On June the 4th I reported on the SWOG-9346 study presented at the ASCO Meeting in Chicago (http://advancedprostatecancer.net/?p=3264). In the presentation by principal investigator, Maha Hussain, M.D., F.A.C.P., from the University of Michigan Comprehensive Cancer Center, Dr. Hussain reported that intermittent androgen-deprivation (IAD) therapy is not as good as continuous hormone therapy with regard to a man’s longevity!
Since the release of the study many other commentators have discussed the study and I too have had a chance to mull over these results. Immediately after the June 4th post, I became engaged in a conversation on the Advanced Prostate Cancer On-Line Support Group about the significance of the study and what changes, if any, I would make going forward (I am currently on an off period of IAD).
At that time I said I would need to think about what my future plans would be going forward. Although I have not yet had the required conversation with my doctor, I have tentatively decided to continue with an intermittent schedule.
I first wish to explain that I do wish to extend my life, despite this I am strongly leaning to stay on the intermittent schedule. Here is my reasoning:
1- In the SWOG study they used the PSA cut off number of 4.0 ng/mL or less to determine who could qualify to be in the trial. Anyone who cannot get their PSA numbers to become undetectable, or near to undetectable, is not having a success with their hormone therapy. Men with an unsuccessful round of ADT cannot yield clinical trial results that are valid for men who have had a successful round of ADT.
2- The trial also confirmed that IAD allows for a better quality of life (QOL). I do believe that my QOL is a factor to be considered when I make treatment decisions.
3- The trial was set up with a pre-determined PSA number which served as a trigger for a return to ADT. I believe that in reality the trigger number for a return to ADT should depend on the man and his cancer. Since my doubling time is usually under 6 months I do not allow my PSA to raise over five. Men with a longer doubling time could easily let their PSA number go a little higher.
4- The speed that the PSA number responds to the start of ADT should also be considered in the decision of when to re-start ADT. In my case the PSA responds quickly and dramatically telling me that the bulk of my cancer is still very responsive to hormones.
5- Previous research has indicated that both IAD and continuous hormone therapy are equals.
Currently, I plan on staying on an intermittent schedule. Again, this is my personal opinion for my own treatment of my advanced prostate cancer.
Joel T Nowak, M.A., M.S.W.
Joel I too am currently on IADT and into my 2nd phase after being diagnosed with metastatic prostate cancer in Feb 2006. I believe it works for me giving me that key element QOL but it also allows my body time to reduce the amount of the drugs circulating in my body. During my first phase of HT I was able to stabalise my PSA at 0.1 from a starting point of 125 after 18 months off HT my 2nd phase took me from a PSA of 55 (considered much too high some say 11 should be the maximum) down to 0.1 again I have now been off treatment for 9 months and my PSA is 5 so I suppose I will be back on HT again in a couple of months. Am I shortening my life? I will never know but the research suggests not so the QOL is worth any risk.Good luck Joel
“Since my doubling time is usually under 6 months I do not allow my PSA to raise over five.”
Why not let it rise to 10 or 15 before restarting?
I am in just that position now, with PSA of 6 and doubling time of 5 months. What’s the rush to return to ADT- should still be asymptomatic until more than 20?
thank you
I have final stage, gleason 9, PC and am now castrate resistant. I was diagnosed in 2008.
I had 18 months of ADT followed by a nine month holiday when my psa reached nadir of 0.3. After returning to ADT (Zoladex), it no longer worked after another 6 months.
My urologist wanted me to continue indefinately with the ADT. When asked why if it no longer works he replied that it was the only thing he had to offer (wrong answer 🙁 )
As a late stage metastaised PC patient, the recent findings probably do not affect me.
However, the ADT side effects destroyed my quality of life so badly that I do not regret taking the hormone holiday – even if it has shortened my lifespan.
Hi Joel and thanks again for your analysis and thoughts on this studies result. I too prefer intermittent for quality of life and was wondering what to do, but, your careful explanation, especially concerning the 4.0 PSA level was very insightful. You are one amazing guy.
Ron Gerhard
Clearly, this is a very personal decision with no science behind any decision to start at any number. Although I agree the chances are excellent that I would be symptom free with a PSA of 20, I don’t feel comfortable allowing that much cancer to develop in my body. I hope that by beating it down while it has not progressed much I have a better shot at keeping it under control for a longer period of time.
Each of us should decide what PSA level we are most comfortable at when re-starting. There is no science behind any of our decisions, just hope and faith. I too wish you the best and happy Father’s Day.
If you read yesterday’s post it is not so clear to me that taking an ADT holiday necessarily shortens anyone’s life. There are many treatments available that can extend your life once hormone therapy stops working. The reason to continue on ADT is that there is probably a number of cancer cells in your body that do actually still respond to ADT. Find an oncologist who treats many men for prostate cancer and change over to their care (from the Urologist). Download my free “Guide to Advanced Prostate Cancer” to see the many possible treatments that are available to a man in your situation. (download at: http://malecare.org/advanced-prostate-cancer-program/).
Joel
Ron,
Thanks for the nice comment. Again, remember that there is no science behind my decision, just what I am comfortable with in the process of living my life.
Joel