question on Intermittent HT: when to stop?

Hi guys,

I'd like to ask a question about intermittent HT.

My father was diagnosed with PCa back in 2000. Following RT, the cancer went into remission with PSA <.1 for most of the next decade. Last year (he's 70 now) it came back, reaching a PSA of 5.8 in January. Bone and CT scans showed 1 possible lymph node involvement and no bone mets.

His urologist recommended HT and he got his first shot of Trelstar along with Casodex. After 3 months his PSA showed 0.1. He got his second shot last month. 4 months into HT he has minimal side effects, hot flashes, but nothing serious.

Now, the urologist wants to stop the shots after six monts if his PSA is still 0.1 or less and nothing shows on scans. His oncologist is recommending going to intermittent after 9 months.

We're confused because what we've read on various forums shows that 6 months is too short an "ON" period, many seem to be taking the shots for 12 months before stopping.
9 months seems closer to the study published by the American Oncological Society report today (was linked in a previous post today).

What is the experience with intermittent therapy for people who are going through it? We know there is no set answer and it depends on many variables, but we're just trying to get a sense of what other people have done.

Is it usual to keep taking the Casodex with the Trelstar, or should we discontinue it after the flare-up period is done? The urologist says we should stop the Casodex, the oncologist says we need to take both.

I just stopped HT after being on ADT3 for 12 months. When I asked my Dr why 12 months his response was that HT will kill all the PCa cells that it is going to kill in 9 months. The additional 3 months is just to make sure. I know that there are a lot of opinions on this topic, but I haven't heard of going on a HT vacation after a period of HT of less than one year.

I am entering that realm as I will be one year on Eligard and Jalyn in October with my next PSA test in July. My uro is suggesting that I be on ADT for a longer period (maybe two years) due to my dx statistics based on studies from the Southwest Oncology Group. My oncologist is suggesting 12-18 months on ADT suggesting more of an intermittent approach. This summer we will get more specific about it as October will be the time for another Eligard shot.

As I recollect, BB_fan's oncologist is Snuffy Meyers. Over the years he has gone from using HT longer term for two or three years to now basically one year (from what I read in his books and newsletter) for a much shorter intermittent approach. In his book he suggests continued use of Proscar or Avodart when the LHRH drugs (Lupron, Trelstar, Eligard) have been stopped.

There are no clear cut rules on this and it appears to me that the balance is between maximizing HT effectiveness, minimizing or deferring potential HT refractory, and minimizing the negative side effects of HT. The goal is to reduce and then stabilize PSA over a long period of time while inflicting as little damage aas possible. I am sure that once I go off the HT I will probably get PSA tests more frequently than quarterly as I don't want to risk getting behind a recurrance.

BB-fan, does Meyers have you on Avodart/Proscar or Jalyn?

Arthur,welcome to HW to both you and your dad. Can't help you on your questions, not on HT, but looks like you are getting some good imput. Hope your dad continues to do well.

David in SC

Thanks Purgatory, we're getting amazing advice for which we are grateful! I'm so glad I found the forum, because he would have never done it himself - doesn't spend much time with computers.

@Fairwind, my father's original Gleason score was 3+3, and then the second biopsy revised it to 3+4.

He's currently taking Casodex along with Trelstar. The oncologist is suggesting he stops the Casodex after the flare-up on his shot in August. In your experiences (except BB_Fan who is on ADT3), are you usually doing combined or mono therapy? Is Casodex the most obvious choice in such combined therapy?
I remember reading that Casodex at some point begins to actually fuel PCa cells.

so much to learn...

Thanks again.

@ralfinaz,

It took about 10 years to go from .1 (post RT) to 5.8. However, I believe it was last September or so that he was already hitting a PSA of 3. That is when his urologist raised the alarm that HT is on the horizon.

arthur:  The standard from Myers and Strum is to have a continuous undetectable PSA which they consider as 0.05 or less for 1 year at that point they suggest you can go off of the HT (but continuing Avodart or such)and monitior every 2 months.  I would guess that they adapt that 1year deal to the patient and the aggreiveness of the disease but I believe they use that as a starting point.

David