r/ProstateCancer • u/Plugger59 • 6d ago
Question Challenging ADT duration?
I’m one month in on a 24 month course of Orgovyx and Nubeqa.
I’m wondering if anyone out there has consistently had basically undetectable readings a couple of times in a row and was allowed to stop before the end of their term?
UPDATE: I should have posted my history. PSA 10+. Biopsy showed 9 of 12 sectors positive: 2 4+3 and the rest 3+4 or under. RALP on 2/25/26. 2 positive margins. PSA 0.4 10 weeks post surgery. PSMA PET scan showed 5 lymph nodes with tracer detection.
UPDATE 2: I am currently finishing 25 fractions of photon radiation.
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u/C63Sedan 6d ago
I had undetectable PSA and testosterone for nearly my entire course of treatment that was scheduled for 24 months for node metastatic spread. Because of QOL issues and assessment of scans and readings, MSK deemed I most likely got maximum benefit at 18 months so I stopped.
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u/KReddit934 6d ago
Depends a lot on diagnosis, details, and what odds you want to play. Is this primary treatment for advanced cancer?
I'm intermediate, unfavorable...but just so.
My RO's resident came out and at first said 24 months, but the RO said, No, no... only 6 months adjuvant to EBRT.
Studies are showing that shorter durations for intermediate are enough. https://youtu.be/UFPakxHnkLs. Watch all the way through...he discusses higher risk cases. (but not recurrence, I think.)
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u/Maleficent_Break_114 6d ago
There is there a lot of people on here who say it’s not a big deal and but it’s really up to your doctor some of them guys won’t wanna give an inch
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u/PeacefulShards 4d ago
What are you doing about the recurrence? Radiation?
ADT is not meant to be curative.
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u/Frosty-Growth-2664 4d ago
I presume you're also having salvage radiotherapy, including the pelvic lymph nodes?
It has to be said, you're a very high risk patient, close to being incurable. This treatment could be your only chance of a cure. I would be looking to maximize its effectiveness to give you the best chance, rather than trying to reduce it. The PSMA PET scan won't have picked up any micro-mets (mets too small to show on any scans) which could be outside of the region treated by the radiotherapy. It's the period on ADT after the radiation which tends to wipe those out.
It's excellent that the ADT has brought your PSA down to undetectable, but you need to hold that there for a period. One UK oncologist who has looked at this said it looks like at least 18 months ADT after radiation is required to kill micro-mets which were outside the region treated by the radiotherapy.
If this treatment doesn't manage to clear the cancer, you could end up on ADT for life. I personally would be trying to avoid that (I extended my time on ADT past the minimum my oncologist required). However, different people view risks differently - there isn't one right answer.
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u/gawalisjr 6d ago
Why 2 ADT meds?
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u/Plugger59 6d ago
They suppress testosterone by two different processes. They’re covering all the bases.
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u/PeacefulShards 4d ago
ADT is only adjuvant to a treatment like radiation or chemo. You might get undetectable PSA with only ADT, but it’s still there.
What do you have planned.
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u/Natural_Science_2112 15h ago
I did the two ADT years and radio. Now testosterone is back to lower end of normal and PSA undetectable. PSA was 0.6 post surgery.
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u/WalnutRoasted 6d ago edited 5d ago
It only takes a few escaped PCa cells to metastasize and get growing again….and they won’t be PSA detectable…for quite a while. Most on ADT after 4 months have undetectable T and almost undetectable PSA (0.01 or less) and / but might still be at risk of BCR.