Stop Anti-Androgen therapy before Robotic Prostatectomy???

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pcBeGone
New Member


Date Joined Jan 2009
Total Posts : 10
   Posted 2/21/2009 9:37 PM (GMT -6)   
 
Does Anti-Androgen therapy shrink the prostate so as to make Robotic Prostatectomy more difficult???
 
My father was diagnosed with PC on Jan 9th. His Robotic Prostatectomy is probably going to be in late March/ early April. Based on his Urologist's suggesstion, he started Anti-Androgen therapy & then again stopped it after the decision to do the Surgery was made, because of being told that it would shrink the prostate therby making the surgery more difficult.
 
Anyone else here hear of this? Thank you.

gpg
Regular Member


Date Joined Jan 2009
Total Posts : 180
   Posted 2/21/2009 10:19 PM (GMT -6)   
Have not heard of this, in fact it is preferable to sometimes shrink the gland before surgery.

No way to respond to this without more information. Have you been in consult directly with the Dr.?

Please tell us more.

Scott
Diagnosed @ 48yo 04/07
focal, low volume tumor gleason 6
RRP 07/30/07 robotic
Persistance of PSA
IMRT 11/07-01/08
Emerg, cysto obstructed bladder 01/08
Persistance of PSA
08/08 learned Dr. left significant amount of prostate
12/08 PCA3 negative
12/08 saturation biopsy 36 cores 24 having normal prostate tissue
12/08 referred whole to med malprac attorney


Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4840
   Posted 2/22/2009 6:55 AM (GMT -6)   

You can google-> Anti-Androgen  and find tons of info like: Antiandrogens can also be used for treatment of benign prostatic hyperplasia (prostate enlargement).

I would guess that since the decission to remove the prostate has been made, there is no need to contiue other treatment.

 

 


Age 53   - 5'11"   205lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6 
 
06/25/08 - Da Vinci robotic laparoscopy
Catheter in for five weeks.
Dry after 3 months.
 
10/03/08 - 1st Quarter PSA -> less then .01
01/16/09 - 2nd Quarter PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.
 


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 2/22/2009 7:02 AM (GMT -6)   
I have heard of it and cannot verify that it is completely truthful even though out of the words from another PCa-surgeon at a support group when I asked him this question a few years ago. I am hip shooting but doing this from memory as this was 5-6 yrs. ago I heard this, it shrinks the gland and kind of makes it more of like a sticky mess or similar concept, so cutting it out is more difficult and the surgeon does not need more difficulty. The LRRP surgery video that Tony has herein somewhere, gives us a heads up on how difficult a normal gland is to do.
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25382
   Posted 2/22/2009 8:52 AM (GMT -6)   
yes zufus, that is the common view, the pre-shrinking before surgery can indeed make sticky mess for the surgeon to deal with. it makes the margins harder to determine, in all, it can take on the same situation as a "salvage surgery", and most agree that is not a good idea if it can be helped.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3
3rd Biopsy 9/8 Positive 7 of 7 cores pos, 40-90%, Gleason 7
Open RP surgery 11/14/8, Right nerves saved, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05
 
 


dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 2/22/2009 9:16 AM (GMT -6)   

pcBeGone:

You can get quite a few varied opinions on this from surgeons, I actually had the therapy before surgery thinking that I might go with radiation instead of surgery, the rad onco assured me that the therapy would not preclude me from surgery if I decided that way.  When I informed the surgeon I chose to do the surgery(DaVinci) he was supportive and didn't think that it would cause any complications.  He did say that it took a little longer than usual for the surgery to be completed but that it wasn't a big deal.

There are some positives and negatives that came from the therapy.  My path report denoted that the tumor had been shrunk substantially meaning that if there was more therapy needed it was obvious that Casodex and Lupron would work very well. I also had the peace of mind knowing that during the lag time from diagnosis to surgery that there would be no further cancer growth which was a huge load off of my mind. It also gave me time to look into all of my options and not feel rushed to make a decision.

The negative was since the medicine did such a good job on the tumor they could not get a defenitive Gleason score on the path report.  I had three reviews of my needle biopsy so I had a pretty good idea what we were dealing with.

The statement that this therapy is akin to "salvage therapy" is way off base.  There are a few guys on this site who have gone the same route as me and had good results. 

Remember, each case is different and we can only give you our personal experience. No one has all of the answers.

Good luck

David 

  


 54 y.o.
 Diagnosed 4/10/08
 DRE Normal
 PSA-5.5
 Biopsy- 12 cores, 4 positive highest 4+4=8
 Bone scan, CT scan and Chest X-ray clear 4/16/08
 Urologist suggested surgery 4/16/08
 MRI on 4/24/08 clear no suggestion of lymph node   involvement.
 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.
Decide to have DaVinci surgery after another consult with surgeon.
6/19/08- DaVinci surgery at University of Washington.
6/25/08- Path report, clear margins, no noted extension
9/12/08- PSA <0.02 
12/05/08-PSA <0.02 Six months after surgery 


pcBeGone
New Member


Date Joined Jan 2009
Total Posts : 10
   Posted 2/22/2009 11:47 AM (GMT -6)   
Thank you all for your input. My father had stopped the therapy & is now not going to continue it.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4250
   Posted 2/22/2009 7:37 PM (GMT -6)   
They only thing that I have heard is that Hormone therapy does something to the nerves that makes nerve sparing procedure very difficult. It should not have any affect other than shrinking the prostate and tumor.
JohnT

I had a psa of 4.4 in 1999 and steadily increasing psa every 3-6 months before reaching 40 in 5-08.Free psa ranged from 16 to 10%

I had biopsies every year, 13 total in all. I saw 5 different doctors, all urologists or urological oncologists at Long Beach, UCLA, UCSF and UCI and had an MRIS at UCSF in 2007. All tests were negative and I was told that because of all the biopsies I most likely didn't have PC, but to keep getting biopsies every year.

in Oct 08 my 13th biopsy of 25 cores indicated 2 positive cores, gleason 3+3 less that 5% in 2 cores. Doc recommended surgery.

2nd opinion from a prostate oncologist, referred by my wife's oncologists said cancer found wis indolant and statistacally insignificant, but PSA histor was a major concern and ordered a few more tests.

Color Doppler ultrasound with targeted biopsy found a transition zone tumor 18mmX16mm, gleason 3+4 and 4+3. CT and bone scans clear, but Doc thinks that there may be lymph node involvement (30% chance) because of my high PSA, and referred me for a Combidex MRI in Holland, currently scheduled for Feb 14.

Changed diet and takiing supplements while I wait. The location of the tumor plus the high psa make surgery an unlikely option. I'm still evaluatiing all treatment options and will make a decision once I get the results of the Combidex scan.

JohnT

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