More ADT or shut it down?

If you were going to get another medical opinion I'd suggest an MO (someone like Dr. Lam in Marina del Rey). You want some one who specializes in the advanced disease. The RO's have given you all they know, time to reach outside the specialties you've talked to.

It's a tough choice. Not sure what I'd do in your place, but I'd be inclined to go the full 12 and error on the side of caution.

but if the SEs are intolerable - likely you've gone far enough (wild hopeful guess).

Andrew

Rich, I would agree with Andrew. Unless you feel it’s really destroying your QOL, I would go the full year especially with G8, and EPE. You’ve made it this far, why not go the last quarter mile.
I’d also agree with Andrew onnthe Marina Del Rey practice. I did a 45 minute phone consult with Dr Scholz, who is Dr Lams partner, when I was first diagnosed.
He was great. It cost $750 if I recall correctly.

So that’s what I’d do. But you’re you, and I’m not in your shoes. It’s def a tough call.

Hi Saipan this is an interesting question, as my wife and I had a discussion with our RO today on the same subject. I will be on 4 months of ADT in early November, and when we asked about follow up, she stated she was going to a convention next week, and there is new discussion about how long to stay on ADT.
With my pathology, I was thinking 1 more 3 month shot, but she wants to discus the path forward in early November. I will let the group know what she thinks when we meet. My side effects have been minimal and manageable.

Saipan Paradise said...
Ken-- $1,200 is the fee for all docs in that practice now.

Yikes! no wonder they can afford Marina del Rey ...

GoBucks said...
I know Cleveland Clinic does remote 2nd opinions. No idea of costs.
https://my.clevelandclinic.org/online-services/myconsult

$745. Looks very efficient, but doesn't seem like you get to choose who the consult will be with.

I’ll be that dart thrower. I would shut it at 6 mos.
you will be fine! It’s time to enjoy Saipan.

i'll save you the 1200 bucks. Dr. Lam would say to go the distance.

I'd agree with Redwing and any "go the distance" recommendations. It would be better to look back and say wow, that HT was tough, but I threw everything at it, rather than, wow I wonder if I'd had that extra shot would I still be in the situation I'm in now.

My original Uro, who did my RP, said I'd probably be on HT for three years, but my RO said one year would be enough. I asked if I should get a MO involved and he said no. So between one year and three years, I was ready to settle for two. But I read here on HW (you know, back in the day) that recent studies found that 18 months was usually sufficient. So I chose that as my target.

My RO is retired now but I'm fairly confident that his treatments got any cancer that was left behind... that is, unless this next surgery finds that my small bowel mass is PCa, which is highly unlikely. So starving any circulating PCa cells with an additional six months of Lupron was more like a safety belt in mu book. You hope you don't need it, but if something happens, you're glad you buckled it before you left.

Now ten months out past my final Lupron shot and the SE's have not let up. Still getting hot flashes, have no hair and my brain is very foggy. There's no way of knowing if I were a full year out of HT if that would be any different. I tend to bet across the board rather than drop all my cash on the favorite, or on a long shot.

Due to the current treatment the cancer is at it's weakest. Many MOs like Kwan and Sartor say hit it hard while it is down and don't let it have a chance to regroup and strengthen requiring another round in the future. When I was dx I was given two different ADT opinions, one being 36 months and the other 18 months. At the time the BOLLA study was suggesting 36 months, but some were saying shorter would also work. I went with the 36 months because of my high risk and a "better to be safe than sorry" attitude. Also, how bad could a few more months of ADT really be? Looking back after eight years of undetectable PSA I am pleased with my decision and hardly remember those hot flashes.

I think you see where I am going........

Dumb question, how's ADT time/duration counted?

Is it the total time on ADT, including the time on ADT prior to RT (neoadjuvant ADT ?) and the time on it while receiving the RT treatments?

OR

Is it just the time on ADT after RT has been completed?

In my case I'm on the last of 4 six month Lupron injections and will hit the two year mark next month, but only nineteen months or so of it will have been after completing RT.

As we've discussed Rich, it's just one more tough decision, with few firm facts to base it on. You know what the 'rock star' docs mentioned above might recommend. There are others, especially on the west coast. Put your history together in a concise form and write several of them. You can also read the numerous conflicting studies. Just be sure to focus on the detail, not just the conclusions.

You know what I'd do in your shoes.....or is that sandals? Good luck my friend.

"Duration is the total of months the drug is effective from the time of the first shot plus any residual.period as the drug finally wears off"

so how many six-month shots did you get? I had three, 3-month shots. I claim nine months of ADT tho of course it took longer than nine months to recover.