PC treatment after age 70

jimekrut

I'm 73, White male, diagnosed Nov. '24 with lesions in the prostate (Gleason 7: 3+4 and 4+3) and PET scan indications of activity in right and left iliac nodes.

I am in my fourth month of daily Orgovyx and yesterday completed my 32nd of 44 radiation treatments for prostate and pelvis. Urologist and radiation oncologist are recommending 24 months of Orgovyx.

My expectation is to die with prostate cancer but from other causes within ten years.

Does someone here have research, experience, or other resources to suggest whether ADT for a full 24 months is advisable? Stopping at age 75 with probable 5-8 years remaining and a considerable time recovering (to the "new normal") from the side effects just doesn't seem all that smart. With information from pcri.org and NIH, I'm considering stopping at a year or less if my PSA has responded well to treatment.

I'll appreciate your input!

Old Salt

The life expectance for a 75 yr old male in the US is ten years.

Just don't get hit by that bus…

Josephg

Two years of ADT has become an accepted standard of care in some PCa cases where metastasis has taken place or has a high probability of occurring. This standard of care has been used in Europe for some time with very good results. I went through the two year ADT treatment protocol along with SBRT after my metastasis in my pelvic bone. I am 72, and I have been undetectable for 2 years and 3 month so far.

There is no getting around it, ADT can be tough, so each of us needs to make the final decision regarding yes/no and for how long. It does impact quality of life, so that has to be factored into the decision. For me, I'm happy to follow my Oncologist's recommendations, as they have taken good care of me and my PCa for well over a decade.

jimekrut

https://csn.cancer.org/discussion/comment/1722121#Comment_1722121

Thanks! I'm a bit skeptical of what quality of life will be left after two years on ADT. Hopefully I'll make a better informed decision by Christmas, following completion of radiation and a couple of three-month follow-up PSA results. Today's a good day, but a couple of weeks ago the side effects were so strong that my sweet wife told me it was okay with her if I discontinued treatment. If I can make it to 80, anything beyond will be a bonus, but stopping treatment now likely wouldn't get me there.

swl1956

Jimekrut,

I'm currently in a similar scenario. 68 year old with cancer in the iliac nodes. I'm taking Relugolix (Orgovyx) plus Zytiga (Abiraterone) prescribed for 24 months, and currently on 23 of 40 IMRTs. I do believe this is a fairly standard approach to locally metastasized Pca. However in your post you didn't mention a second generation hormone drug (Zytiga or others) which statistically gives a substantially higher chance of remission? The combination of ADT and radiation is wearing me down a bit, but I'm hoping a while after finishing the radiation things might improve? But yes, I too was thinking about asking if a shorter course of ADT might be appropriate perhaps one year or 18 months? I think PCRI info you're referring to also states that close monitoring after cessation is essential. This way if PSA rises and appropriate scans are done to locate the bandit further treatment can be recommended. Sometimes depending on location and number of spots if found, radiation can be applied directly to cancerous area with practically no side effects. Mark Scholz indicated he's had some patients having spot radiation that did not require any further treatments. Anyhow, I believe some of the cutting edge stuff is not yet recognized as Standard Of Care which makes it a bit difficult when working within the systemic recommendations of many cancer oncologists. I think you have a valid question to discuss with your oncologists. I too plan on this discussion with my medical oncologist, but it's too soon yet. Like you, some days are better than others. Hang in there!

jimekrut

I have wondered about adding Zytiga, but so far it's just Orgovyx. I recall Dr. Sholz commenting that the second drug adds protection but no more side effects. My first PSA after radiation is scheduled for May 22. I'm wanting to get a couple of 3-month favorable PSAs before discussing stopping ADT. All the best for your treatment success!

Josephg

I did failed to mention above that my two year ADT treatment was actually a cocktail treatment of Lupron, Zytiga, and Prednisone. This is the cocktail that has been used successfully in Europe to improve remission outcomes. IMO, the ADT cocktail is no more difficult to handle than Lupron alone, as I previously had that ADT treatment, as well.

jimekrut

https://csn.cancer.org/discussion/comment/1722148#Comment_1722148

Just to note that I had a primary care checkup soon after completing radiation, and my PSA had dropped from 6 to .11 the day after 44 treatments were completed. I had official oncology labs done a month following radiation and will find out the results 5/29. Hopefully PSA is still dropping.

Clevelandguy

https://csn.cancer.org/discussion/comment/1722883#Comment_1722883

Hi,

Sounds like your radiation plus ADT is controlling the cancer. As long as you are tolerating the side effects of the ADT if it was me I would stay on the ADT. Future PMSA PET scans will hopefully catch any new areas which again can be radiated.

Dave 3+4

jimekrut

https://csn.cancer.org/discussion/comment/1722887#Comment_1722887

I'd say I'm more surviving ADT rather than tolerating it. Darolutamide seems to have fewer side effects while preventing any remaining cancer cells from becoming castrate-resistant. This will definitely require consistent PSA monitoring. I have an oncologist conversation this Thursday.

swl1956

Hi again Jimekrut,

I have an appointment with my medical oncologist in a couple of days. I will be asking her about perhaps shortening the ADT course, but from what I've read it's doubtful she will recommend it. Have you discussed with your oncologist adding Zytiga (Abiraterone) with 5mg prednisone? Perhaps I'm just lucky but the combination of Orgovyx, Zytiga, and prednisone has been pretty tolerable for me. I do get the hot flashes especially at night, but other than that I feel pretty good. I have been struggling a bit with urinary frequency / urgency but that only started during and continuing after the IMRT sessions. I started on the ADT combination in January and finished up 40 sessions of IMRT end of April. My PSA has dropped from 9 down to .04 which is considered undetectable. Most things I've read are consistent with this approach for metastasized Pca and it's what my medical oncologist at Fox Chase Cancer Center immediately prescribed for me. It's been shown with clinical trials that the combo of drugs produce better outcomes. Anecdotally, I believe the prednisone gives me a little more pep and has reduced my arthritic back pain. I'm not an exercise nut, but I have been taking a brisk 3 mile walk daily and do a few calisthenics a couple times a week. I believe it helps with the ADT side effects. I have had to pee in the bushes a few times at the park where I walk due to the urinary issues. Hope no one calls the cops for indecent exposure, but when I have to go, I have to go. Lols!

Here's a google AI explanation:

"Zytiga (abiraterone) is added to Relugolix (Orgovyx) in the treatment of advanced prostate cancer to enhance the effectiveness of hormone therapy by targeting different aspects of androgen production. Relugolix is a gonadotropin-releasing hormone (GnRH) antagonist that suppresses testosterone production in the testicles, while Zytiga inhibits an enzyme (CYP17) that is crucial for androgen production in the adrenal glands and within prostate cancer cells themselves. This dual approach aims to significantly reduce androgen levels, potentially leading to better disease control and longer survival." 

Anyhow, congrats on your reduction of PSA. Hope your side effects subside.

jimekrut

https://csn.cancer.org/discussion/comment/1722890#Comment_1722890

Thank you! I have a call with my radiation oncologist Thursday. PSA monitoring is of course vital. At issue is that my oncologists disagree on the status of my disease. The radiation oncologist agrees with the PET interpretation as metastatic; the hormone specialist thinks the scan was misinterpreted. Both say they will allow adding the second drug but that their patients report much worse side effects. If I add or as I prefer switch, I want to use Nubeqa because its side effects are listed as fewer and less strong, and then only add Orgovyx back in if PSA rises or isn’t low enough. Fortunately, my insurance covers it. I look forward to hearing the results of your coming appointment!

jimekrut

https://csn.cancer.org/discussion/comment/1722891#Comment_1722891

from my 12/9/24 PSMA PET scan

Marlon

"My expectation is to die with prostate cancer but from other causes within ten years."

Your urologist will count that as a success!

Paul_Cancer_Survivor

https://csn.cancer.org/discussion/329236/pc-treatment-after-age-70

Good Morning,

I have been on the combination of Orgovyx and Xtandi for 14 months now, and the meds are working well, my PSA is at an undetectable level. Side effects are minimal although it would sure be nice to be done with all the hot flashes.

But that's me. (Age: 72, Gleason Score 9, BRCA1 Gene, Prostate removed in 2017.)

We all know our individual situations differ. Some of us may be handed a "Medical Vacation" by our oncologist and some of us may be at a risk level that precludes this.

So onward we go. In the face of all the uncertainties we confront, let's be mentally strong and push back against the anxieties and fears cancer attempts to create.