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.