Is start stop approach of ADT an accepted protocol

Hello Warrior, you ask a really good question!  I don’t know the answer but what I do know is that my husband was on decapeptyl for 18 months. He finished it May 2024. One year later and he’s only really got his energy back! So, I question whether stopping / starting , say 3 months on and 3 months off would actually make much difference?

incidentally, he, too was diagnosed with borderline osteoporosis this year - prescribed just calcium and vitamin D supplements 

Hi Warrior68 . Thanks for another good question and looking at your bio I can understand why you have asked it. When you are first diagnosed with prostate cancer it usually consists of different types of cells (heterogenous). As they grow each cell multiplies in its own image (homogenous) and sometimes a cell can escape from its primary source and lodge elsewhere prior to you having your initial radical treatment. After a Prostatectomy a recurrence is usually in the prostate bed when not all the cancer has been removed and, depending on your risk factors, you will be offered adjuvant or salvage radiotherapy. Depending on the initial radiotherapy dose it may be possible to have additional radiotherapy to the pelvic area to sort out any further spread in that area. Most prostate cancer cells react to hormone therapy for a time but eventually one of these homogeneous types of cell can find a way round the hormone therapy and continue to multiply and needs a different strategy to keep it under control. It is my understanding that it is the continuous use of hormone therapy which prompts the cells to find this escape mechanism. Intermittent hormone therapy is thought to delay the time until the cells overcome the suppression and so improve the quality of life. How long you come off hormone therapy for depends on how long the PSA remains low. In terms of overall survival I think the jury is still out when comparing intermittent to continuous HT but in terms of QOL and time to recurrence then intermittent HT has its benefits for those eligible.

Hi thanks for your detailed answer. My worry is the QOL. The hormone therapy is jus sucking my energy,  and comes with its own side effects ranging from elevated liver enzymes, developing long QT, high lipids, hyperglycemia.

In my case after 6 months of ADT I am now in the diabetic range, with a HbA1C reaching 6.7. Triglycerides have also increased, and i am losing BMD fast. Bordeeline osteoporotic within 6 months of adt.

I plan to take it up with my onco in my next apptt. 

Thanks a million

 God bless  you.