Opinions on intermittent hormone therapy?

Hello, Bally 123 ~

What are your father's thoughts on this possibility?

I think this might be a great opportunity to seek out a valued second opinion.

Seek out a consultation with an oncologist with lots of experience.

Just a thought to offer, as you weigh decisions.

With my best ~

CYCLONE ~ # Iowa State University

The use of intermittent ADT is not uncommon. Several well known medical oncologists have advocated the use of intermittent ADT for decades and several men on the board have used the method. I think the reason most doctors don’t use it more is that they fear PCa recurrence and figure if what we are doing is working, why stop? I agree you should seek an assessment from a well known medical oncologist that specializes in PCa. Among the ones I would suggest include Oliver Sartor, Eugene Kwan, Mark Schulz, Robert Leibowitz, and some others.

Where are you located? Have you been using the current medical oncologist throughout the years of treatment? What was his original diagnosis including PSA, number of positive cores and extent of the G7, and any evidence of spread from scans. Now what is your father’s age and overall health? Is he in great shape other than PCa or does he have other serious issues like cardiovascular disease or various metabolic problems? Has he experienced problems with his bones? Has he had regular bone density tests?

You will never know what the effect of intermittent ADT will be until you try it. Most doctors will have specific targets as to when to start back on ADT and the types of scans to use to monitor and disease progression. If the ADT vacations are too brief, only a few months, it is less likely he will see a relief from ADT side effects. If he does this I would recommend the use of the oral ADT Orgovyx as it has is cleared from the body very quickly and may better promote testosterone recovery and benefits from an ADT vacation.

Thank you all for taking the time to respond, and providing such detailed response, I really appreciate it.

We are based in Ireland so there is obviously less choice of oncologists, but after reading all your replys I think it would be really useful to get a second opinion.

JNFs reply made me realise that we didnt even get that much information on his dianosis-- just that it was an aggressive Gleason 7, and bone scan density tests arent being regularly done.

My Dad is open to going off the hormones, but we just dont really know what that means-- his last appointment with his oncologist was a phone call lasting a few minutes where he was told that in 6 months he may be taken off hormones but no discussion on the implications of this other than a reduction of side effects.

He is 72, very fit and active and says his main side effect is fatigue--he can often find it difficult to motivate himself to do things compared to previous-- but still the most active 72 year old I know! He is also on thyroid medication for previous thyroid cancer, and blood pressure medication.

I had assumed that if he goes off hormone therapy it is almost certain his PSA will rise, but from some of the posts it sounds like that isnt definite? Has it happened to anyone that they have stopped and the cancer hasnt returned?

Thank you so much, you have given us a lot to think about

Here is a link to a more in-depth discussion of this issue:

https://www.prostatecancer.news/2023/04/intermittent-adt.html

https://clinicaltrials.gov/ct2/show/NCT05241860
The above is a trial in the US for stopping treatment for patients who have responded well to hormone therapy. I am not in the trial but I stopped all my meds in June 2022. I feel great and still at <0.01. The trial tells me that many guys are doing this. It is scary to think that our PSA will rise and the cancer will return. My thought is that I responded great before and I will again so I'm giving it a go. By the way my testosterone has not recovered, only up slightly. I'm ok with that because I feel better.

The link provided by Sr Sailor above goes to a very thorough discussion of iADT. It would seem to indicate that there is no advantage at all for increasing the time to castrate resistance compared to continuous ADT. It also seems unlikely that men would get relief from ADT symptoms because the T usually doesn't sufficiently recover before it's time to resume ADT. However, the review noted that Orgovyx could be a different story because it clears the system much faster than Lupron.

From the review:
II. No Difference in Time to Castration Resistance

""The original hope of iADT was that it would slow progression to castration resistance. This was based on tests in mice conducted by Bruchovsky. In clinical trials, this early hope did not pan out. All of the randomized clinical trials with homogeneous patient populations: SWOG-S9346, NCIC-CTG PR.7, ICELAND, and EC507 confirmed that the time to castration resistance was not different for iADT and cADT. Any reduction of evolutionary selection pressure with iADT is balanced by the reduction in sheer numbers with sustained cADT. This is not surprising, given that intensive hormonal treatment with ADT and Zytiga, Xtandi, or Erleada has been proven to delay castration resistance in men who are mHSPC.""

The above excerpt seems to quash the "evolutionary pressure" theory that I sometimes see promoted on another PCa support site

Personally, I feel inclined to stick with continuous ADT for a few reasons. It has been working well for me. My junk is so atrophied that I doubt I would ever recover enough T to feel a benefit. 😐 And, even if I did feel a little better for a few months, I'm not sure it would be good for me psychologically to return to full throttle ADT.

So, I guess iADT could be a good deal for a few men, but it may make no difference at all for most men.

Bill,
From your signature I can see that you and your oncologist didn't panic with an increasing PSA, and delayed treatment until a fairly high PSA reached. My PSA went even higher before I started lifetime ADT. No need to start the ADT clock ticking early.

I think Lupron/Xtandi will take your PSA low and keep it there.