anybody on INTERMITTENT androgen deprivation?

User

Posted 09 Dec 2016 at 15:15

Intermittent androgen-deprivation therapy (ADT) seems be a well-accepted treatment modality and, by allowing discontinuation of androgen-suppression and recovery of the testosterone, reduces the side-effects of treatment. Clearly it is not suitable for all men, but one of the randomised trials of intermittent ADT (New England Journal of Medicine 2012;367:895-903)in men with raised PSA after primary or salvage radiotherapy, and no metastases, showed that the risk of death was the same as with continuous treatment but quality of life was better.

I do not get the impression, though, that there are many men on intermittent ADT in the centre where I am being treated. I have also noticed the results of a recently published survey (ESMO Open 2016;1:e000040) which showed that there were significant variations in the proportion of patients receiving intermittent ADT in different countries: in the UK only 10% of patients in this survey had intermittent ADT, as opposed to 35% in Australia and France, 32% in Canada and Germany, and 26% in the USA.

Is it difficult to get intermittent ADT in the UK?

User

Posted 09 Dec 2016 at 15:51

There are loads of men here on ADT - but I am not sure how that would be evident to you in a waiting room?

If you put ADT or 'hormone holiday' in the search box you will find plenty of threads and members.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 10 Dec 2016 at 08:33

Lyn, Thank you. Can you give me a bit more detail?
Intermittent ADT is a different type of ADT with a specific protocol: for instance 8 months of ADT followed by non-treatment intervals which usually ended only when the PSA reached 10. In the NEJM 2012 trial a number of men achieved long non-treatment intervals without impact on mortality and some improvement of the quality of life.
In my local support group meeting I have met a number of men on ADT, but none on intermittent. When I asked a tactful question, I had the impression (I hope I am wrong) that intermittent ADT is frowned upon. Liede in 2016 has published a very large international survey of 99,177 prostate cancer patients which suggests that intermittent ADT is less frequently used in the UK.
In essence my questions are:
1) Do most hospitals have protocols for intermittent ADT?
2) Are patients starting ADT being offered the option of intermittent ADT when appropriate?
I presume Prostate Cancer UK is a champion of patients’ choice.

User

Posted 10 Dec 2016 at 09:00

my onco put me on iht after 2yrs of zolodex,because my psa fell to undetectable,no evidence that 3yrs is better than 2yrs,thats what they say anyway.

User

Posted 10 Dec 2016 at 16:54

You don't need to explain these things to us on the forum, most of us have been there, done it, read the research and/or supported other members through it many times!!!

Read the profiles for Ray, George, TopGun for starters. The only reason for a hospital not to encourage IADT is where the ADT does not keep the PSA low enough for long enough.

Not really sure why you are thinking about hormone holidays at this stage?

Edited by member 10 Dec 2016 at 16:56 | Reason: Not specified

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 12 Dec 2016 at 19:23

I think we should seriously consider anyone's post which might help us to consider options.
I don't go with an answer which says " do your research or don't try to explain things to us because most of us have already been there". I don't think you can say that for all of us.
Things change year by year and I for one might be at a stage where IADT might be of interest.
I'm not an experienced researcher into cancer and its treatments.
I spend most of my time getting on with living and find any posts of interest extremely helpful and worthy of looking into.

I read recently in a Times article suggesting that a rebooting of the cancer cells with high dosages of testosterone could make them sensitive to treatment again. This is from a small study by the John Hopkins Medical School in Baltimore.
If this is the same treatment that is being referred to then why is it still being studied in small groups.
I've been on ADT now for 24 months and hope it continues to work for me but if it stops working then hopefully the above might be an option.
I'll certainly ask my onco at my next visit.

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