Average time hormone therapy takes to become refractory.

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LuvMyDAD
Regular Member


Date Joined Dec 2009
Total Posts : 104
   Posted 5/11/2010 5:48 PM (GMT -7)   
Hi guys, I hope you are all doing well. Just to keep you updated with my dad, he is almost half way through his radiation treatments. 4 months after he completes radiation he will take a PSA test, and hopefully (with the help of GOD) it will come back undetectable.
 
I just had a quick question about hormone therapy maybe some of you can help me out. I was reading Dr. Myers's book on hormone therapy and he states that if a patient has not removed his prostate control of the cancer with hormone therapy on average will last longer than someone who has not removed his prostate. It sounds logical but when I asked the doctor (at Soan) he told me this is basically bolony. The average time someone lasts on hormone therapy is 18 months regardless. Has anyone else heard this conflicting information?
 
Thanks,
LuvMyDAD (Lynne)
Father diagnosed Nov. 9, 2009
Open radical prostatectomy Dec. 21, 2009, post op pathology report T3a, Gleason 7
5 week post op psa .55
Combination therapy, hormone and IMRT. 40 sessions 72gy.
Hoping and praying for a cured dad.


BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 977
   Posted 5/11/2010 6:09 PM (GMT -7)   
I have also read Meyers book and am getting an appointment at Sloan right now. I think that 18 months may be may you can expect with continuous HT. But with IHT you get 5 years or so. Would love to here what others think.
Dx with PC Dec 2008 at 56, PSA 3.4, Biopsy: T1c, Geason 7 (3+4)

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Junl 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31
Aril 10 MRI and Bone Scan show lesion on lower spine, no SRT


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3769
   Posted 5/11/2010 7:15 PM (GMT -7)   
The doctor at Slone doesn't know what he is talking about. As far as removing one's prostate or radiating, it accomplishes the same purpose for matastic PC. It debulks the tumor and lessens the tumor burden that HT has to overcome. The length of time HT can control PC depends on the type of PC, whether it is a varient or not and the ratio of androgen independent cells to androgen dependent cells. If the PC is mostly androgen dependent then hormone therapy can last for 15 to 20 years. If psa goes to 0.05 and stays there for 3 months, HT will work for quite a long time. The nadir reached (lowest PSA) is the prime determinant of how long the Hormone therapy will work. The 18 month comment is pure nonsense. I personally know several people that have been on HT for over 10 years and are having no problems.
If you want to learn about HT, join prostate pointers P2P, and review what Dr Strum recommends as far as testing and protocols that work.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 2978
   Posted 5/11/2010 8:09 PM (GMT -7)   
Thank you , John T!!!!
age 66 First psa 4/17/09 psa 8.3, 7/27/09 psa 8.1
8/12/09 biopsy 6 out of 12 pos 2-70%, rest <5% 3+3
10/19/09 open rrp U of W Medical Center, left bundle spared
10/30/09 catheter out. continent from the jump.
pathology- prostate confined, only thing positive was the report.everything else negative
9% of prostate affected. gleason 3+4, I suppose thats a negative
After reading pathology myself, gleason was 3+4 with tertiary 5, 2-3 foci That is a negative, but I am a positive !!
Ed an issue but keeping the blood flowing with the osbon pump
Dec 14,2009 psa 0.0 May 10 2010, psa 0.0

" Hypocrisy is vice's homage to Virtue " read it in Bartlet's book of quotation years ago stuck with me, can't remember who said it.


montee
Regular Member


Date Joined Mar 2007
Total Posts : 288
   Posted 5/11/2010 8:21 PM (GMT -7)   
I have a friend in Atlanta who has been on HT since 1999. Monthly shots. Still travels the state weekly on his job, had RP and RT prior.
diagnosed sept 2006 @ 54 years old, live in Georgia, gleason 3+4=7, (r) lobe only

psa 4.7 (psa rose 1 point per year for 3 years, urologist said still under 4 and no concern. If I can find out about PSA velocity, why didn't he know!)

Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT

RP Emory Atlanta December 2006. Path-negative margin, negative lymph nodes, negative SV, both Lobes involved, 40% gland involved
multifocal perineural invasion, Gleason 3+4=7

1st psa April 2007-<0.04, 6 mos-<0.04, 9 mos <0.04, 1yr <0.04, 21 mos <0.04, 2 yr 0.04 (rising?) 26 mos-0.05, 27 mos-0.04, 29 mos 0.06 Sept 09 ,<0.04 3 year <0.04 39 mo. 0.07 (rising again)


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/11/2010 9:18 PM (GMT -7)   
John T,

can you elaborate on your comment "If psa goes to 0.05 and stays there for 3 months, HT will work for quite a long time. The nadir reached (lowest PSA) is the prime determinant of how long the Hormone therapy will work."? I am not sure I follow. Is it nadir after primary treatment or after HT?

Thanks,

Greg
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


LuvMyDAD
Regular Member


Date Joined Dec 2009
Total Posts : 104
   Posted 5/12/2010 7:16 AM (GMT -7)   
Hi guys thank you all for your comments. As Geebra commented above, John T can you clarify your comment?
I am glad to hear of so many people on hormone therapy for so long. I wonder what percent of people's PC is androgen dependent..
Father diagnosed Nov. 9, 2009
Open radical prostatectomy Dec. 21, 2009, post op pathology report T3a, Gleason 7
5 week post op psa .55
Combination therapy, hormone and IMRT. 40 sessions 72gy.
Hoping and praying for a cured dad.


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3769
   Posted 5/12/2010 10:15 AM (GMT -7)   
Stephen Strum, MD> You want as a goal a PSA nadir of 0.05 or less.
Our published research indicates that this nadir is the most significant variable relating to cancer specific survival.

Scholz M, Lam R, Strum S, et al: Prostate cancer-specific survival and clinical progression-free survival in men with prostate cancer treated intermittently with testosterone inactivating pharmaceuticals. Urology 70:506-510, 2007. 17905106.

OBJECTIVES: More than 85% of men with prostate cancer die of other causes. An effective method is needed to distinguish fatal forms of prostate cancer from benign variants. METHODS: We performed a retrospective chart review from a medical oncology practice specializing in prostate cancer. All men with negative bone scans, prostate-specific antigen (PSA) level less than 100 ng/mL, adequate records for review, and who started taking testosterone inactivating pharmaceutical (TIP) agents before January 2000 were included in the study. Six factors were evaluated as potential predictors of prostate cancer-specific mortality: PSA nadir greater than 0.05 ng/mL while taking TIP, PSA doubling time of less than 12 months, Gleason score, stage, baseline PSA level greater than 20 ng/mL, and age. RESULTS: The study criteria were met by 160 men. The median follow-up was 10 years.
The median age, PSA level, PSA nadir, and PSA doubling time was 65.6 years, 9.6 ng/mL, 0.03 ng/mL, and 10 months, respectively. Of the 160 men, 39 died of prostate cancer. Death from prostate cancer was far more common (78% versus 11%) and accelerated (median of 4 years versus
7 years) for men with a PSA nadir greater than 0.05 ng/mL than for those with a lower nadir. Multivariate Cox regression analysis indicated that the hazard ratio for prostate cancer-specific mortality in men with a PSA nadir greater than 0.05 ng/mL was 11.6 (P <0.0001).
The hazard ratio for men with a PSA doubling time of less than 12 months was 2.9 (P = 0.04). Gleason score, stage, baseline PSA level greater than 20 ng/mL, and age were not statistically significant.
CONCLUSIONS: Of the factors studied, the PSA nadir while taking a TIP was the best predictor of prostate cancer-specific mortality.

JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 5/12/2010 1:23 PM (GMT -7)   
Thanks, John. But I am still a bit unclear: is this a study of HT as a primary treatment of when the primary treatment fails?
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 3769
   Posted 5/12/2010 2:56 PM (GMT -7)   
Geebra,
I don't think that it matters. The reason to go on HT as either a primary or a secondary treatment is because a local cure failed or someone was not deemed to be a candidate for local therapy. If you are on HT then it is presumed you have matastis outside the local region of the prostate. Your objective is to kill or keep the cancer cells outside your prostate from growing, because this is what is going to kill you, not the cancer cells in your prostate.
JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G7, 4+3, approx 16mmX18mm.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


Carlos
Regular Member


Date Joined Nov 2009
Total Posts : 469
   Posted 5/12/2010 3:18 PM (GMT -7)   
Lynne,  Dr. Mark Scholz on the PCRI web site, http://www.prostate-cancer.org/pcricms/node/142, has an informative article about HT. This is what he had to say about the benefit of HT following surgery: " A recent study of ADT administered continuously in men with rising PSA after surgery indicated that the average duration of ADT effectiveness was 10.8 years."  The article was written in 2004, but PCa treatments don't change too rapidly.  Hope this helps.
 
Carlos

Diagnosed 2/2008 at age 71, Gleason score 5+3=8, stage T1c, PSA 9.1. 
Robotic surgery 5/2008, nerves spared, stg. pT2c, N0, MX, R0, Gleason 5+3=8 
PSA <0.1 at 20 months and each test since surgery.

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