Follow up regarding questions about hormone treatment

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New Member

Date Joined Jan 2009
Total Posts : 17
   Posted 1/22/2009 9:04 AM (GMT -6)   
Wanted to share for thoughts and comments the advice of a retired chemist who is well recognized, long time activist in PCa matters.

He wrote:  I can understand not reacting quickly to a PSA elevation, but waiting for a PSA of 10 makes no sense. Usually salvage treatments work best when the tumor load is at the lowest point. This is because mutations accumulate with time and these tend to cause treatment resistance.

More so when the biopsy samples contain Gleason Grade 4 cancer. That said, the typical systemic treatment is hormone suppression. This is a treatment that when done early can improve survival.

You can try hormonal suppression with the objective of going intermittent after a period of 9 to 13 months based on your PSA response to treatment. The faster the reduction of PSA the sooner you could decide to go intermittent. about the drugs used:

1. Trelstar. This is a LHRH agonist injection that will reduce testosterone to castrate level. Try the 28 day depot injection first for two or three cycles. Switch to a 84 day injection thereafter.

2. Casodex. This is an antiandrogen to be taken at least two weeks before the first Trelstar injection. Continue taking this antiandrogen for at least one month.

3. Avodart. This is a 5-alpha reductase inhibitor. It prevents the formation of dihydrotestosterone which is the most potent androgen. This should be taken all the time along with Trelstar.


Age 73.  Health excellent (work out five days a week) except for prostate cancer and colon cancer, the latter was 12 years ago and seems to be fine as evidenced by continuing colonoscopies. 


Four biopsies.  Two positive and two negative.  Positive reflects involvement in one area (Left Apex 3%).  Gleason 3+4=7, T1c,  negative DRE.  Received 40 doses of IMRT delivered by Fox Chase affiliate 05/05.   PSA 10.5 before IMRT - drop to 1.8 - now 3.1



























































































































Veteran Member

Date Joined Jul 2008
Total Posts : 637
   Posted 1/22/2009 9:22 AM (GMT -6)   
That's interesting information. Thank you.... Ill save it....Diane
Husband Pete
dx Jan 2001 gleason 4 + 3 PSA 16.5
Seed implant and conformal radiation and Lupron from Jan 2001 to Jan2002
2005 Dec PSA began to rise from .5 to 8 within 6 months
Salvage surgery at MSK 9/06 Dr. Eastham
Fistula operation 2/07 MSK Dr. Wong
Many cystoscopies and ER visits with strictures
Catheter for one year....Catheter taken out Sept 07..
Total Incontinence since then....
PSA .52 3/08
AUS Operation at MSK Sept 8 2008 Dr. Sandhu
Activated Oct 28th Dr. Sandhu..MSK
Some difficulty with AUS arising Nov 10 2008
Meeting with Dr. Sandhu to discuss AUS problems and new PSA test Dec 11, 2008
PSA .6 12/08
AUS improving..only 2 pads a day and one at night
Complete hip replacement surgery Dr. Waters Gainesville, FL 1/9/09
Forging ahead to health!

Doting Daughter
Veteran Member

Date Joined Aug 2007
Total Posts : 1064
   Posted 1/22/2009 10:08 AM (GMT -6)   
Thanks for sharing. I agree with his thought process. You can see from my signature, that my father was on Casodex for the HT flare, but now is on Lupron alone. I often wonder if he should be on Avodart too. I think it would be really difficult to convince him to take anything else at this point. Good luck and keep us posted!
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
Oct. 10, 08 PSA <.02
Praying for a cured dad.

Co-Moderator Prostate Cancer Forum

Post Edited (Doting Daughter) : 1/22/2009 9:01:34 AM (GMT-7)

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 1/22/2009 10:54 AM (GMT -6)   
That is called ADT3 hormone therapy (aka-Dr. Leibowitz et al)
Highly useful in many scenarios.

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