When to stop ADT?

[Guest guest]

Hi All,

I would like to poll your thoughts and knowledge regarding my

husband's dilemma of when to stop his hormone deprivation therapy? 1

year vs. 2 years?

Short background: He was diagnosed with PCa in February 2007, PSA 10,

Gleason score 8. We live in the Los Angeles area, he had good access

to great doctors and and latest technology. He consulted specialists

at the Cedar Sinai Hospital, and at City Of Hope. Despite of his high

Gleason score, he was told, that a surgery was still an option. He was

very comfortable when he finally selected robotic prostate removal at

City of Hope in May 2007. Pathology after surgery comfirmed ductal

seminal vesicle invasion (which was suspected pre surgery), and some

positive surgical margins. Neither prostate bed invasion nor lymph

node involevement were detected post surgery.

10 days after the surgery his first PSA test came back at 0.2. As

planned - he was stared on hormone therapy few weeks after surgery.

Fist Casodex, then Lupron shots were administered. At 2-3 weeks into

hormone therapy, he received 7 weeks of external beam radiaton on the

prostate bed. The subsequent PSA dropped to undetectable level, and

remained undetectable so far. His oncologyst's original plan was to

keep him on ADT for 2 years. But based on my husband's request to

re-evaluate the time-length after a year, the oncologyst is " willing "

to approve to stop the ADT.

My husband visited his oncologyst last week. PSA is still

undetectable, the oncologyst gave him the last dose of Lupron, which

will last up to mid July. (That will be a full year on ADT.) But he

still stated, that he would like to keep my husband on ADT for 2 years

(not just 1 year), due to his original high Gleason score. He left the

decision up to my husband. Well, this is nerve wrecking. ly he

does not know what to do. His current testosterone level is 6 (!!!!),

down from about 500. He can reasonably tolerate the ADT, he could

commit to an other year of ADT. But what we would like to know is:

1. is there a real benefit in being on ADT for 2 years vs 1 year.

2. Will his natural testosterone production so athrophied (testicles)

that he won't be able to recover naturally after the ADT is over in 2

years.

3. My personal worry is that he can become hormone refractory sooner,

if there are microscopic cancer cells still around.

Thank you for any help/advice,

Judy