How do you counsel patients with high risk prostate cancer treated with RT + long term ADT who want to allow their testosterone level to rise above castration before receiving their next Lupron injection?

I would not support this strategy unless the patient is on longer term ADT for biochemical recurrence after prior local therapy. In that setting, intermittent ADT is a viable option supported by literature and could be considered. Otherwise, once ADT is stopped, there's no basis for resuming.

The conversation would change to whether ADT can be stopped. Many patients find prolonged ADT difficult and in individual cases, the patient and I, together, sometimes decide to stop earlier than initially ...

For someone on LT-ADT for definitive management of prostate cancer, I presume they are receiving a total of 18-36 months of therapy. The concept of ADT is to keep the patient in a castrated state throughout this duration of time, and to do it in a manner that can be reversed by cessation of medication.

Thus, 'waiting' for testosterone to recover between doses is likely to be actively harmful to a patient's oncologic outcome compared to continuing on it regularly. That is what I would tell the pa...

I'd tell the patient it comes down to whether they think the ADT is doing something to help their cancer treatment or not. If the answer is "yes", then why would they want to wait until they were sure it wasn't doing anything before delivering it again? If the answer was "no", why take it at all?

And from a practical POV, I'd ask why the patient would want to spend the time worrying about, presenting for, and paying for, a bunch of testosterone levels rather than just getting a couple more shots...