Dr. Myers: Can you give me your opinion about ADT (Casodex/Finasteride) used ALTERNATEVILY, …as in taking it until PSA goes down to say, 0.05 and then stopping until a predetermined say 2 or even 3 or 4 PSA. In my case there is Quote: “biochemical evidence for recurrence, likely metastatic rather than local based upon hi-grade nature of the cancer, (T3 at NOMO..Gleason 4 + 3 = 7) rather short doubling time (6 mos) and clean margins” I understand there is a point where ADT will be ineffective, so why hasten this end point..do you call it clinical failure? And at what point do PSA numbers indicate bone or tissue metastatic involvement? What I am trying to do…justify… is to stay away from the effects of ADT as long as possible and to hell with longevity if it involves sick and uselessness. I had prostectomy 5 years ago and 3 years after that PSA came back..started Casodex/Finasteride end of Mar 2009 at 2.1 PSA & stopped in 3 mos at .05 due to side effects that caused concern with my Urologist/Surgeon.. I value your opinion…Thank You Tom
You are basically bringing up the issue of intermittent hormonal therapy. However, most clinical trials on intermittent hormonal therapy involve 9-13 months on treatment. What you propose is a form of intermittent hormonal therapy that has not been adequately investigated for me to recommend. My approach is quite different. When I start hormonal therapy, my goal is to put the patient into a complete remission. By this, I mean a PSA less than 0.01 ng/ml and complete disappearance of metastatic disease like bone metastases or lymph node involvement. Additionally, we try to reach this goal within 12 months if possible. At that point, we then stop hormonal therapy and place a patient on a program to prevent or slow the disease from recurring. Most of our patients remain off hormonal therapy for at least two years and a number are approaching ten years. With this approach, Lupron and related drugs usually stop working after 4-7 cycles of treatment. If you take those who need to go back on hormonal therapy early at, for example, the two year point off hormonal therapy, they will have had one year on and two years off or three years per cycle. This means that these patients will fail Lupron after 12-21 years. In contrast, when hormonal therapy is stopped at a PSA of 0.05 ng/ml, the cancer will rapidly regrow after treatment has stopped and you will likely have to restart treatment within 12 months. You mention side effects of hormonal treatment, but except for loss of sex drive, most of the side effects from treatment are easy to treat. For example, hot flashes decrease dramatically when patients are placed on Vivelle dot patches, 0.025 mg every 3.5 days. That treatment also appears to be very effective at preventing bone loss.
So, I wonder what side effects you are having and what has been done to manage them?
