question on Intermittent HT: when to stop?

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New Member

Date Joined Jun 2011
Total Posts : 5
   Posted 6/9/2011 7:50 PM (GMT -6)   
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.

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4463
   Posted 6/9/2011 8:01 PM (GMT -6)   
arthur, welcome to the forum. I am not an expert on the subject but someone will be along shortly to help.
James C, 64, East TN
Gonna Make Myself A Better Man
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% inv, lf. lobe, GS6
9/07: Nerve Spar. open RP, Path: pT2c, 110 gms., clear except:
Prob. microscopic inv.-left apical margin -GS6
3 Years: PSA's .04 each test until 4/10-.06, 9/10-.09, 12/10-.09, 2/11-.08, 5/11-.08
Bimix .30

Veteran Member

Date Joined Jan 2010
Total Posts : 1011
   Posted 6/9/2011 8:22 PM (GMT -6)   
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.
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11 PSA < .01

New Member

Date Joined Jun 2011
Total Posts : 5
   Posted 6/9/2011 8:50 PM (GMT -6)   
Many thanks to all you guys for clarifying this puzzle. Ok, so it looks like we'll have to ask our oncologist about the 12 month mark vs. his 9 month suggestion.

Veteran Member

Date Joined Dec 2010
Total Posts : 3886
   Posted 6/9/2011 8:54 PM (GMT -6)   
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?
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010
HDR Brachytherapy December 6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.
PSA <.1 on 4-7-2011
Second Eligard shot on 4-7-2011

Veteran Member

Date Joined Jul 2010
Total Posts : 3892
   Posted 6/9/2011 8:55 PM (GMT -6)   
The whole idea is to live as long as possible while enduring as few side-effects as possible..Urologists and Medical Oncologists seldom see eye to eye...The 6 month, 9 month issue is minor. I would favor the oncologist in all things at this point, he was trained to do this. For urologists, it's a profitable sideline...JMHO....

You should know that the effect of the drugs does not wear off instantly..It will take several months for Dad's testosterone to recover and possibly stimulate his PC..The key measurement to survival will your Dad's PSA doubling time after the shot wears off..Hopefully, it will rise very slowly (what was his original Gleason score?) and there will be no rush to return to the ADT shots and allowing him time to recover from them..

When employing intermittent ADT, some oncologists keep the patient on Avodart, claiming it can extend the "time off" period without imposing any serious QL issues...

The bright side of all this, when a reoccurred PC takes 10 years to appear, these slow-growing cancers are usually fairly easy to control with the tools available to your oncologist....Best of luck to your Dad..
Age 68.
PSA age 55: 3.5, DRE normal.
age 58: 4.5
61: 5.2
64: 7.5, DRE "Abnormal"
65: 8.5, " normal", biopsy, 12 core, negative...
66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
67 4.5 DRE "normal"
68 7.0 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Elite Member

Date Joined Oct 2008
Total Posts : 25393
   Posted 6/9/2011 9:00 PM (GMT -6)   
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
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06, 2/11 1.24, 4/11 3.81
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10

Veteran Member

Date Joined Jan 2011
Total Posts : 735
   Posted 6/9/2011 9:15 PM (GMT -6)   
Hi Arthur,
I agree with your father’s medical oncologist. When androgen-dependent cells, both normal and cancerous are deprived of androgen, as they go through their proliferation cell cycle they undergo apoptosis (cell death).

Because of the potential number of cells present it takes time (usually 9 months) for this process to involve all cells present. If the patient is experiencing many side effects, this is the minimum deprivation time. On the other hand if the side effects are bearable it is safer to do another three months of deprivation.

You do not provide any diagnostic parameters like Gleason Score and number of positive cores. Also how long did it take for PSA to go from <0.1 to 5.8?

Phoenix, Arizona
Surviving prostate cancer since 1992 at age 58. RP; Orchiectomy; GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall; Stage T4; Last PSA September, 2010: <0.1 ng/ml
Laughter is still the best medicine!

New Member

Date Joined Jun 2011
Total Posts : 5
   Posted 6/9/2011 9:16 PM (GMT -6)   
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.

Veteran Member

Date Joined Jan 2010
Total Posts : 1011
   Posted 6/9/2011 9:17 PM (GMT -6)   
Yes. Dr Myer is having me continue avodart. I'm not sure for how long, but he gave me a prescrition for 9 months. His program calls for maintaining the remission induced by ADT3 with avodart, diet, and suppliments (pomegranate, curcummin, resvesterol, and vit D).
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11 PSA < .01

New Member

Date Joined Jun 2011
Total Posts : 5
   Posted 6/9/2011 9:19 PM (GMT -6)   

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.

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4268
   Posted 6/9/2011 10:24 PM (GMT -6)   
Ask your oncologist about continuing on Adovart or Proscar during the off period as it will extend the off period time. Also insure that your Dad's testestorne is checked regularly as it should be <20 for HT to be effective. The most common protocols used by oncologists specializing in PC is ADT3; Trelstar, Casodex and Adovart with Adovart continued in the off period.
66 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Regular Member

Date Joined Apr 2008
Total Posts : 364
   Posted 6/9/2011 10:34 PM (GMT -6)   
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.

New Member

Date Joined Jun 2011
Total Posts : 5
   Posted 6/9/2011 10:39 PM (GMT -6)   
John and dkob131

Will do. He didn't mention Avodart at all, so we'll bring it up - so far he's been on Casodex and Trelstar only. Thanks!
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