Intermitten or Continuous ADT

TN1932,
You're dad is getting the standard of care, which seems to be working well for him, and can continue work for a long time. It's not uncommon to use the lower dose Xtandi for older patients to minimize side-effects while still providing good protection.

I'm inclined to say don't fix what's not broken. Typically, by the time men start feeling better from an ADT break it's time to go back on ADT due to rising PSA. (I've never taken an ADT break, so I don't have experience with intermittent ADT).

If your dad's main concern are the hot flashes something as simple as having a fan handy can help a lot. My flashes have greatly reduced over time.

I guess the bottom line is that your dad may get some short term relief from iADT, but he'll have to decide if it's worthwhile to break from what's now working.

There are guys on the forum who have done iADT, so they can give a better perspective.

mattam,
I think the selling point of intermitten ADT (for my dad) is prolonged time before castration resistance. But from what i understand, there's no clear conclusion about intermitten ADT and prolonged time before castration resistance. If it's just for the purpose of reducing side effects, my dad probably will decide to keep it going without breaks.

TN1932 said...
mattam,
I think the selling point of intermitten ADT (for my dad) is prolonged time before castration resistance. But from what i understand, there's no clear conclusion about intermitten ADT and prolonged time before castration resistance. If it's just for the purpose of reducing side effects, my dad probably will decide to keep it going without breaks.

There has been an evolution in the use of ADT drugs the past decade. It used to be Lupron (Trelstar is very similar) was used until castrate resistance, at which time adding chemo was tabout the only option. During this period there was some experimenting to see if iADT could stretch out the effectiveness of Lupron. I do not know if much success came from these trials. Too shorten a long story, I will just say that drug trials have brought us to the point where it's known that the early addition of a second tier ADT drug like Xtandi to a Lupron type drug gives the most robust survival. This what your dad is getting.

I don't recall any guys on the forum doing intermittent use of these combination drugs. I don't think trials are happening for it, but I don't know.

Are the doctors suggesting the intermittent use of your dad's Trelstar and Xtandi?

TN1932,
Well, that's a new one for me, and explains my confusion over the reason behind putting the treatment on hold. I was thinking your dad wanted a "vacation" from the treatment side-effects.

I'm on Lupron/Xtandi and I personally would be hesitant for trying intermittent use. The researchers have barely had time to establish the drug combinations and the timing of their use, let alone any evidence for intermittent use. At least to my knowledge.

I may try to look up papers and trials on the subject, but there are forum members who are more skilled at that than me, if it interests them to do so.

How is his health otherwise? What is the estimate of longevity? I could see going intermittent with a PSA target say of 10. On ADT to very low PSA then a vacation till it goes up to an acceptable level then back on ADT. Will it make much of a difference on side effects? Only if he is off for 12-18 months. So is intermittent worth it? Who knows? When I am 90, I will be looking for the best quality of life.

BTW, who in the H#ll let his PSA climb so high? I am amazed he was even having PSA tests at his age. But if he was, why so high before anything was done? Hope I haven’t misread something.

Thank goodness he has you in his corner looking out for him.

Thanks TN. At his age, don’t worry about becoming castration resistant from a practical standpoint. Theoretically, intermittent treatment probably delays this, but it all depends on the man. I have a friend that has been on Lupron more than 15 years and I have known others that the first shot had no effect. We know he is currently sensitive, just don’t know how long that will continue.

I was on ADT for three years and tolerated it well. Of course I was 30 years younger than your dad. If he is tolerating it well and controlled, why change? I would try to get on the lowest medication possible to maintain control. I might suggest only the trelstar for a few months and see the effect. Does he really need both drugs? Questions I would be asking the oncologist.

JNK,
According to studies, taking both Trelstar/Xtandi yields better OS than ADT alone. He's already on the lower dose of Xtandi and he tolerates well with this low dose.

TN1932 said...
Duck2,
That's true: may or may not. But if T level doesn't recover when ADT is stopped, then he doesn't need ADT, does he?

The main point I want to make is that your Dad is doing quite well; no need to change anything.
The second point is a bit more subtle. Yes, his T might not recover to 'normal' if he stops ADT, but it might slowly rise above the 'castrate' level (<20). One doesn't want to risk that.