now so I'm typing from memory so I hope I didn't misrepresent anything, Tony and a few others will probably comment and have great insight.

Good luck

David

Posted 4/4/2010 3:11 PM (GMT 0)
Arno:
Your response to treatment has been little short of fantastic. Congratulations!!
And in such a relatively short time. This is a predictor for extended response. Now to your question: Many doctors would be reluctant to allow an off period in a patient such as yourself. The thinking would be that with widespread metastases the cancer could start growing anywhere in your body and your previous response cannot be guaranteed. These points are true. However, if your psa remains in remission as it is now, AND if the metastases resolve on a bone scan (or are at least significantly reduced in number and size) Then an off period can be considered. This off period should have close monitoring and regular testing, and scans if necessary. It should also include the Avodart or proscar treatment while off the heavier drugs. Perhaps other milder support drugs could also be included including vitamin D3, Celecoxib, and others.
As to the question about proscar/Avodart while on treatment, a test of DHT will identify if it is worth considering. If DHT is suppressed with your current two drugs, as I believe it to be, then there is no need for further drugs. In any case, despite all, your psa has been reduced to below the minimum level the test can read, so adding another drug will be impossible to assess using that technology. Your doctor(s) will likely argue that in such a case it is not relevant to the treatment plan.
Posted 4/4/2010 3:14 PM (GMT 0)
Arno, just wanted to welcome you to HW Prostate Cancer. Hopefully some of our advanced brothers will be able to answer all your direct questions. You are welcome here, and I hope you stick around to share your PC journey.

David in SC
Posted 4/4/2010 4:45 PM (GMT 0)
Most of the noted oncologists in the US subscribe to ADT3 and this is no coincidence. If you read Dr Strum there are a lot of things that must be monitored while you are on ADT to insure that you have total blockage. "A Primer on Prostate Cancer" By Dr Stephen Strum
There is no doubt that adding proscar to ADT and using it as maintenance during the off period will significantly prolong the off period.
JohnT
Posted 4/4/2010 6:29 PM (GMT 0)
The reason for avodart or proscar is that your body makes Dihydratestosterone (spelling?) it is atleast 10-30? times more potent than regular testostorone, and PCa would prefer that kind of feeding is the theory I was told, so by blocking that like in Leibowitz programs after ADT3 (13 mos.) and off, you stay on proscar or avodart (avodart is more potent vs. proscar)  used as your maintenance drug thus giving you a long sustaining period and slows PCa from progression time is the theory, not a cure.

If you fail these drugs you are on, consider looking at these: DES, emcyt, estradiol patches, ketoconazole as great second line hormone therapies, can be used as 1st line also, they can work against HRPCa (when the other stuff stops working), how long is always your next question??? You are already on Zometa for bone issues and that is expensive and looks helpful to mets situations. I had worse stats than yours, except for the Psa number yours was very high, I was at  46.6 (total urinary blockage e-room),   but had way worse on the other parameters(Gleasons found-7,8,9's- 2 sets) and 12/12 cores all PCa 75-95%, scans appeared clear which is no guarantee...I made it 8 yrs. so far and currently in very good condition, subject to change with this dragon.  My pathway is unique in protocols and probably not duplicated by anyone on this forum, I thank Dr. Strum for the book of enlightenment on PCa.  Check out a website for advanced PCa issues,  www.hrpca.org  is a suggestion.cool

Posted 4/5/2010 9:46 AM (GMT 0)

tarhoosier said...
Arno:
Your response to treatment has been little short of fantastic. Congratulations!!
And in such a relatively short time. This is a predictor for extended response. Now to your question: Many doctors would be reluctant to allow an off period in a patient such as yourself. The thinking would be that with widespread metastases the cancer could start growing anywhere in your body and your previous response cannot be guaranteed. These points are true. However, if your psa remains in remission as it is now, AND if the metastases resolve on a bone scan (or are at least significantly reduced in number and size) Then an off period can be considered.

Thank you very much for your response ! And for the cordial responses of the others I am grateful as well.
At my age you would expect another 20 years or so of life, and the devastating message of the diagnosis seems to be that 'years' have become 'months' now.

The fact is that the PSA of 575 has not been my first PSA measurement: March'06 I had a 4-yearly medical check at work, and for the first time they included a PSA measurement, evaluated at the nearby hospital. Their lab returned a value 3.6, and I was informed that only values above 4 were suspious and would require a biopsy. I was naive, and did not know anything about PCa then. Actually I had almost never seen our family doctor(s) for 40 years, not even having a cold.
Combining these two PSA's makes my PSA doubling time about 5.6 months, so if they had just suggested that I should have had another PSA measurement half a year later... I might have been in a curable stage.

But now, with this successful response on Hormone Blockade therapy, one starts hoping for more again.
Posted 4/5/2010 10:39 AM (GMT 0)
Welcome to the club Arno and thanks for your post and question. It looks like some of the guys have replied with excellent suggestions. I do think that your response to treatment thus far has been awesome. I personally was on ADT3 for two years and now I am only on Avodart. The break has been wonderful. Keep us posted as to how you are doing.





peace to you
dale
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