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Duration of ADT - 18 or 36 months

User
Posted 17 Apr 2024 at 17:54

I started Prostap ADT in September 2022 and had RT in March 2023. All seems successful so far with PSA at 0.03. My Oncologist has prescribed 3 years of ADT. However, I'm keen to come off it as soon as possible. I have found a medical paper which states:

Conclusions: In localized HRPC, our results support that 36 mo is not superior to 18 mo of ADT. ADT combined with RT can potentially be reduced to 18 mo in selected men without compromising survival or QoL. Thus, 18 mo of ADT appears to represent a valid option in HRPC.

Patient summary: In this study, we report outcomes from high-risk prostate cancer patients treated with radiotherapy and either 36 or 18 mo of androgen deprivation therapy. There was no difference in survival between the two groups, with the 18-mo group experiencing a better quality of life.

I think the NICE guidance is 36 months but, before I speak to the oncologist about this, I wonder if anyone else has been on 18 months of treatment.

Regards

Bob C

User
Posted 18 Apr 2024 at 00:35

Hi all,

here's a couple of different studies: pcf study and ASCO

You'll notice that in the latter study the 5 year survival rate for 3 years of HT is 92% as against 86% for 18 months. Really, they're not comparing apples with apples. The interesting results would be 5 years after ending the 18 months treatment as compared to 5 years after ending the 3 years plan. Put another way, if you've had 3 years HT it can take maybe 18 months for testosterone to come back, so really the 3 years is more like 4.5 years without testosterone which gives the cancer only 6 months to fully develop and kill you. High probability in that situation that it's a failure of the RT and not the length of the HT.

There's always going to be some people for whom the RT treatment doesn't achieve its primary goal and it's not going to matter if the RT is 18 months or 3 years because if all of the cancer has not been treated, it will come back, it's just a question of when.

Personal opinion bit: RT now is way superior to RT ten years ago so hanging on to 3 year HT where you have every reason to believe your initial treatment was successful makes little sense. If you've had RT with a LINAC machine, active monitoring and and the latest technology it's a big step up from the past and the results quoted above for survival will now be out of date. 

If you have reason to believe that the initial treatment didn't miss anything and your psa has been rock bottom  since that treatment, it's strong support for ceasing HT at 18 months. I was supposed to go for 3 years but stopped at 21 months after a chat with my oncologist. My psa dropped like a stone from very shortly after my RT and stuck at <.01 for the duration on my HT. I suspect that the fast initial psa drop might be significant though I haven't seen any discussion about it here.

I find the idea that stopping HT is merely about QoL somewhat insulting. This stuff is not good for you and as we know, it can increase weight, decrease bone density, increase cholesterol, decrease muscle mass + a few other nasties. Cancer specialists can get a bit narrow in their views of long term goals but if there's nothing to be gained by being on HT it's actually important to stop taking it for your health.

Jules

 

edit: I should have made it clear that loss of testosterone is the cause of most of these HT problems, not the drug itself but I do reckon there are unpleasant side effects from the drug[s].

 

Edited by member 18 Apr 2024 at 23:21  | Reason: Not specified

User
Posted 17 Apr 2024 at 20:57
Hi Chaps,

There are a number of conversations about this, and links to the trial - some within the last couple of weeks.

A number of us have had the original 36 months reduced.

Chris

User
Posted 17 Apr 2024 at 22:42

Hi Bob,

I have just had my last Prostap Injection. I will have been on it 2 years in total, but was suppose to be on it for 3.
My PSA is now <0.1. I have had severe joint problems in my legs due to Prostap and the Onco is happy for me to stop.

Derek

User
Posted 18 Apr 2024 at 19:55

My ( private) onco guy was happy for me to stop HT pretty much immediately after my 5 day RT blast ( though I had been on it for 2 years by then). Local hospital onco wanted another 3 months, but wasn't pushing too hard.

User
Posted 18 Apr 2024 at 23:54

High risk patient - I was told it would be 18-36 months at the outset.

When I was getting near 18 months, I asked again. My oncologist said that since my PSA had been <0.01 ever since the RT, I could stop whenever I liked. If my PSA had been more than 0.5, he'd want me to do the full 36 months. I guess that might have been the case if I'd had a high Gleason score or been T3b or T4 too.

Your best chance of a cure is this first treatment. If you need salvage treatments later, they have lower success rates, and if it goes metastatic, then you're on HT for life. So given the HT wasn't causing me any problems I couldn't put up with a bit longer for the sake of a better chance of a cure, I continued a bit longer to 22 months.

Edited by member 18 Apr 2024 at 23:55  | Reason: Not specified

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User
Posted 17 Apr 2024 at 19:41

Hi Bob any chance you could give the date and authors of the paper? It would really help in forthcoming conversations with the oncologist.many thanks Kate 

User
Posted 17 Apr 2024 at 19:42

Sorry meant to say with our meeting with the oncologist not yours!

User
Posted 17 Apr 2024 at 20:57
Hi Chaps,

There are a number of conversations about this, and links to the trial - some within the last couple of weeks.

A number of us have had the original 36 months reduced.

Chris

User
Posted 17 Apr 2024 at 21:23

Kate, it should be in the link but I think 2018, European Urology which looks respectable.

https://pubmed.ncbi.nlm.nih.gov/29980331/#:~:text=Patient%20summary%3A%20In%20this%20study,a%20better%20quality%20of%20life.

 

User
Posted 17 Apr 2024 at 21:24

Chris, I'd like some links please, especially to trial.

Bob C

User
Posted 17 Apr 2024 at 22:39

Hi Bob thank you so much for this. I’ve just realised this is in relation to radical treatment whereas my OH is dealing with biochemical reoccurrence so falls outside the ambit of this study. Interesting though to see that 18 months can do the trick. 

User
Posted 17 Apr 2024 at 22:42

Hi Bob,

I have just had my last Prostap Injection. I will have been on it 2 years in total, but was suppose to be on it for 3.
My PSA is now <0.1. I have had severe joint problems in my legs due to Prostap and the Onco is happy for me to stop.

Derek

User
Posted 18 Apr 2024 at 00:35

Hi all,

here's a couple of different studies: pcf study and ASCO

You'll notice that in the latter study the 5 year survival rate for 3 years of HT is 92% as against 86% for 18 months. Really, they're not comparing apples with apples. The interesting results would be 5 years after ending the 18 months treatment as compared to 5 years after ending the 3 years plan. Put another way, if you've had 3 years HT it can take maybe 18 months for testosterone to come back, so really the 3 years is more like 4.5 years without testosterone which gives the cancer only 6 months to fully develop and kill you. High probability in that situation that it's a failure of the RT and not the length of the HT.

There's always going to be some people for whom the RT treatment doesn't achieve its primary goal and it's not going to matter if the RT is 18 months or 3 years because if all of the cancer has not been treated, it will come back, it's just a question of when.

Personal opinion bit: RT now is way superior to RT ten years ago so hanging on to 3 year HT where you have every reason to believe your initial treatment was successful makes little sense. If you've had RT with a LINAC machine, active monitoring and and the latest technology it's a big step up from the past and the results quoted above for survival will now be out of date. 

If you have reason to believe that the initial treatment didn't miss anything and your psa has been rock bottom  since that treatment, it's strong support for ceasing HT at 18 months. I was supposed to go for 3 years but stopped at 21 months after a chat with my oncologist. My psa dropped like a stone from very shortly after my RT and stuck at <.01 for the duration on my HT. I suspect that the fast initial psa drop might be significant though I haven't seen any discussion about it here.

I find the idea that stopping HT is merely about QoL somewhat insulting. This stuff is not good for you and as we know, it can increase weight, decrease bone density, increase cholesterol, decrease muscle mass + a few other nasties. Cancer specialists can get a bit narrow in their views of long term goals but if there's nothing to be gained by being on HT it's actually important to stop taking it for your health.

Jules

 

edit: I should have made it clear that loss of testosterone is the cause of most of these HT problems, not the drug itself but I do reckon there are unpleasant side effects from the drug[s].

 

Edited by member 18 Apr 2024 at 23:21  | Reason: Not specified

User
Posted 18 Apr 2024 at 07:04
Thank you, Jules - that's most reassuring. The pcf study is about 6 vs 18 months and Zoladex but the ASCO is supportive of 18 vs 36. Together with the Euro Urology study, also 18 vs 36, there appears to be a strong case for 18 months.

None of the papers specify but I suppose that this time is counted from after the Radiotherapy and does not include the 6 months before it to shrink the prostate.

Given the cost of the ADT at several £100s per 3 months one would think NICE would be keen to take this research from 2013 and 2018 on board.

BobC

User
Posted 18 Apr 2024 at 09:13

Great post Jules and it so resonates with me. As you know it has seriously affected my body in so many ways and I am so pleased to be off it for life(hopefully🤞🤞🤞🤞). Yes, it does affect your QOL but that’s down to the damage being done to your body…I can only hope that when my current Prostap starts to wear off in 11 weeks from now, on the 4th July(Independence Day! How Apt!) that my body will start to slowly recover. That’s 13 weeks from my last jab and I am counting down the weeks.

How ironic though that just as you start to get your testosterone back and start to feel like a man, you then have to start worrying about whether the treatment HAS indeed worked knowing that if it hasn’t it probably means being on this stuff for life😩. If that happens to me I will seriously consider having an orchidectomy.

Derek

User
Posted 18 Apr 2024 at 19:55

My ( private) onco guy was happy for me to stop HT pretty much immediately after my 5 day RT blast ( though I had been on it for 2 years by then). Local hospital onco wanted another 3 months, but wasn't pushing too hard.

User
Posted 18 Apr 2024 at 21:40

Originally Posted by: Online Community Member
I can only hope that when my current Prostap starts to wear off in 11 weeks from now, on the 4th July(Independence Day! How Apt!) that my body will start to slowly recover.

Derek, The "rule of thumb" is apparently that it takes as long to recover from the HT as you've been on it. I was rather dreading something so drawn out but in reality the worst stuff passed really quickly and a bit over a year post HT I feel normal. At 78 my EF is stuffed but that's not surprising, nor a particular concern at my age. Interestingly though, my testosterone levels are very good and I've brought my weight down by about 9 kg.

I hope you have a quick recovery too Derek, given the pain it's put you through.

Jules

User
Posted 18 Apr 2024 at 23:54

High risk patient - I was told it would be 18-36 months at the outset.

When I was getting near 18 months, I asked again. My oncologist said that since my PSA had been <0.01 ever since the RT, I could stop whenever I liked. If my PSA had been more than 0.5, he'd want me to do the full 36 months. I guess that might have been the case if I'd had a high Gleason score or been T3b or T4 too.

Your best chance of a cure is this first treatment. If you need salvage treatments later, they have lower success rates, and if it goes metastatic, then you're on HT for life. So given the HT wasn't causing me any problems I couldn't put up with a bit longer for the sake of a better chance of a cure, I continued a bit longer to 22 months.

Edited by member 18 Apr 2024 at 23:55  | Reason: Not specified

 
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