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Big Decision: Stop the ADT?

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User
Posted 14 Feb 2026 at 11:42

Hi, as you can see by my profile, I'm a 68 year old man with locally advanced, high risk prostate cancer. I've had 20 fractions of radiotherapy to the prostate and been on Zoladex injections for two years. I am about to enter my third and last yearon Zoladex. I've also been taking Abiraterone and Preddnisolone for nearly two years, (just three months left to go). I've coped with all the ADT pretty well apart from accunulating body fat round my middle. I have some heart issues - Bradycardia, low burden Atrial Fibrillation - although these do not affect me much and I'm pretty fit and active generally. Currently my PSA is stable around 0.09.

In my most recent consultation, my Oncologist - a lovely bloke - has suggested I might want to consider ending my treatment altogether, once I finish the Abiraterone. He said that it would of course be my decision, but as I had no nodal involvement and to avoid prolonged exposure to side effects of ADT, it is worth considering. He didn't give me the impression there was any particular evidence-base for this (or is there?), save that 'conversations' were being had in the medical community about whether for some people, intensive aggressive treatment may be overly long, and the benefit of staying on Zoladex for another year 'marginal'.

It's a big decision and he took me completely unawares. Do I finish the initially prescribed course of treatment which I'd been resigned to, or cut the ADT short from three to two years? Has anyone else been given such a choice to make? Does anyone know what the science behind this apparent change in thinking might be?.

User
Posted 14 Feb 2026 at 15:04

Kaja555 welcome to the forum. My diagnosis at age 70 was similar to yours although my PSA was a bit higher at 48. I also had 20 fractions of RT and endured 5 three monthly injections of Prostap and just under a year of Abiraterone before I could no longer tolerate the toxicity. My PSA was undetectable as at March last year and once the effects of the HT wore off say by September rose to 0.9 and in December the reading was 1. The oncologist commented “only to be expected and perfectly acceptable”. Next test is late April. I was to be on HT for 3 years but the doctor accepted that it would be safe to stop given the histology and pronounced effect of the treatments. At the meeting in December I was prepared for my PSA to have risen given my high risk diagnosis and to resume HT this time in tablet form so there was no happier man than me that day. The expanded waist and sensitive nips remind me of the journey to date. Fortunately I have not needed to employ the Somoerect but the situation would have been a lot different had I continued with HT for the full term. You are fortunate in tolerating HT so far. There is comment to the effect that  to recover takes as long as your treatment and even if it’s 9 - 12 months this will take you to the 3 years recommended term. So I would agree nothing to loose by taking the break. Will be interested to hear what you do and how the recovery goes. Most guys on the forum have had surgery not so many like us. I am pleased to have you in the club to share experiences and perhaps better inform those who follow us here.

John from Glasgow, Scotland 

User
Posted 14 Feb 2026 at 19:08
I was locally advanced starting with PSA21, T3b & gleason 8 later upped to 9 following TURP. I started this aged 59 in 2015. I was on Zoladex for 3 years with 32 sessions of RT with abiraterone,enzalutimide,prednisolone added for 2 years on trial. My treatment finished 2018 I think at that time there was no thinking of shorter Adt etc so I went for the full time. Obviously suffered all expected side effects but they did fade well enough. My situation remains good with my PSA nadir being 0.5, it has been below that since.

If after 2 years of Zoladex the consultant said its fine to stop I think I'd have stopped simply on his advice. I do not think I'd have asked to stop voluntarily, I must admit.

Doesn't really help you I guess apart from follow the guidance of oncologist.

Peter

User
Posted 15 Feb 2026 at 00:33

To Kaja555

                    In Australia the extended use of ADT for those in their latter years, and particularly for those with cardiac issues as well, is under considerable review. The most salient issues are longevity and quality of life. Recent research (see Pub Med) tells us that aggressive ADT in a man of advancing years, for the most part, does not yield better longevity, but does put considerable strain on the quality of life. Needless to say PCa progression and doubling time also factor highly in the analysis. Thus I am not surprised that your Oncologist decided to bounce the cessation of treatment option on you. Just be aware that medical opinion in the treatment of PCa is constantly evolving and the risk/benefit ratio is more specific these days in our senior years.

Like you I also have cardiac issues. Mine are heart failure, stage 3 AV block (pacemaker), aortic stenosis (tavi) and pulmonary oedema. Unlike you I do have node mets (2). Both treated with SRT. My doubling time is not a clinical issue. You might care to bounce some of my thoughts on your Oncologist.

 

Edited by member 15 Feb 2026 at 00:37  | Reason: Not specified

User
Posted 15 Feb 2026 at 02:36

My diagnosis was similar to yours, but I was 53 at the time. I was treated in 2018 similar to your treatment, not quite identical. I was only on Zoladex for two years. It is very much considered that the benefits of ADT follow the law of diminishing returns. The first year being very important, the second year quite useful, but by the third year the extra benefit is minimal. If I were in your position I would be finishing now. BTW my PSA is now 0.1 and has been for nearly 8 years.

Dave

User
Posted 19 Feb 2026 at 14:28

Originally Posted by: Online Community Member
He didn't give me the impression there was any particular evidence-base for this (or is there?),


... there is, as jfd says, and I was going to give you a link to some stats on 18 months v 3 years but since I last visited, one site has become "page not found". In brief the results of that study were that for 5 year survival there was a very slight advantage with 3 years of ADT treatment but for survival to 10 years there was no difference. The 5 years after ending RT v 10 years after RT results aren't strictly comparable and maybe a better comparison would be 5 years after ending ADT v 10 years after ending ADT. 

Here's a link, though not the best I've seen:

18 month ADT v 3 year ADT

I pulled out at 2 years [see my profile], aged 75 with G9, seminal vesicle and 3 lymph nodes having been treated with RT. So far, so good at 6 years post treatment. The side effects of ADT often don't rate much of a mention from oncologists whose prime focus is treating PC but they are significant and include lowering bone density and increasing cholesterol levels as well as the more obvious ones. 

In a very broad sense my own feeling was that the ADT "experience" was a heavy burden to bear and even though I've bounced back well, it did take a long term toll and some of that is not reversible. There's a balance to be considered when the advantage of longer ADT is only fractional. 

Jules

Edited by member 19 Feb 2026 at 20:39  | Reason: Not specified

User
Posted 19 Feb 2026 at 22:01
There is more forthcoming on this aspect and also intermittent HT which some men are on so that they have a Hormone break and then restart HT when their PSA reaches a certain level agreed in their individual circumstances with their Oncologist.
Barry
User
Posted 12 May 2026 at 00:02

Stop me if you already know this Keith but the sequence of coming events gives you about 12 months until testosterone returns to your system, though sometimes it doesn't. Up until then your psa will probably stay at about the same level as it has been recently. When testosterone returns you'll probably get a slight lift in your psa, because you've still got a prostate. 

Just having the drugs out of your system might make you feel better. I certainly did when Zoladex had finally faded out after about 4 months. 

While on Zoladex I dipped into ostopaenia, raised weight, lowered muscle strength, poor sleep and raised cholesterol. All of these problems have gone since I've had testosterone back in my system, possibly because like you I'm fit and active.

All the best for the recovery stage!

Jules

User
Posted 14 Feb 2026 at 11:42

Hi, as you can see by my profile, I'm a 68 year old man with locally advanced, high risk prostate cancer. I've had 20 fractions of radiotherapy to the prostate and been on Zoladex injections for two years. I am about to enter my third and last yearon Zoladex. I've also been taking Abiraterone and Preddnisolone for nearly two years, (just three months left to go). I've coped with all the ADT pretty well apart from accunulating body fat round my middle. I have some heart issues - Bradycardia, low burden Atrial Fibrillation - although these do not affect me much and I'm pretty fit and active generally. Currently my PSA is stable around 0.09.

In my most recent consultation, my Oncologist - a lovely bloke - has suggested I might want to consider ending my treatment altogether, once I finish the Abiraterone. He said that it would of course be my decision, but as I had no nodal involvement and to avoid prolonged exposure to side effects of ADT, it is worth considering. He didn't give me the impression there was any particular evidence-base for this (or is there?), save that 'conversations' were being had in the medical community about whether for some people, intensive aggressive treatment may be overly long, and the benefit of staying on Zoladex for another year 'marginal'.

It's a big decision and he took me completely unawares. Do I finish the initially prescribed course of treatment which I'd been resigned to, or cut the ADT short from three to two years? Has anyone else been given such a choice to make? Does anyone know what the science behind this apparent change in thinking might be?.

User
Posted 12 May 2026 at 11:16

I did almost 2 years on Zoladex. (I didn't do Abiraterone - it wasn't used this way back in 2019.)
At the outset I was told 18-36 months of HT.
At the 18 month point, my PSA was <0.01 and I was told I could stop any time - up to me. (If my PSA had been 0.5 or more, they would want me to do the full 36 months.)
I already had the next Zoladex in the fridge and it wasn't causing me any issues I couldn't put up with for a bit longer, so I took that which took me to 22 months.

Testosterone came back quite suddenly 9 months after last injection ran out.
It takes your body about another 3 months to respond to the return of Testosterone.

I would strongly recommend getting Testosterone level added to your PSA tests when you come off HT, so you know when it's come back. My oncologist did that anyway because he said you can't interpret the PSA test results unless you know when and how far Testosterone has returned. They kept doing the Testosterone tests until the level was stable for a year (one of the potential failure modes is Testosterone initially comes back, but then drops away to nothing).

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User
Posted 14 Feb 2026 at 15:04

Kaja555 welcome to the forum. My diagnosis at age 70 was similar to yours although my PSA was a bit higher at 48. I also had 20 fractions of RT and endured 5 three monthly injections of Prostap and just under a year of Abiraterone before I could no longer tolerate the toxicity. My PSA was undetectable as at March last year and once the effects of the HT wore off say by September rose to 0.9 and in December the reading was 1. The oncologist commented “only to be expected and perfectly acceptable”. Next test is late April. I was to be on HT for 3 years but the doctor accepted that it would be safe to stop given the histology and pronounced effect of the treatments. At the meeting in December I was prepared for my PSA to have risen given my high risk diagnosis and to resume HT this time in tablet form so there was no happier man than me that day. The expanded waist and sensitive nips remind me of the journey to date. Fortunately I have not needed to employ the Somoerect but the situation would have been a lot different had I continued with HT for the full term. You are fortunate in tolerating HT so far. There is comment to the effect that  to recover takes as long as your treatment and even if it’s 9 - 12 months this will take you to the 3 years recommended term. So I would agree nothing to loose by taking the break. Will be interested to hear what you do and how the recovery goes. Most guys on the forum have had surgery not so many like us. I am pleased to have you in the club to share experiences and perhaps better inform those who follow us here.

John from Glasgow, Scotland 

User
Posted 14 Feb 2026 at 19:08
I was locally advanced starting with PSA21, T3b & gleason 8 later upped to 9 following TURP. I started this aged 59 in 2015. I was on Zoladex for 3 years with 32 sessions of RT with abiraterone,enzalutimide,prednisolone added for 2 years on trial. My treatment finished 2018 I think at that time there was no thinking of shorter Adt etc so I went for the full time. Obviously suffered all expected side effects but they did fade well enough. My situation remains good with my PSA nadir being 0.5, it has been below that since.

If after 2 years of Zoladex the consultant said its fine to stop I think I'd have stopped simply on his advice. I do not think I'd have asked to stop voluntarily, I must admit.

Doesn't really help you I guess apart from follow the guidance of oncologist.

Peter

User
Posted 15 Feb 2026 at 00:33

To Kaja555

                    In Australia the extended use of ADT for those in their latter years, and particularly for those with cardiac issues as well, is under considerable review. The most salient issues are longevity and quality of life. Recent research (see Pub Med) tells us that aggressive ADT in a man of advancing years, for the most part, does not yield better longevity, but does put considerable strain on the quality of life. Needless to say PCa progression and doubling time also factor highly in the analysis. Thus I am not surprised that your Oncologist decided to bounce the cessation of treatment option on you. Just be aware that medical opinion in the treatment of PCa is constantly evolving and the risk/benefit ratio is more specific these days in our senior years.

Like you I also have cardiac issues. Mine are heart failure, stage 3 AV block (pacemaker), aortic stenosis (tavi) and pulmonary oedema. Unlike you I do have node mets (2). Both treated with SRT. My doubling time is not a clinical issue. You might care to bounce some of my thoughts on your Oncologist.

 

Edited by member 15 Feb 2026 at 00:37  | Reason: Not specified

User
Posted 15 Feb 2026 at 02:36

My diagnosis was similar to yours, but I was 53 at the time. I was treated in 2018 similar to your treatment, not quite identical. I was only on Zoladex for two years. It is very much considered that the benefits of ADT follow the law of diminishing returns. The first year being very important, the second year quite useful, but by the third year the extra benefit is minimal. If I were in your position I would be finishing now. BTW my PSA is now 0.1 and has been for nearly 8 years.

Dave

User
Posted 19 Feb 2026 at 12:04

Gents; thank you so much for these replies, all really useful and give plenty of food for thought. I've got about 10 weeks yet before I need to make a decision one way or another, but I'm starting to wonder just whether that third year on the 3 monthly Zoladex injections may be more trouble than it's worth. Sometimes I guess it's about what's in your head as well: that scary moment coming up on th rails where I'll 'drop off the treatment cliff' and be left on my own without a 'safety net', other than periodic PSA checks!

My PSA has dropped slightly again to 0.06, and my PSA has declined in a nice curve without any bumps, so things seem to have gone well over these two years in terms of response and control over my disease. I'll continue to mull it over, but I'm thinking at the moment it may be worth stopping after my final 3 months of Abiraterone, on balance.

Many thanks again folks, and may I wish you every good fortune for your own personal journeys. If you or anyone else have any further insights, I'd welcome them.

User
Posted 19 Feb 2026 at 14:28

Originally Posted by: Online Community Member
He didn't give me the impression there was any particular evidence-base for this (or is there?),


... there is, as jfd says, and I was going to give you a link to some stats on 18 months v 3 years but since I last visited, one site has become "page not found". In brief the results of that study were that for 5 year survival there was a very slight advantage with 3 years of ADT treatment but for survival to 10 years there was no difference. The 5 years after ending RT v 10 years after RT results aren't strictly comparable and maybe a better comparison would be 5 years after ending ADT v 10 years after ending ADT. 

Here's a link, though not the best I've seen:

18 month ADT v 3 year ADT

I pulled out at 2 years [see my profile], aged 75 with G9, seminal vesicle and 3 lymph nodes having been treated with RT. So far, so good at 6 years post treatment. The side effects of ADT often don't rate much of a mention from oncologists whose prime focus is treating PC but they are significant and include lowering bone density and increasing cholesterol levels as well as the more obvious ones. 

In a very broad sense my own feeling was that the ADT "experience" was a heavy burden to bear and even though I've bounced back well, it did take a long term toll and some of that is not reversible. There's a balance to be considered when the advantage of longer ADT is only fractional. 

Jules

Edited by member 19 Feb 2026 at 20:39  | Reason: Not specified

User
Posted 19 Feb 2026 at 22:01
There is more forthcoming on this aspect and also intermittent HT which some men are on so that they have a Hormone break and then restart HT when their PSA reaches a certain level agreed in their individual circumstances with their Oncologist.
Barry
User
Posted 11 May 2026 at 18:25

Ok, I’ve taken the plunge….

I saw my Oncologist on 28th April 2026. After much discussion (including him saying, “look Keith, I can’t tell you what to do, but if we haven’t nailed your cancer by now, I don’t think we’re going to”.), I’ve decided to stop my remaining HT treatment. Today (11th May), I took my last dose of Abiraterone and I am now going to spend 4 weeks weaning off Prednisone. In that time, I will arrive at the point of exit for Zoladex injections: all in all, I’ve had 24 months of Abiraterone and 27 months of Zoladex, on top of my 20 fractions of radiotherapy, back in September 2024.

I have now cut loose. No more treatment (at least, not yet!). It feels as joyous as jumping off a cliff into the unknown can possibly feel, I guess. My AI Chatbot tells me I’ve had an ‘excellent response’ to my treatment, and the current letter from the good doctor didn’t give a figure, but instead said “Keith’s PSA remains undetectable “.

Given the comorbidities I have, I feel it’s the right plan. I’m pretty fit, although the ADT has dragged me down more in the last 6 months in terms particularly of weight gain round my middle, muscle loss and general fatigue. Hopefully, onwards and upwards with optimism, but a sense of realism also. Many thanks once again to you wonderful people who offered a response, and my respect and good wishes to all who are going through this. STAY STRONG!

“You gotta get busy livin’ or get busy dyin’”

User
Posted 12 May 2026 at 00:02

Stop me if you already know this Keith but the sequence of coming events gives you about 12 months until testosterone returns to your system, though sometimes it doesn't. Up until then your psa will probably stay at about the same level as it has been recently. When testosterone returns you'll probably get a slight lift in your psa, because you've still got a prostate. 

Just having the drugs out of your system might make you feel better. I certainly did when Zoladex had finally faded out after about 4 months. 

While on Zoladex I dipped into ostopaenia, raised weight, lowered muscle strength, poor sleep and raised cholesterol. All of these problems have gone since I've had testosterone back in my system, possibly because like you I'm fit and active.

All the best for the recovery stage!

Jules

User
Posted 12 May 2026 at 11:16

I did almost 2 years on Zoladex. (I didn't do Abiraterone - it wasn't used this way back in 2019.)
At the outset I was told 18-36 months of HT.
At the 18 month point, my PSA was <0.01 and I was told I could stop any time - up to me. (If my PSA had been 0.5 or more, they would want me to do the full 36 months.)
I already had the next Zoladex in the fridge and it wasn't causing me any issues I couldn't put up with for a bit longer, so I took that which took me to 22 months.

Testosterone came back quite suddenly 9 months after last injection ran out.
It takes your body about another 3 months to respond to the return of Testosterone.

I would strongly recommend getting Testosterone level added to your PSA tests when you come off HT, so you know when it's come back. My oncologist did that anyway because he said you can't interpret the PSA test results unless you know when and how far Testosterone has returned. They kept doing the Testosterone tests until the level was stable for a year (one of the potential failure modes is Testosterone initially comes back, but then drops away to nothing).

 
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