Quick PSADT and HT

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compiler
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Date Joined Nov 2009
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   Posted 4/10/2011 10:00 PM (GMT -6)   
I think I've asked this before but don't remember getting an answer.
 
We know that a fast PSADT is bad news, pointing the an aggressive cancer. We also know that HT varies in it's effectiveness, from 0 months to 10 years at the two extremes.
 
Can one conclude that a fast PSADT implies HT will only work for a brief time? It seems logical, but I have not read of any predictors on how well HT will work (there may be some at the genetic/molecular level).
 
It would be encouraging, for those of us with fast PSASDT, to hear that this has no bearing on predicting HT failure.
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .Biopsy 11/30/09. Gleason 4+3. Age: 64. Surgery: Dr. Menon @Ford Hospital, 1/26/10. Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- yes.. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13,3/1/11--0.27. Now doing SRT

BB_Fan
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Date Joined Jan 2010
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   Posted 4/10/2011 10:18 PM (GMT -6)   
I just re-read an article today by Dr Strum that discussed the issue of the effectiveness of HT in the context of the use of IADT. I'm sure that someone posted it on Healingwell. It was a re-print from PCRI Insights.

ralfinaz
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Date Joined Jan 2011
Total Posts : 713
   Posted 4/10/2011 10:46 PM (GMT -6)   
Hi Mel,
You are dealing with recurrence and although PSADT is an important factor in driving salvage treatment timing, it is not necessarily something that predicts hormonal suppression failure.

Response to androgen deprivation depends on various factors. The most significant one is the ratio of androgen dependence to androgen independence cancer cells of the tumor load of the patient. This is difficult to ascertain because it depends on how long progression has occurred unabated. Another is how significantly advanced the disease is. The less metastatic lesions the better the response. The response once the cancer has invaded the skeleton is usually not as good because PCa in bone tends to grow much better than in the prostate itself. The general rule is that the higher the number of lesions the poorer the HT response.

Wish you the best possible outcome with your SRT,

RalphV
Phoenix, Arizona
Surviving prostate cancer since 1992. RP; Orchiectomy;
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!
www.pcainaz.org/phpBB304

BB_Fan
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   Posted 4/11/2011 6:29 AM (GMT -6)   
Ralph's response was supported in the Strum artical that I mentioned above. Supports the notion of hitting PCa earlier, rather than waiting for symtoms to occur. With Drs like Strum and Myer taking this position, I immediately went to HT when it became likey that PCa was advanced. The use/benefits of HT is also the reason I no longer see a local medical oncologist. This guy is very good and was highly recommended, but he is a generalist. His response to my questions on when to start HT was that, it didn't really matter in terms of extending your life. It would only be effective for a certain period of time regardless of when it was started. His recommendation was to wait untill symtoms occur. I think that this notion is now rejected by most experts for high risk patients.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01

JNF
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Date Joined Dec 2010
Total Posts : 1741
   Posted 4/11/2011 9:16 AM (GMT -6)   
My oncologist, radio-oncologist, and urologist all advised me to hit it as hard as possible and as soon as possible.   They all advised that the IMRT, HDR and ADT should be concurrent (adjuvant) rather than sequential.
 
They all agreed they would expect a better treatment result by hitting the cancer from multiple fronts concurrently.   They explained the ADT would weaken the cancer and allow the radiation to work better when used concurrently.
 
This is in line with the oncologists so often listed as specialists.   I don't detect much "wait and see" or "wait until it can be felt" advise from Strum, Sartor, Meyers, and others.   What I read about them is that they are active with treatment and not afraid to try different things if the response isn't what they hoped for. 
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.

compiler
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Date Joined Nov 2009
Total Posts : 5248
   Posted 4/11/2011 11:27 AM (GMT -6)   
JNF:
 
Again, Dr. Hussein (no lightweight) suggested just SRT. She didn't even suggest scans (I guess with a 0.27 PSA it is not justified yet) and she didn't suggest ADT.
 
In fact, she said exactly what I wanted to hear (and I gave no indication beforehand of what I wanted to hear). I really dread the HT SE. I also dread the SRT SE! But I'll do what I have to do.
 
I may well be making a mistake by NOT doing the ADT. But I made a reasoned decision. We will soon see if the SRT appears to be working. I'll be done with it in 5 weeks and my first post-PSA will be in August. I may see Dr. Hussein and Dr. Scholz even before I do the first PSA so everything will be in place. If SRT is a TOTAL failure, I may get a shocking PSA result. Regardless, I am leaning towards hitting it hard early with ADT is the SRT fails, unless the experts suggest otherwise. It may well be that I get a split decision, too. That's the danger of having two experts!! But two is better than one and definitely one if better than none!!
 
Mel

F8
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Date Joined Feb 2010
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   Posted 4/11/2011 11:42 AM (GMT -6)   
>>They all agreed they would expect a better treatment result by hitting the cancer from multiple fronts concurrently.   They explained the ADT would weaken the cancer and allow the radiation to work better when used concurrently.<<
 
 all my doctors agreed with this approach and i pretty much agreed to it on my initial visit.
 
ed
 
 
 

age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

John T
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Date Joined Nov 2008
Total Posts : 3734
   Posted 4/11/2011 11:45 AM (GMT -6)   
According to Myers and others the refactory cancer cells are a mutation that occurr in 1 out of 1 million cells. This is why tumor burden is so important. The more total cancer cells the more mutated cells.
Being a math professor you can understand the idea of killing as many cancer cells as early as possibe as this reduces the total number of mutations and increases the time period in which the mutate cells would become a problem by multiplying, as you are starting with fewer total cells.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 5248
   Posted 4/11/2011 12:25 PM (GMT -6)   
John T:
 
Tell that to Dr. Hussein.
 
Apparently this isssue has not gotten to the clear and obvious stage.
 
I can only listen to the experts, in particular the one I went to.
 
I may or may not have made a mistake.
 
Mel

John T
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Date Joined Nov 2008
Total Posts : 3734
   Posted 4/11/2011 12:57 PM (GMT -6)   
Mel,
Neither you or I have the skills or training to decide which is the correct course. Obviously the experts disagree. They disagree with just about everything on PC including psa screening and treatment options. That's why it is so frustrating. In the end it is only you that can decide which makes more sense.
There are so many different opinions out there that there is just too much noise to make sense out of all of it.
I decided to put my faith in a few experts in each field, Walsh and Scardino for surgery, Strum, Myers, Scholz in oncology, Barantsz and DiAmico in radiology. It's more of a personal choice and these guys seem to me to make the most sense and they have tons of experience to back up what they say and all are well respected by their peers. This is not to imply that they are the best or the last word. You just have to draw the line somewhere or it will drive you crazy. I think listening to these guys gives the best probability of reaching the right decision.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24302
   Posted 4/11/2011 2:23 PM (GMT -6)   
Which is why no one here should be dogmatic and pushy in their views on treatments. You can't even get the experts to agree.
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 5248
   Posted 4/11/2011 3:49 PM (GMT -6)   
David:
 
I agree. I do have the sense that soon ADT before/during SRT will be the standard of care. Just a feeling from what I've been reading.
 
Mel
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