hormone treatment

New Topic Post Reply Printable Version
[ << Previous Thread | Next Thread >> ]

mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 9/10/2008 3:33 PM (GMT -6)   
At what post surgery and radiation psa numbers do most Doctors start or recommend hormone therapy?
50 years old
gleason 3+4=7 psa5.8 clinical stageT3a
Da vinci surgery April10 2007 Mayo clinic Rochester, Mn.
extraprostatic extension Gleason -same
pelvic lymph nodes -negative
Catheter out April 19
37 treatments IMRT ended 10/26/07
psa Jan 29 2008 0.10
psa april 30 0.14


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 9/10/2008 9:11 PM (GMT -6)   
We found different recommendations depending on the circumstance. Some of the recommendations said .1 some said .2, other's said after three consecutive PSA rises. What was your PSA prior to radiation?
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 9/11/2008 4:23 AM (GMT -6)   
I would agree with Doting, usually .2 is consider a rise, but even then three consecutive increases would most likely be done before adding hormones to the regimen. When is your next doctor appointment? I see according to your post your last PSA was in April, so I am guessing you have another coming up real soon.
Please keep posting, by the way are you experiencing some type of anxiety?

peace and love
dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
cancer in 4 of 6 cores
92%
80%
37%
28%
 


mgl
Regular Member


Date Joined Feb 2007
Total Posts : 122
   Posted 9/11/2008 5:07 AM (GMT -6)   
My last psa was at the end of august and it was 0.16 up from last april which it was 0.14

50 years old
gleason 3+4=7 psa5.8 clinical stageT3a
Da vinci surgery April10 2007 Mayo clinic Rochester, Mn.
extraprostatic extension Gleason -same
pelvic lymph nodes -negative
Catheter out April 19
37 treatments IMRT ended 10/26/07
psa Jan 29 2008 0.10
psa april 30 0.14


sterd82
Regular Member


Date Joined Sep 2006
Total Posts : 187
   Posted 9/11/2008 6:16 AM (GMT -6)   
I think the previous posters misunderstand the question --- or maybe I do.   The .1 or .2 thresholds they mention in their replies are typically associated with the point after PRIMARY treatment (in your case, surgery) you initiate salvage treatment (your 37 sessions of IMRT). 
 
I believe your question relates to at what point in PSA rise will doctors recommend hormone therapy after SALVAGE treatment "fails".  At that point, the recurrence is no longer considered localized, and is systemic disease --- problem is, you don't know where the cancer cells are that are generating the PSA.  The next step in the normal course of action is hormone therapy.
 
I discussed this with my doctor, and he said he'll let the psa "run up" some before initiating ht at this point (he never gave me a definite number) for a few different reasons.  One, he's seen instances where the PSA might run up a little, but then stabilize.  Two, at this point you really need to get an accurate reading on PSA velocity to gage how aggressive the recurrence might be.  And finally, you have time.  "PSA only" recurrence will often preceed actual clinical evidence of advanced PCa by YEARS in many cases.   PSA doubling time will give your team some ideas in treatment options.
 
My doc also said not to panic at that point --- he's put patients on intermittent HT, and has seen cases of durable response to ht --- suggesting a curative result from a treatment not considered curative.
 
This is merely my understanding of the situation --- other members might have a better handle on this.  I'd also recommend posting your question on the American Cancer Society Prostate Cancer bulletin board ---- all questions there are answered by experts and staff members.   You can also call their 24 hour hotline and ask -- 1·800·ACS·2345.
 
Hope this helps -- good luck!
Sterd82
Age 47 - pre-surgery PSA 39
Open Radical Prostatectomy 6/9/2006
Pathological Stage T3a, Positive Surgical Margin
Gleason 3+4
PSA rose to .24 in November of 2006
6 month hormone therapy initiated December 1. 2006
36 sessions of IMRT Ended Feb 1, 2007
PSA as of May 25, 2007 undetectable
PSA as of November 29, 2007 undetectable
PSA as of May 14, 2008 undetectable
Next PSA November of 2008


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 9/11/2008 8:35 AM (GMT -6)   
I'm definitely no expert:) Thanks for the clarification and great resource Sterd!

Since my father's biopsy showed ln involvement, the doc's recommendations were to do HT and radiation, unless his PSA was undetectable. Which according to some it might have been, but we moved forward with salvage treatment. (It came back .07, then .05) He did HT first and then IMRT. Your situation is a little different, but I agree with Sterd that there are options and not to panic. Keep us posted! Best wishes!
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
July 2, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum


Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 9/12/2008 11:34 AM (GMT -6)   
What about hormone therapy BEFORE surgery? What are the side effects.

I am 61...gleasons of 3+4=7 and 4+3+7 diagnosed July 10th of 2008...went to Memorial Sloan Kettering and saw Dr Guillonneau. He would not operate because of my obeisity.

My local urologist in NM is considering hormone treatment while I await bariatric surgery for drastic weight loss.

PSA 4.6 but went from 0.08 to 4.6 in 8 years and 2.3 to 4.6 in about 3 1/2 years.

Anyone with any anecdotal experience here. Also spoke to Dr Randy Fagin in Austin who has done a number of obese DaVinci's with some complications and he advised to lose weight asap before daVinci....

thank


Mbshine
Angel Fire, NM

mlbsm
Regular Member


Date Joined Mar 2008
Total Posts : 85
   Posted 9/12/2008 12:08 PM (GMT -6)   
I had a 3 month Lupron shot before surgery that my Dr. told me was to put me "On hold" until he operated.

I had a fast evolving Pca according to him, and the Lupron would take my testosterone to 0 which it did.

The shot itself for me wasn't that bad, you take it in the rear.

I felt like I was sitting on a wallet for a few days, and had a definate bump back there that was a little sore, but no big deal.

On Lupon, prepare for hot flashes, because they ARE coming.

I took the shot in February, and my testosterone was STILL at 10 in June, so I wouldn't count on any extra curricular activity for a good long time.

Hope that helps.

Billy
DIAG. 2/08
DRE POSITIVE
PSA 6.8
CONTAINED, LEFT SIDE, GLEASON 9
LUPRON, (3 MO.) 2/28
SURG, SCHED. 3/26/08
RRP, 3/26, HOME 3/31
BIOPSY REPORT:
GLEASON SCORE, 3+4
TUMOR CONFINED TO THE PROSTATE, INKED EXTERNAL SURFACE FREE OF INVOLVEMENT.
VD AND SV CLEAR AS WELL AS LYMPH NODES AND A BLADDER SECTION.
INCONTINENCE EBBING FAST
ED, FLAT TIRE. MAYBE LUPRON?
PSA 5/21 O.O1 UND
PSA 6/30 O.OI UND
TEST. 10 SHREDDED TIRE STILL LUPRON
INCON. HISTORY
PSA 9/30


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 9/12/2008 12:26 PM (GMT -6)   
Mike,
I didn't respond your post! I am so sorry. 0.4 is the gold standard before commencing salvage HT, but there really is no rules about it. But you can make the call yourself anytime. And you don't have to wait for the oncologist to say so. You are having a hard time lately. I am very sorry for that. But HT will get this knocked down, and likely for a long time. You have my email, so if you want to chat, send your number, I'll call you up. Sometimes it's just better to chat about it live.

Your friend,

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 9 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


RBinCountry
Regular Member


Date Joined Apr 2008
Total Posts : 270
   Posted 9/12/2008 12:53 PM (GMT -6)   
MB,
I received a Lupron, like Mlbsm, only mine was 4 months. My biopsy was not pretty, but more than that I was originally going to go for IMRT, then seeds. The doc I was originally going to for radiation wanted me to also be on harmones for 8 months as studies show that recipe is best. He called it the blue plate special (shoot all the guns).

I ended up going to Dr. Fagin in Austin and having the prostate removed. I am now more than 5 months out from a 4 month shot. Although I have not had hot flashes for a month I have been totally dead down south. It is difficult for me to know whether it is residual from the Lupron or now just related to the RRP.

The Lupron was liveable, and in one respect, while I was struggling with trying to determine what to do, it was of some comfort that it was holding back the growth of the cancer. On the other hand, it does carry with it side effects, usually making you miserable in the middle of the night. I think for me the biggest side effect was thinking I was no longer a real man. That of course is silly - my voice didn't change nor anything else other than sexual desires.

The bottom line on all this is that we have to do what we have to do! MBshine you are going to one of the very best if you are seeing Dr. Fagin, and I am sure you will do great. This may just be the prompting you need to lose some weight. Blessings to you!

RB

Age 61
Original data - pre-operation
PSA: 5.1
T1C clinical diagnosis, Needle biopsy - 10 cores, Gleason 7 = 3+4 in 1 core (40%), 7 cores Gleason 6 = 3+3 ranging from 5% to 12%
All scans negative
Lupron administered 4/9/2008 for 4 months (with idea I would undergo external beam radiation followed by seed implants - then I changed my mind).
Robotic DiVinci surgery - Dr. Fagin (Austin) May 19th
Post operative - pathology
pT2c NX MX
Gleason 3+4
Margins - negative
Extraprostatic extension - negative
seminal vesicle invasion - uninvolved
1st Post PSA .04

Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 10/4/2008 5:21 PM (GMT -6)   
 
RB and friends..
 
   I guess I withdrew into a shell for a few weeks but here is an update, all your thoughts are sincerely welcome.
 
No prospect of DaVinci or anything else until I lose weight. Petitioning insurance company for Lap Band surgery and there is not a single bariatric surgeon in my state of NM. Primary Care physician gave me a referral to Colorado and another to Arizona, both rejected. Dr Fagin--who I have never met but who is a saint in my book--referred me to the two top bariatric guys he knows in Austin. Their offce was responsive but unless I want to pay cash upfront it is unlikely they will get added to my in- network plan....so I am in the final stages of weight loss surgery  at the ONLY approved insurance center, one in El Paso with two guys who are young, fairly well experienced, definitely not part of anyone's A-list but they did train in Galveston, the same place as Dr Fagin's guys.
 
No PSA's taken since my DX in July or my visit to Dr Guillonneau at Sloan Kettering.
 
about three weeks ago my local urologist who I like and trust, said neither he nor I like "watchful waiting" and he stuck a hormone needle into my stomach that left a bruise for a week but didn't hurt much. I don't know what the drug was, and I didn't care. he said I need a shot every three months until  my prostate is removed.  He gave me a Rx for
 
50mg of Casodex once a day. First Wal-Mart said the 90-day supply would be $545, then they said my insurance indeed had it on a copay list so the cost dropped to $105.
 
Two days ago I got the Insurance companies notice that the in-office hormone shot--are you sitting down?   $1,800 of which they "allow" $1,200. I won't even talk about the "great" policy I have that includes an annual deductible of 3k or 5k or whatever...
 
As with some of you, the combination of three blood pressure pills had killed my libido more than 5 years ago, but occasionally the little guy stirred down there in the middle of the night---3-4 hours after one pill and 3-4 hours before the next one...yes, I tried the blue pill and it didn;t work...but at least once or twice a month my wife knew I was alive...the hormone pills and shot killed that off...at a meeting yesterday conducted by a charming, intelligent, vibrant 20-something Ph.d, blonde 5-foot-11, movie star smile, etc. for a fleeting moment I wished I had just been born a ***, period.
 
Okay...I'm hauling slash, riding my ATV, getting ready for winter, going to work, emailing my son in Iraq, and basically only discussing this with you guys and gals..
 
mbshine

Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 10/17/2008 9:15 PM (GMT -6)   
Tony et al..

Head for required bariatric lap band seminar tmw. Insurance will only pay if I use two surgeons 11 hours away in El Paso. Two days ago the insurance company, Presbyterian, threw in another surprise, they will not accept referrals without a complete psychological/behavioral exam. They approve only four shrinks in my nearest city and I found a guy to do 4 hours of testing for $500. Money on the table. Insurance says they will not cover any psych tests....so, still no approval for bariatric surgery which is the gateway to prostate DaVinci, but keeping positive.

Taking my 50mg of Casodex each day...like the end of the Civil War, here too, the southland is dead.
Tempted to watch "the View," redecorate in pink, and sing soprano, but as noted by others, really few side effects ....will take my first blood test PSA since DX in July in another few weeks, but if this is the catalyst for weight loss, so be it. It could be a blessing in disguise.

thanks to you all

Mbshine

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 10/18/2008 9:50 AM (GMT -6)   
Mbshine,
The key is being positive and getting your excersize. But don't resort to the "View". Sing saprano, redecorate, shave and talk on the cell phone while driving, even go window shopping, but don't watch the "View". There are no studies that show it is helpful in the fight against PCa. Seriously, I hope you get this worked out soon. Don't be afraid to fight the insurance companies about the psych tests. If the band surgery requires it then have those doctors prescribe it and use that with your provider.

Mike,
Just thinking of you buddy! I hope things are well.

Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)
Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (September 17 '08): <0.1 ~ Undetectable!
 
You can visit my Journey at:
 
STAY POSITIVE!
 
 


Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 11/1/2008 7:12 AM (GMT -6)   

Tony et  al

 

   well presby health care has not paid a penny of the $500 shrink fee but at the bariatric seminr they said I will not have to duplicate the shrinkification required at their clinic...awaiting final referral ruling but at least have firsdt consultation in el paso at el sol bariatric 25 nov.

 

 

the sort of positive news is first PSA since july DX and since  late Aug start of hormones..

 

PSA scores  0.27 down from4.8...local uologist says "no guarantees but this is a good indicator that hormones are acting as we had hoped go starve he tumors....."

 

 

on the flip side testosterone levels were about the same as a 4 year old irl, and no--i will not watch the View...I have advanced directly to Ellen.    LOL

 

 

mbshine

 

 

New Topic Post Reply Printable Version
Forum Information
Currently it is Tuesday, June 19, 2018 10:16 PM (GMT -6)
There are a total of 2,973,496 posts in 326,136 threads.
View Active Threads


Who's Online
This forum has 161011 registered members. Please welcome our newest member, brittrosalia.
344 Guest(s), 5 Registered Member(s) are currently online.  Details
myilah, Girlie, marcell, junior568, RobLee