Considering taking a treatment holiday from hormone therapy? Here’s what you need to know

For many people, relaxing on a warm beach in the shade of a palm tree with the sand between your toes and a good book on your lap is the idea of a perfect holiday break.  For many men with prostate cancer, taking a holiday from hormone therapy is a close second. 

Hormone therapy is very effective against prostate cancer.  But there are side effects from the deprivation of testosterone.  The list of problems is rather long and includes loss of libido, fatigue, weight gain, and others.  Some can be managed but others only go away after treatment is stopped.

Some men may wonder if they will have to cope with low testosterone side effects forever!  Luckily this is not the case.  Many men are eligible for a break from treatment, a “treatment holiday,” where they stop the therapy and allow their testosterone to return to normal and their side effects to dissipate. 

Oftentimes treatment holidays, while much desired, generate a lot of questions and even anxiety.  However, after weighing the pros and cons and talking to their doctors, many men find treatment holidays a welcome respite.

Treatment Holiday FAQs:

  • How long before testosterone recovers?

After stopping therapy, testosterone and PSA are monitored every three months.  Recovery of testosterone usually occurs within six to nine months.  Some men may have an even greater delay in testosterone recovery, especially as men get older.  If recovery is too protracted it is feasible to consider taking testosterone in the form of a shot or a testosterone gel rubbed on the skin.

  • Is stopping therapy safe?

Several large, multimillion-dollar studies confirm that intermittent therapy is safe.  They show that men who take holidays have survival time equivalent to those of men who stay on hormone therapy continuously.   The best candidates for a holiday are the men whose PSA has dropped and remains stable at less than 0.1 while talking hormone therapy.

  • When should treatment resume?

When on holiday men should have their PSA monitored every three months and hormone therapy should be restarted when the PSA rises up to 5.0 or dependent on each individual’s specific situation as discussed with their doctor.

  • Can more than one holiday be considered?

As long as the PSA drops to less than 0.1 and remains suppressed during the hormone therapy, it is reasonable to consider embarking on another holiday.  This treatment pattern is often referred to as intermittent therapy.     

  • Do treatment holidays impact hormone resistance?

No, intermittent therapy neither accelerates or retards the onset of hormone resistance compared to men who remain on therapy without taking a holiday. 

  • How long do treatment holidays last?

Multiple factors affect the duration of the holiday including a patient’s age, how long the treatment has been ongoing, how quickly testosterone recovers after stopping, the Gleason score, and other factors.  If men take an initial course of Lupron lasting one year, one study showed that the average holiday period was around 18 months.

  • Does treatment need to be tapered before stopping?

As pointed out above, when treatment is stopped, testosterone recovery takes several months.  So even though the medications are stopped “cold turkey,” the actual recovery occurs slowly.

  • Do any men on holiday remain off treatment indefinitely?

Most everyone has to resume treatment at some point, though I have seen a couple of exceptional cases where men who stopped therapy never needed to restart again.

Conclusion:

For eligible men, treatment holidays are a safe way to improve quality of life.  Many men are excited to recover their testosterone (and their libido).  Others, however, experience consternation when they see their PSA increasing.  Therefore, if the side effects of a low testosterone state can be sufficiently minimized, some men may opt to remain on testosterone deprivation therapy without taking a holiday.  Since studies clearly show that survival is not impacted either way, deliberations about taking a holiday should be based exclusively on the quality-of-life preferences expressed by the patient. 

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