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Intermittent ADT
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cagey8828 posted:
I am a 68 year old who underwent laparoscopic nerve sparing surgery
in Jan 2008. Initial PSA was 4.47 (while on oral finasteride). Pathology revealed positive margin at the bladder neck and minimal microscopic
involvement of one seminal vesicle. Gleason score was 7 (4+3).
One year later PSA increased and I underwent radiation therapy.
In spite of this, PSA rose 10 months later. Doubling time of PSA appeared to be about 3 mo. 0.38, 0.78, 1.44. Combined androgen blockade was started. First PSA was 0.14 and all subsequent tests
are below level of detection (?< 0.10). I am now at 15 months on CAB
and am trying to decide the value/risks of attempting intermittent therapy with CAB. I feel fortunate to have experienced this response.

I am aware of potential benefits but have trouble assessing whether
there is a risk of earlier androgen independence. I would be interested
in hearing professional opinion on this matter. I am aware that there are not prospective studies available to help answer this question..
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Basir U Tareen, MD responded:
You are correct in that there are not any good prospective trials looking at intermittent androgen deprivation. There is a growing number of urologists, however, (including myself) who are starting to use intermittent ADT in light of increasing knowledge of the harmful effects of long term ADT.

I don't believe there is any data to suggest that using intermittent ADT (ie, re-starting ADT when the PSA starts to rise or perhaps using an arbitrary cutoff such as PSA of 10 or doubling time <6 months) has a detrimental impact on overall survival.

I have found that many of my patients appreciate the "drug holiday" and report significant improvement in quality of life when they are able to come off the hormonal therapy -- even if its for a short amount of time.
 
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cagey8828 replied to Basir U Tareen, MD's response:
Thank you both for your response. I am presently on my second round of suppressive therapy. I chose to start early and restart early with the feeling that development of adrogen resistence may well be related to total tumor mass and may be a random event/mutation. So far so good with rapid re-suppression after therapy. kg
 
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cagey8828 replied to Anon_12340's response:
Thanks, see below. kg


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