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Posted 9/11/2018 3:59 PM (GMT 0)
I have a question about the effectiveness of ADT in
Terms of the length of time before it becomes resistance.
I have heard a doctor that says one of his patients were on
It for 17 years, I have read on other sites that some patients
Lasted 18 years on it. Some patients with similar stats like mine
Said pc is not life threatening for at least 15 years from now and
On the other side, I have heard a lot that adt lasts 2-3 years before
Resistance and then you go on another adt that might last for less time
If I can have a realistic answer to this, I would relax a bit and try to
Go on with my life instead of going crazy trying to find an answer to
This.
Thank all for your input, truly appreciated
Posted 9/11/2018 4:13 PM (GMT 0)
Ak123,

I too have read that ADT on average lasts about 2 1/2 years. Being that I have been on ADT for 4 of the last 5 years, I was really nervous about my situation.

But recently I've become a bit more philosophical about it all. I'll die when I die, I just want to leave my loved ones with good thoughts. Maybe they won't remember me for the crap that I put them all through.
I try to not stir crap up.
I really am trying to make my wife happy.

We also need to really start to understand that ADT is not the only treatment route, todays PCa treatments are remarkable in their scope and range. Most of us have a good while before we push up daisies, but until then I'm trying to appreciate all that God has given me.
Posted 9/11/2018 4:14 PM (GMT 0)
I don't know what the range of ADT effectiveness is, but I do know that it vary quite a bit. One of our members here Todd had advanced cancer and has been on it for many years...I'm guessing at least 10, although I'm not really sure.

Are you being seen by an MO now? Particularly one that specializes in prostate cancer? I would presume they'd be very helpful with this.
Posted 9/11/2018 4:18 PM (GMT 0)
From my observations of people here on HW, the range seems to be from a couple of years to 10 or more.

Too many variables for me to give a certain number.

I think it's simply a case of you take your best shot and ride the ride for as long as it lasts.

Andrew
Posted 9/11/2018 5:05 PM (GMT 0)
It's too bad that we can't get definitive answers to these kinds of questions. From my reading it seems that so much depends on the individual. Some get TX of any kind and it is good forever others the same stats and TX and it all goes south on them quickly.

It's hard to accept but, as was said in an earlier response, we will all die so make the most of the time we have.

Roger
Posted 9/11/2018 5:07 PM (GMT 0)
I believe everyone is different. And every tumor is different.
Something that in my mind seems to point to this, is that the Decipher genomic test produces a "Grid Report" and among the many datapoints it provides, is how responsive ones cancer would be to Hormone Therapy based on the genomics of their individual tumor. (THIS has not however, been fully validated yet for clinical use)
Posted 9/11/2018 5:34 PM (GMT 0)
AK123 I have a friend who is still on it after 5 years however he had to go to Chemo. So if you need it you go as long as you can. In the old book Invasion of the Prostate Snatchers, Ralph H. Blum may have made it 20 years on and of, I believe I read in the Key to Prostate Cancer in the chapter on TIP intermittent hormone therapy by Mark Scholz, MD. that he believes it could be used for intermediate PC but there hasn't been any interest in a clinical trial. There aren't a lot of Radiation Oncologists or Urologists that have advocated for this. We need some Medical Oncologist to start championing this. If folks know what they are doing via clinical trials it might end up helping a lot of men. I have been on Lupron 4 1/2 months prior to my 44 photon treatment which begins next week.


-68 yrs., PSA .012, 8.12.18, 1.42 June 18, 2018 (Lupron 5.21.18 & 8.15.18), 12.7 May 2018, 13.7 Jan. 2018, 2.1 May 2012. SpaceOar 9.6.18, testosterone >7, 8.15.18, Tot Mayo 19 ng .17 testosterone Free 6.18.18, Gleason 3+4=7 involving 15% of the right apex and 15% of the right mid, 3+3=6 prostate cancer involving 5% of the left base. Pathology interpretations by John Hopkins, UNM Cancer, and SF Path 3+4=7 or 4+3=7 MD Anderson Proton Center w/o %. T3 MRI 1.8 lesion left side 5P, Neg. Bone Scan. Prolaris test 3.5 consistent with intermediate and a PTEN test negative. Father PC age 78 RT & ADT now 93 yrs. Neurogenic bladder due to lumbar disk disease and recurrent bladder neck contracture with urinary retention man. 20 years doing catheterizations. TURP & scaring 2003, Finasteride 5 milligrams daily since 2002.----------------------------
Posted 9/11/2018 6:05 PM (GMT 0)
It looks like your prior surgery and radiation have failed to cure your cancer..about the ADT..At this point it's the most effective treatment...It's as simple as that...How long does it work ? That's impossible to say as the time length of the remission varies greatly..Anywhere form 2 years to 10 years and more...The fact that your are a G-7 and not a G-9 or 10 usually translates into better results, longer lasting results. Also, treatment protocols are changing all the time as better methods are developed..Today, a round of chemotherapy, Docetaxel, is sometimes started early where it seems to work better..

Many men go to great lengths to avoid going on ADT...Who can blame them ?? But no other treatment will extend your mortality as effectively as ADT will...And no one can tell you accurately exactly how long the life extension will be...Every case is different..Best of Luck to you..
Posted 9/11/2018 6:23 PM (GMT 0)
My understanding - though I can't cite a source - is that the mean time between biochemical recurrence and resistance to ADT is about 8 years - meaning about half will do worse and half will do better than
that. This isn't much to go on as individuals. My MO told me he is really pleased with the immediate and sharp drop in my PSA after I started Degeralex (Firmagon). He says this suggests to him it will probably be effective for a longer time than if my response had been slower or not as low and that he may be able to give me a longer "vacation" from shots once we finish the first round than I'd be able to have otherwise. But he could be wrong. You, I, and all of us would be much happier if this was all more predictable - like the time it takes a broken bone to heal. But unfortunately medical experience can only tell us what the odds are across a large population of patients with no guarantee that any one patient will be at, below, or above average.

One of the harder parts of living with cancer is learning to live with uncertainty. I was nearly T-boned at an intersection by a driver running a red light a couple of years ago. It struck me as kind of funny - in a perverse black humor way - that if I'd been a couple of seconds sooner into the intersection all of my worry about cancer over the years would have been wasted on worrying about the wrong thing. I can see that you are heading for ADT at some point in the future and have reason to be concerned. I'm sorry I can't offer any solid answer to your question.

Jim
Posted 9/11/2018 7:05 PM (GMT 0)
For my situation, systemic micro mets, my MO said the current average for remission using Lupron/Zytiga is four years, but he expects the average to improve as more men use the combination of the two drugs because it’s a fairly new modality to use them at the same time on the front end. A guy has to hope he falls on the favorable side of the curve. The MO suggested that PSA doubling time figures into the effectiveness of the drugs.

I am getting my first Lupron shot in one week. I am having a lot of anxiety, but it has been manageable. I am certain that if ADT wasn’t available I would sure be wishing something was. I have tried to reframe my anxiety into gratitude for the life extending treatment, but it’s not helping my anxiety much. It’s funny how foolish our minds can be.
Posted 9/11/2018 7:15 PM (GMT 0)
Thank you all for your sincerity in your answers. I do appreciate it.
any recommendations when I should start adt considering my PSADT is 5.5 months?
Posted 9/11/2018 7:37 PM (GMT 0)
AK - good luck to you. I don't remember what scans you may have had recently (sorry, Lupron brain) but I do remember your story. If you intend to have any more scans to localize any tumors or mets then you maybe could wait on the ADT so the tumors might grow large enough to be visible. I'm guessing that ADT will be just as effective at a PSA = 2 as it is with a PSA = 0.2

Mattamx... don't worry too much about your ADT (good luck by the way). When my RO said he was putting me on HT I had no idea what would be involved. Of course, I raced home and looked up as much as I could. This is sort of the "just hold your nose and jump in" approach. Not knowing what I was in for, I had no opportunity to say no... and also, zero chance of looking back someday and wishing I had't said no, if you catch my drift.
Posted 9/11/2018 8:18 PM (GMT 0)

Ak123 said...
On the other side, I have heard a lot that adt lasts 2-3 years before Resistance

I also read that very often. Usually this is stated in the introduction of a study report and no citation is provided. If there is a citation, you end up at another article just making this statement. I could not find a trial with statistics that would provide an answer to Ak123's question.

George
Posted 9/11/2018 8:18 PM (GMT 0)
Thanks RobLee,

Maybe it’s payback for having my pets neutered all these years. 🙂
Posted 9/11/2018 8:26 PM (GMT 0)
i am not sure if i should start a new thread or not but this leads me to the next
Question which relates to the first one which is the effectiveness of spot radiation
To one or two Mets before starting ADT. if we know we are going to have ADT
anyways, why all the trouble of trying to find a smal Mets site to treat it with
Spot radiation knowing that being on ADT will shrink that met and also prevent
A micro met from becoming visible on these sensitive pet scans?
When I met my MO and asked him, he didn’t seem too excited about oligometastatic
treatments
Posted 9/11/2018 8:37 PM (GMT 0)

Ak123 said...
any recommendations when I should start adt considering my PSADT is 5.5 months?


I'd leave it to the MO to offer a judgment of when to start ADT.

My own situation differs from yours in that I had a very long time between surgery and SRT and then another few years after SRT until my PSA reappeared. My PSA reappeared at .02 and took nearly two more years to reach .2, but after that doubling times accelerated. I switched my care from my RO at UMass Medical Center to an MO at Dana Farber in Jan 2017 soon after my PSA reached 0.2. He said then that given my history of slow progressions he'd be comfortable letting me go to somewhere between a PSA of 5 and 10 before starting treatment. As it turned out my doubling times kept dropping (getting shorter) over 2017 into 2018 -- from about 7 or 8 months at first to less than 3 months by last May when I started ADT with a PSA of over 6.

I'm in the control arm of a clinical trial. Because I was randomized into the control arm I'm getting the same treatment I'd be getting even if I wasn't in the trial - just Degeralex - though I have to stay on it for a full year before taking a break to stay within the trial's protocol. The trial's other arms are Degeralex plus Apalutamide in the second trial arm and Degeralex plus Apalutamide plus Zytiga in the third arm.

Jim
Posted 9/11/2018 8:37 PM (GMT 0)
With a G7 you can reasonably expect about 11 years. My neighbor made it 19.
Posted 9/11/2018 9:07 PM (GMT 0)
JohnT, 11 years to ADT resistance or in the case of your neighbor to 19
Or to death?
Posted 9/11/2018 11:14 PM (GMT 0)
I'm just going to post here since I have been on HT for over 7 years now. I think the 2-3 years you mentioned is a typical effective time for remission when a patient first starts HT. Mine was two years. Anyway you can see my story in my signature. Good luck!
Posted 9/11/2018 11:58 PM (GMT 0)
I would say 11 years before psa starts to skyrocket and other treatments are started. This happened to my neighbor at 14 years and death at 19 years.
I got the 11 years from Dr Scholz, a prostate oncologist, when I was first DXed and had a psa of 40. He suspected it was systemic and could control it for at least 11 years based on his experience with ADT.
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