Understanding Intermittent Hormone Therapy For
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- Опубліковано 26 лют 2024
- Embark Clinical Trial: Improved Outcomes with Enzalutamide in Biochemically Recurrent Prostate Cancer: www.nejm.org/doi/full/10.1056...
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1:13 What is intermittent hormone therapy, and how does it work?
4:43 How is intermittent hormone therapy administered?
6:12 Is letting a patient's PSA rise to 2 advisable during therapy?
8:24 Is nine months a reasonable treatment period before considering a holiday?
9:12 How often is PSA checked during intermittent hormone therapy?
9:33 Does the type of therapy matter during intermittent hormone therapy?
11:13 Is intermittent hormone therapy complicated for insurance coverage?
12:00 How much do side effects usually recede during the holiday period?
13:45 How long can intermittent hormone therapy last?
14:45 Alex's conclusions
15:13 If you need help
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Yes, 6 years intermittent, my choice with approval from my Onc. Happy
I'm from the 🇬🇧 uk aged 55 psa 125 gleason 3+4just started adt minimum 18 months i was told. Start radiation therapy in a couple of months, these videos have been a blessing so much information thank you so much.good luck to everyone going through this🤞👍
Great news. I'll be asking my medical oncologist about a holiday soon. I've been on ADT for 7.5 months. Last two PSA tests were
Please provide a link for the 5 year study, that was published by, New England Journal of medicine, about Intermittent Hormone therapy.
Thank you so much Dr Scholz and Alex...you have been my main source of information on prostate cancer since my diagnosis about 2 years ago.
Im reaching my one year mark of ADT in May and i am seriously considering taking a holiday because of the side effects. My PSA is currently 0.07ug/l. 😊
With such a low p , s , a , why in the world would you be on hormone therapy ....STILL,,.!!!!???!! W T F ? duh. Just saying.
I have been on Intermittent hormone therapy since 2013 after surgery and radiation with a residual psa of .28. This was by my own request after reading about it.
Great info. Thank you!
Thank you
Really,really good video, thank you very much
As usual, excellent video.... All the best
Thanks a lot Dct Scholz and Alex, for this great and interresting video. And greatings from Belgium for you and everybody who pass by. Noel
Thank you for these videos! We so appreciate having a resource that helps us understand all our options ❤
Thank you, folks, so very much! Your shred information is appreciated!
Male aged 78, five years ago had a PSA of 10, Gleason 8, had 28 doses of radiation plus firmagon injections monthly. PSA dropped right down 0.04. Almost three years ago it went up to 5. My urologist suggested biopsy, small amount of cancer detected Gleason 8-9. Had a pet scan small amount spread to pelvic lymph node. Was put on Erleader and three monthly Eligard injections. PSA almost immediately dropped to 0.01, has been at that for two years now. Get the 'sweats' every three hours and muscle aches, bearable but a pain in the ass. Have my three monthly check up and Eligard injection coming up next Wednesday. Going to tell them I am coming off the meds for a three month trial after seeing this video. Have a feeling that they will object but am going to do it. Thanks for all the videos and information.
How did it go with docs?
Went to the oncologist last week, PSA up to 0.06, barely measurable. Told her I am coming off Erleada and Eligard for a while. She did not agree said the PSA is on an upward trend which is not true it has varied between 0.01-0.06 for the last two years. Anyway said she did not recommend it and I need a bone scan which I agreed to, end of April. After two days of stopping the treatment my muscle aches almost disappeared and my energy levels increased dramatically. The sweating is still there but seems to be decreasing. Almost a week on I feel 100% better than I did one week ago. Muscle aches gone and energy levels back up.
One other point, I asked the Oncologist if she had heard of Dr Sholz, she had not.
Best,
GM
Have been on Xtandi and Eligard for several months. I am active and go to social events, but all my friends know I have cancer. They say it will prolong my life but they can't cure it. Im living with hot flashes, constipation, backaches, no sex life and fear of seizures or heart attack. I have to ask myself: Is it worth it?
@@Mrbynby I have been off my medication now for one month, immediate reaction was getting my energy back and feeling generally better. The three hour sweats are now just diminishing in effect, i.e. less sweat now but still get them every three hours just not as intense, just shows how long the medication stays in the body. Not sure if it is Eligard or Erleader that cause the sweats, probably both. Going for a PSA check next week paid for by myself. See how that goes, if it is up significantly I will go back on the meds. For the sweats I bought a $21.00 neck fan from Amazon, found it effective during the day, only needed it on low speed for about four minutes, a charge lasted me almost a week. In bed I have a bedside fan which I use. I am 78 and I think it is worth the pain in the backside to have the treatment. Just hoping the break in treatment goes OK.
@@Mrbynby PSA was 0.1 last week, has been around 0.04. See how it goes over the next month. Not sure how accurate these PSA measurements are, there must be some variation tolerance/accuracy in the measurement.
Thanks!
Alex, as a followup to this helpful video regarding intermittent therapy, I think it would be a very good idea to look at what Hopkins is doing with their BAT approach. Here when ADT has failed and the patient appears to have high PSA's they stop the ADT, let Testosterone return and cycle this for a bit and it then seems to have re-enabled the ADT to begin working again. This finding could be why Intermittent therapy might work cause re-introduction of the therapy after a wait period, may somehow enable the ADT to become effective. The average medical oncologist seems to lock and load people on ADT explaining that it will fail after 2 years and then you can "try" another one. So the "on and "off strategy could be an important therapy regimen to extend the utility of your initial ADT as well as give you more runway to engage with a new ADT.
Very relevant discussion, and very useful
This is the most helpful and informative site. I’m a UK patient with recurrence after radical prostatectomy and now experiencing the hormone therapy, Zoladex with holidays. Thank you.
Very interesting, thank you. I stopped Zolodex after 18 months. I am considered in remission. This information is very helpful. You are my major source of prostrate information. Thanks you such a lot.
Thanks for sharing
Thanks
So good to hear you guys talking about BAT!💪🙏
(Bipolar Androgen Therapy)
BAT is a different treatment modality to IHT. BAT gives 4-weekly testosterone injections while the patient remains on a T-blocker; IHT involves periodically ceasing to use T-blockers for periods when PSA is low.
BAT has less empirical support than IHT, but is promising way to "re-sensitise" CRPCa to ADT.
Very informative
I do appreciate you both and PCRI, so please don’t take this as a negative comment. Many of your videos talk about initial PSA in the less than 10-50 arena. What about us folks with more than 1,000 initial PSA reading, (mine was 1,300 with a Gleason 4+5)? I’m on first and second gen meds, Xtandi daily,and Lupron every 6 months, and Xgeva monthly. Mets to spine, arms, and ribs. PSA reading of 0.09 in less than 4 months after beginning treatment. No chemo, no radiation, no surgery. PSMA PET scan after 10 months showed clear. I had my 2 year anniversary of my diagnosis last week. Is taking a ‘vacation’ from ADT realistic for men like us?
Good question and your comments will give others optimism. Really would be good to get an answer.
Yes. Great question! Family member same as you. He did an initial ADT injection, now daily Abiraterone, prednisone, Lupron (I think) every three months. Docs say he’ll be on meds for life. He’s 75. Recent images showed no mets. Has bone pain in one spot but radiation seems risky. What’s the current thinking on treatment?
If it helps I can just relay my journey so far. Was diagnosed 4 years ago with PSA 587 . Gleason 10. Mets to lymph nodes , spine, hips and ribs. Did one year of ADT which got my PSA down to 0.01. After that I have been doing intermittent hormone therapy successfully. My doc allows PSA to climb no higher than 4 then restarts ADT. It was on this channel that I discovered the possibility of doing intermittent . Thx Alex and Doc Scholz! Luckily my doctors were open to it. Quality of life off the ADT is amazing and gives one something to look forward to. Blessings!
@@maverickat4544 How long would you be off ADT before needing to be back on, and how long are you on again?
Thank you for sharing your stories! My husband had a PSA around 400 and a Gleason of 9 total. (I don't remember the breakdown.) He is on Lupron quarterly, Zytiga daily and had chemo. PSA is now .25. He was diagnosed a year ago. It is very helpful to hear from others with years of a very low PSA and to hear about experiences with intermittent ADT. We will discuss it with our oncologist if the PSA drops further. We appreciate that you took the time to comment 😊
Thank you for this fantastic presentation on intermittent hormone therapy. Sadly there is so much resistance from oncologists when it comes to do doing IHT in high risk metastatic prostate cancer.
Orgovyx+abiraterone is this considered 1st and 2nd generaton? Keep the videos coming!
One 3+4, three 3+3. Targeted fusion biopsy. Pirads 4. Psa 7.12, age 70. Intermediate favourable. Radiation and hormone therapy offered. I have elected to pass on the hormone. RO is onboard as we can start the HT down the road if needed. I would appreciate your thoughts on my decision which was based on a lot of research and quality of life concerns. Thank you.
Does this apply to Matastatic prostate cancer also ?
Great video
Thank you
My dad was diagnosed with pc in November of 23. He was diagnosed with a gleason score of 4+4 with a psa of 198. Started nubeqa and 3 month injections in January due to insurance issues on getting a psma pet scan. Psma scan was done in January of this year and they found that he had pc in prostate, liver, lungs and tail bone. Today psa is a 5 and cancer in lungs was a 9mm and 2 months later it was at 12mm. No chemo yet as he is kinda weak. Please let this be on next new video. Thanks
Another educational video that's helping me prepare for my first appointment with a medical oncologist in 3 weeks.
I had an RP in January 2011 where the prostate came out cleanly (negative margins, no ECE, LNI, SVI, pathological Gleason 3+4). I was undetectable until September 2015 when my PSA hit 0.05 ng/mL. It took until July 2021, nearly 6 years later, for my PSA to hit 0.21.
I really wanted to see if we could find the cancer's location BEFORE starting salvage radiation therapy (SRT), so I had a PSMA PET scan at UCLA at the end of November 2021 when my PSA was 0.22. The scan showed no signs of cancer.
My PSA began to accelerate in its increases, and by April 2023, it was 0.36. We agreed to start concurrent ADT and SRT, with a six-month dose of Eligard in May 2023, and SRT to the prostate bed only in July and August 2023.
Thanks to the Eligard, my PSA dropped to 0.05 in November 2023. The Eligard wore off and, in March 2023 my PSA was 0.13 and in May 2023 it was 0.11, giving early indications the SRT was working. But in late October 2024, my PSA nearly doubled to 0.21 and, five weeks later in early December 2023, it was 0.37-higher than when we started SRT.
Bone and PSMA PET scans in January didn't reveal any cancer even with the higher PSA, and I meet with the MO on19 March to map out what's next. These videos are helping educate me in advance of that appointment. Thanks!
I’ve seen a couple of recent videos suggesting that those choosing post-RP salvage radiation to the prostate bed (in the absence of PSMA avidity) should now consider including pelvic lymph nodes too.
Don’t know if that was always common practice or if it is becoming so.
Hi, not clear to me, why did you agree to go on with ADT and ART (I think it was Adjuvant RT -not SRT) with such low PSA value (0.36) and no shining spots detected on psma pet? Was not a good option just wait for higher PSA detectable on pet scan and just after that go for SRT targeted on shining spots? Thanks
@@steppenwolf3930 Thanks for your comment. Adjuvant radiation therapy is usually given not long after surgery to help prevent recurrence. My radiation therapy happened over 11 years after my surgery, thereby classifying at salvage therapy.
Current literature shows that in some cases, offering ADT concurrent with SRT is beneficial and offers a better chance of success. My medical team agreed with that approach as well.
In some ways, I do regret not waiting for the lesions to become detectable on a PSMA PET scan. Even though my PSA was low (0.36) the factor that played a large part in my decision to go forward was the fact that my PSA doubling time dropped from several years to six months. The acceleration in the increases was quite concerning to me.
Lastly, current literature also suggests that SRT is most successful when initiated when your PSA is below 0.5 ng/mL. The 0.36 number was rapidly approaching the 0.5 number.
Add it all up, and that's why I elected to get SRT with concurrent ADT.
Ok, thanks for quick answer. I asked, as have to decide what to do next. My surgery 3 months ago failed (psa after surgery 30. Before 40,Gs 9.), so cancer was spread somewhere .. 2 months ago I started ADT And despite the fact, that following psma "was negative" and psa decreased to 0,01 doctors suggested to go for additional radio therapy-some pelvic node And prostate bed. But I am not sure how effective could be this "on blind" radiarion, taking into account potenciál negative side effects?!
@@1958zed Good luck. I'd be interested to hear what your Oncologist said in March. Are you able to have further RT or another psma test?
👍 Why is Glasgow adding mebendazole (iirc) to Docetaxel?
Many thanks. Does your reasoning hold in cases where the patient has a gene mutation such as BRCA 1 or 2?
Madan what about estradiol hormone for prostrate cancer it worked well in a patient for 2 years lowering psa , with side effects, from India.
Curious about hormone therapy working 17 years as stated in video. I thought castrate residence occurs usually around 2 years?
I had my first Firmagon injection yesterday after 2 months on bicalutimide. Scheduled for IMRT in two months. The biculatimide dropped my PSA from 50 to 8 during that time. Little in the way of side effects from the bicalutimide, most noticeable is the breast tenderness. I am hoping to do a holiday from the Firmagon, if the numbers allow, in 8 months which would give my T time to recover before my 50th wedding anniversary. I am thinking/wondering if going back on bicalutimide during the holiday would be the ticket. As an anti-androgen, it does not stop T production but could help keep the PSA down. Time will tell but wondering if this makes any sense.
Three blood test by different labs (results=22.5/22.5/25) three weeks apart.
Not good I guess.
Link to the article?
Thanks for all your videos, learning.
I am on Lupron and have been for about 2.5 years. My Dr. is talking about a "holiday" as I have been experiencing continuing side effects. Dr. Scholz mentioned that one could go on holiday once the cancer was "undetectable". Mine is .01. is that undetectable?
Is 3 months on hormone blockers long enough if the PSA level is undetectable?
If my psa is 0.06 and I still have my prostate can I expect there to still be cancer my cancer is was in my prostate and lymph node in pelvic and cyberknife radiation therapy Is it possible to have psa and no cancer I had a psma scan while on treatment and there were no more tumors
If I stop hormone therapy, and my PSA rises to some level as you suggest, doesn't higher PSA level energize the prostate cancer which is what causes the PSA to rise, and-- it would also energize the cancer which would likely let it spread ? That would be the time to have a psma pet scan and find where the cancer is located and treat with radiation therapy? I have been on lupron,3mo shots, and casodex for 3+yr. psa .02/.01 Bruce W
I have to have treatment. 😊 prostectimy or radiation. Been T o Four five doctors. I am going to have a Prosta😢ctimy . I am NOT going to deal with hormone treatment ADT!! I will take my chances with carrying around a BAG for awhile. ( hopefully) .
I am Oligo metastatic, a few bone spots....my psa has been 0.01 for last 9 months ....I have had chemo and radiation to prostate....lupron for 18 months should i have my fourth Lupron injection in may? making me have been on Lupron for 2 years Can I have intermittent hormone therapy in my situation ???
😮Hi guys Have a PSA of 15 Have 2 nodules in prostate Will be certainly asking my urologist about intermediate Hormone Therapy That's for the heads up
I like your videos but I can’t find any published articles by the New England Journal of Medicine. Can you refer to this article. I am a frequent donor to your cause but I don’t see where you have personally responded to any comments.
Is it ok for a prostate cancer patient to eat dates or dates smoothies?
My PSA jas been lower than 0.03 for over 2 years. T3b. Nodal metastasis. My oncologist won't hear of me going on intermittent HT. I'm desperate to get my testosterone back. I've no other medical problems and very fit. So confusing.
Is a PSA level of .07 considered an undetectable level or must it be .00?
My doc said
My doctor says
My doctor says
"undetectable" just means that the T level is lower than THAT LAB's ability to detect. It does not mean any specific number. Only the very best labs can detect below the .00 level. Remember, any prostate tissue left after surgery (spared bladder neck or nerves) can generate very small amounts of PSA, so a true 0.0 is rarely attainable, or measurable. After only radiation, the remaining prostate can easily generate a nadir of 1 or 2 even if not cancerous.
I was recommended against vacations. I wanted to go off so I could utilize the axumin or psma scan to git rid of everything, so I changed doctors. My psa is going back up faster than I like to think but maybe that is to be expect when you still have your prostate? I keep wondering if psa density is something I should ask for.
Your PSA went from what to what?
@@truthseeker1959 which time? April of 2020 I went from 2.7 to 5.0 in a month.
I am not taking radiation with adt. Especially when they come up with names like vacation or holiday. That's all b s. Why don't they just call it a break. It make it sound so appealing. "HOLIDAY"? WTF ,,,,!!!!
How long are these intervals or breaks between taking hormones for most people?
Until PSA starts creeping back up
@@daysleeper062 I understand that but is there a common or likely range of how long that interval may be ?
Hi, what is considered undetectable is 0.1 undetectable 0.2 please what is considered undetectable PSA sorry I should’ve mentioned that when I first started at a PSA at five Gleason score of 3.4 out of 12 samples nine came back one and the 10th and came back at two
Lo studio embark, per i pazienti affetti da recidiva biochimica dopo prostatectomia o radioterapia con rapido raddoppio del PSA inferiore a 9 mesi, ha dimostrato che adt + enzalutamide, oppure enzalutamide in monoterapia, in termini di efficacia , sono entrambe superiori alla adt + placebo. Lo studio ha inoltre dimostrato che terapia intermittente rispetto alla continua è efficace allo stesso modo. A questo punto mi chiedo se non sarebbe applicabile la monoterapia enzalutamide anche per gli uomini affetti da cancro alla prostata metastatico sensibile agli ormoni, garantendo quindi un' ottima qualità di vita scevra da quei fastidiosi effetti collaterali che provoca la deprivazione androgenica.
Taking Lupron and Eligaurd wondering if that is normal?
🤘
The NEJM article was published in April 2013. Are conclusions still valid? Any more current research?
Ted, did you ever figure this out. I just read the 2013 article, the best I could, and I didn’t see anything about it being helpful. Others have asked for clarification but I have yet to see any. I really want to take a break but my Dr. at MD Andersen says he know of no data suggesting it’s a good idea.
Can your psa become undectable when you still have your prostate?
No
I still have my prostate and went from 37 to
Yes. It depends on how well your body responds to the hormone therapy. Mine spread to my bones, so surgery was off the table. After 3 weeks of treatment, including radiation, my PSA dropped to 1.0. By the time my radiation was done, my PSA was undetectable at
No way only those that have had their prostate removed and have NO detectable metastasis of prostate cancer cells will show undetectable on the PSA , those that have their prostate will always show a prostate PSA above undetectable -normally around 3-4 , undetectable is 0.01 PSA prostate ca
@@paulmartin2429 I can speak to my own levels... Still have a prostate and last two tests were less than 0.1. The hormone therapy drugs are designed to drive PSA down to undetectable levels, even with a prostate.
Regretfully I received hormonal therapy with a Gleason 7 psa 6 very hurtful MD Anderson did that to me for two months testrone never returned post before oh well I still alive treated 2012
This hormone therapy talking about is it zoladex?
Orgovyx is possibly the fastest to recover from after discontinuing. But it might not be covered by your insurance.
I heard after a year or more, sometimes testosterone does not come back and men are chemically casterated. Is this true?
Do you mean after hormone therapy ??
@@panoramatv6294 yes
I have a PSA of 25 which the doctor seems alarmed about. My Gleason is 3 + 4 = 7. There is no evidence of spread from the scans. I still prefer active monitoring rather than experiencing the side effects of treatments. This is against the doctors advice of 3 years hormone treatment and radiation treatment. 74 years old. Unsure if I am being unwise to go against the doctors advice.
Why not talk to a doctor who can discuss a focal treatment like HIFU with you? Frankly hormone treatment for a 74 year old with 3+4 cancer seems fairly aggressive…I presume the negative scan reference is to a PSMA pet?
Please I need to understand for clarity sake
I’m in Nigeria. My dad started with zoladex nd casodex
He had a relapse after the second zoladex shot his doc had to change the casodex to abiraterone
And he’s been taking those since Jan and I dunno if he’s doing the right thing
Abiraterone (can be 4 a day or 2 a day) is a part of Hormone therapy whereby doctors combine these oral medications with Leugard/Lupron (administered 3 monthly). It helps to reduce testosterone levels and stops the cancerous cells to grow by depriving them on feeding on testosterone. After 9-12 months when the PSA gets controlled the doctor might combine a radiation or surgical removal of prostate gland given that the above medication has helped in localizing the disease.
@@piyushmaheshwari4824 is lupron not the same therapy as zoladex?
He takes zoladex every 12 weeks
I only hear about lupron here
We administer Abiraterone 4 daily and methypedisolone daily. Some pain killers and oral blood tonic
I will never allow ADT
Why
@@heartchakra2 due to the horrible side effects
@@Tom-pi1cz I know many who don’t experience
Thank you