New medication, Apalutamide (a handrogen receptor inhibitor)

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  • G53
    G53 Member Posts: 33
    #22
    Way too low
    VGama wrote: "I expect to restart ADT when the PSA reaches the trigger threshold of 2.0 ng/ml."

    I think to restart at a PSA of 2.0 ng/ml is way too low. See the trial:
    "Locally Advanced and Metastatic Prostate Cancer Treated with Intermittent Androgen Monotherapy or Maximal Androgen Blockade: Results from a randomised Phase 3 Study by the South European Uroncological Group"
    https://www.europeanurology.com/article/S0302-2838(13)00342-4/fulltext
    (cut and paste) and
    https://www.urotoday.com/conference-highlights/aua-2018/aua-2018-prostate-cancer/104252-aua-2018-phase-3-study-of-intermittent-monotherapy-versus-continuous-combined-androgen-deprivation.html

    In this trial they restarted ADT when the PSA value got above 20 ng/ml! As far as I recall the trial included patients with a higher risk than you. But I think you could still wait till your PSA value reaches 20 ng/ml. The only reason could be that you may never reach a PSA value that high during your remaining lifetime. So you will get a very long ADT holiday.

    G53
  • VascodaGama
    VascodaGama Member Posts: 3,701 Member
    #23
    Terminology

    MTOP,

    Some doctors use the term "non-metastatic" in extraprostatic extensions cases of localized cancer. They use this to distinguish from far metastases at areas where cancer has set in organs (lungs, liver, etc) and bone (ribs, etc). I believe that he is telling you that the cancer is localized (at surrounding tissues where the gland used to lay). However, the close lymph nodes expands beyond this area which may be seen differently by other experts. Treatments for localized cases have more assurances of success than cases with far metastases (not you case).

    G53,

    The trigger switches in intermittent ADT (IADT) approaches varies by the initial conditions of the patient and histology of PSA. Aggressive and high risks cases also do intermittent ADT but they use substituting drugs while on ADT vacation. Their approach tend to have shorter terms on vacations (reaching faster the trigger threshold) which leads to use higher PSA levels for allowing the benefit of being in intermitent instead of continuous.

    My case has been established by my doctor according to the period in remission and time taken from nadir to recurrence after RT. My case follows the practice of famous medical oncologists specialists in treating advanced cases of PCa such as Dr Myers. In my case remmission was one year in PSA levels lower than 0.05 ng/ml but Myers prefer at least one year on PSA= 0.01 ng/ml. I also use monotherapy with an agonist alone (if enough). The majority of aggressive cases use 3 blockades with antiandrogen plus agonist plus 5=ARI, therefore an increase in side effects that lead to faster deterioration of other functions. These guys are the ones that benefit the most from IADT.

    Best wishes,

    VG

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