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

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Arno
Regular Member


Date Joined Apr 2010
Total Posts : 54
   Posted 4/4/2010 8:12 AM (GMT -6)   
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.
Diagnosed at age 63 Sep'09: PSA 575, GS 7 (4+3)
3 positive cores in 6
Bone scan: as a fully lit christmas tree
With Zoladex+150mg Casodex PSA <0.1
Additionally 4-weekly Zometa (zoledronin acid)


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 4/4/2010 8:20 AM (GMT -6)   
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
 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 
3/02/09-PSA <0.02 Nine months after surgery
5/02/09-PSA .10
8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.
 


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 495
   Posted 4/4/2010 10:11 AM (GMT -6)   
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.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/4/2010 10:14 AM (GMT -6)   
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
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14 out - 27 days, Cath #15 - 3/29


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 4/4/2010 11:45 AM (GMT -6)   
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

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 4/4/2010 1:29 PM (GMT -6)   
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
 


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 4/4/2010 2:42:09 PM (GMT-6)


Arno
Regular Member


Date Joined Apr 2010
Total Posts : 54
   Posted 4/5/2010 4:46 AM (GMT -6)   
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.
Diagnosed at age 63 Sep'09: PSA 575, GS 7 (4+3)
3 positive cores in 6
Bone scan: as a fully lit christmas tree
With Zoladex+150mg Casodex PSA <0.1
Additionally 4-weekly Zometa (zoledronin acid)


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 4/5/2010 5:39 AM (GMT -6)   
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
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%

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