When to start HT

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Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 6/18/2010 8:52 AM (GMT -6)   
 
As most of you know my robtic surgery failed, then looks like my SRT failed, now what.  I have said all along I am not a big fan of HT and wanted to put it off as long as possible.  Dr. Walsh's book states that some doctors feel wait until something is seen on a scan rather than when PSA is rising,  that currently there is no data to prove anyone survives any longer on either treatment.  However, yesterday I was talking to my surgeon's PA regarding my latest PSA results and she said that we do not want to miss the window of opportunity to start HT while they are still affective.  I was not aware there ever was a window of opportunity and that you need to start right away.  I feel I was rushed to surgery, rushed to SRT and both failed now what.  Sorry for all the complaining just one of those days.  Just wanted to know if anyone else heard this from their oncologist.  I am waiting to hear from a medical oncologist I met with before SRT for an appointment but he is on vacation until Tuesday.
 
Thanks for any info on HT.
 
Jerry1 
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 
Finished IMRT
First PSA after 3 mos. 1.5 not good news


Galileo
Veteran Member


Date Joined Nov 2008
Total Posts : 697
   Posted 6/18/2010 10:48 AM (GMT -6)   
Jerry1,

There is evidence that early is better in men with short doubling times like yours. A recent study reported "early salvage hormonal therapy may significantly and substantially prolong overall survival in the subgroup of men who experience an early biochemical recurrence with a rapid PSADT". And this study is from the Johns Hopkins crew that has not been an advocate of early HT: Walsh, Trock, Han, Partin, etc. www.asco.org/ASCOv2/Meetings/Abstracts?&vmview=abst_detail_view&confid=65&abstractid=35669

I have a personal interest in this, because my doubling time was under 3 months the last time it could be checked. If I fail SRT, and my doubling time is still rapid, I won't hesitate to get started with hormone therapy.

Jerry, best of luck to you.
Galileo

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NX MX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 and thereafter <0.1
http://pcabefore50.blogspot.com


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 6/18/2010 11:42 AM (GMT -6)   
Jerry,
Dr Strum is a leading advocate in starting HT as early as possible. PC cells mutate and it is important to catch them before they mutate and are unable to be controlled by HT. Be sure you oncologist is up on the latest protocols, such s ADT3 and ADT4. Strum feels it is also stupid to add other hormone drugs later. Hit is hard with everything you have while the cell population is still low. There are a lot of good articles of HT on both the PCRI and PAACT websites. Read "Prostate Cancer Basics" by Stephen Strum and "Beating prostae Cancer- Homone therapy and Diet" by Charles Snuffy Smith.

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


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 6/18/2010 12:48 PM (GMT -6)   
 
Thanks guys for the information I will read the articles you both mention.
 
Jerry1
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 
Finished IMRT
First PSA after 3 mos. 1.5 not good news


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/18/2010 3:53 PM (GMT -6)   
Jerry, I still feel strongly, that if my SRT fails, that it is my intention not to go the HT route. So far, nothing I have read, has changed my mind on the subject. Just hoping I don't have to really decide it as an option. Good luck on your situation.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Jakester
Regular Member


Date Joined Aug 2009
Total Posts : 288
   Posted 6/18/2010 5:18 PM (GMT -6)   
Jerry, just my personal two bits (and only speaking for myself), when and if I come to the HT juncture, I'm going for it, for my family especially even though I said I wouldn't earlier. If I don't like it or feel it isn't worth it, then I stop. Nothing written in stone.

You got our support with any decision you make.

Our best,
Jake
Diagnosed 8/2008 Pre-op psa 4.2, Age 60 at dx
7 of 12 biopsies positive 3+3
DaVinci LRP 11/08
Post Op pathology clear margins, confined to prostate, absent extraprostatic extension, vascular or perineural. Gleason 3+4=7, 5-10% of 4 and location in right mid-gland.
3 month psa .1 2/09, 6 month .1 5/09, 9 month .2 8/09
broke ankle bones 6/09
9/21/09 Bone scan clear, psa still .2
11/12/09 chest xray was clear, psa however up to .3,
01/05/10 psa still .3, radiation setup done with tats, 01/19/10 started 39 sessions 70.2gy, psa at 6th week salvage IMRT up to .4
Post SRT psa at 10 weeks (5/31/2010) down to .2


Heavy Leaker
Regular Member


Date Joined Feb 2010
Total Posts : 63
   Posted 6/18/2010 5:56 PM (GMT -6)   
Purgatory said...
Jerry, I still feel strongly, that if my SRT fails, that it is my intention not to go the HT route. So far, nothing I have read, has changed my mind on the subject. Just hoping I don't have to really decide it as an option. Good luck on your situation.

David in SC

Hi David,

 

My PSA was <.1 6 weeks post op, .1 6 months post op & .2 at 7 months post op.  My surgeon says that if it continues to rise I will need radiation.  Since I still have incontinence he says that he will give me hormone therapy until I have had maximum time to heal if my PSA continues to rise & then I would receive radiation.   I don't look forward to HT.  Why have you decided not to go for HT?

 

Ray


4 biopsies over 4 years starting in 2006, 4th biopsy showed 5% of one core Gleason 3+3=6.  PSA in 2005 6.0, rose to PSA 18 shortly before surgery.  Chose surgery over radiation due to conflicts in PSA versus biopsies.  PSA 18, Gleason 3+3+6, Age 58, Rising PSA since 1999, Biopsy 5% of one core
Robotic surgery 10/26/09  T2B Tumor 30% of prostate  involving left & right lobes  NOMX Gleason 3+4=7  Urethral Resection margins &  resection surface clean Seminal vessicles clean.


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/18/2010 8:34 PM (GMT -6)   
Ray, if you are still battling incontinence, then delaying your radiation through the use of HT makes a lot of sense. As a general rule, incontinence issues rarely improve after salvage radiation, but of course, there are exceptions to that as well.

I am not the only one here who has negative feelings about going down the HT path, if you would like to discuss my personal reasoning on the subject, be happy to do it via e-mail. My address is open and available here.

It's another one of those subjects that brings out strong emotions and opinions, and I would rather not be jumped on for feeling the way I do about it.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 6/19/2010 6:16 PM (GMT -6)   
 
 
David,
 
I agree as you know HT is not what I wanted in my future.  I am only married for 9 years and I have been spared enough with the radiation and surgery for us to still have a fairly active sex life.  I know HT kills all this and believe me my wife feels if it saves my life that is the most important thing to her, having me with her for years to come is the most important thing.  However, I have not read or been told that HT started early offers any more years except ones with awful side affects.  If I am wrong please someone tell me because believe me I am as scared of dieing as the next guy.  I just feel good and not sick and want to stay that way for as long as I can then maybe I will go the HT route am I wrong?   The different between me and you is I am alot older you are a young man with many more years so it hopefully will not be a decision you have to make.  I am just tired of doctors trying to push drugs that make them rich and me sick.  Sorry if I offended anyone but sometimes I need to express how I feel.
 
Jerry1 
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 
Finished IMRT
First PSA after 3 mos. 1.5 not good news


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/19/2010 7:48 PM (GMT -6)   
Jerry, your honest feelings and opinions are most welcome at anytime. If what you says offends someone, then clearly they don't understand where you are coming from.

Quality of Life is a very complex and personal and subjective topic at best. It means different things to different people. Aside from a person's medical condition at a particular point in time, one would have to know the person, what they have been through in their lives, their philosphical and/or religious views on life in general, etc. So many factors.

This is why some people have "Living Wills" in place. My wife, as a nurse that looks over a lot of terminally ill people, and trust me, they are not just "old" people, they have patients even in their 40's at her facility, she sees a lot of things in her patient's eyes and hearts, along with their loved ones and family.  She has strong feelings on the subject, and has learned to respect the patient and their family's wishes.

I would never, ever force my views or try to influence another human being on the subject. Too personal. For me, I am not afraid of dying, I am just not ready to check out yet, lol. I want to live as long a natural life as I can within reasonable means. Reasonable means to me, would or could be entirely different concept to you or anyone else.

Years ago, I did a lot of religious based hospital counseling type work, and was involved in a lot of death bed scenes and cases, and from those experiences, I learned a lot about life and quality of life issues.   I saw a lot of pain, misery, and suffering along the way.  One reason why I have such strong feelings on Pain Management for example.

I am hoping that my PC is in remission, right now, I have just one reading that indicates this, so it will take several more good readings to be more convincing. Even my uro realizes this, as he's a big believer in pre-treatment PC PSA velocity. Either my PC has been knocked into full remission (and that is my choice), or its just be knocked silly for a spell, and will re-group so to speak, and come back again. If, and only if it comes back again, and recurrance is verified, would I even have to consider the next path, and we both know there is nothing left (at this point in PC treatment) that would be curative if the SRT ultimately fails. Right now, if I were faced with that choice to go down the HT path to "buy" some time, I wouldn't do it, nor do I have any interest in doing it. I can't say that with certainty, because I am not faced with that choice, can only tell how I feel about it.

Beyond that level of reasoning, I wouldn't discuss it online here in the open. I would reserve further conversation and reasoning to those I feel would have a caring interest, and not to get into some kind of "pissing" contest about who is more informed or educated on the subject than the other. I am not into those kinds of deals, very non-productive in my opinion.

You area good person, and I hope only the best and most positive thoughts for you. I don't know what your future holds for you, but am confident you will make the right choices for yourself, and your loved ones as well. And I would always respect your decision, as we all should.

David in SC


Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17

Post Edited (Purgatory) : 6/19/2010 6:53:34 PM (GMT-6)


Jerry1
Regular Member


Date Joined Mar 2007
Total Posts : 460
   Posted 6/20/2010 6:20 AM (GMT -6)   
David,
 
Thank you for your very thoughtful reply.  I wish you only the best and will pray that the SRT killed your PC and you will live a long and happy life.  Thanks again I will keep you informed of my decision.
 
Jerry1 
Age 70
DX 8/13/08 , PSA 4.0, Biopsy 14 samples 1 positive 12% of sample,
Gleason Score 4+4 =8  Bone scan and MRI negative
Da Vince surgery on Oct 17, 08 Florida Hospital Dr Vipul Patel
Post Gleason report  4+4 = 8 Lymph nodes on both sides negative
margins Negative  Stage II (pt2a) 
Cath out on October 29th left in longer due to small leak.
11/19/08 dry no more pads
12/2/08 first PSA <0.1
 3/6/09 6 Month PSA 0.0
6/3/09 9 month  PSA 0.1
7/14/09  PSA still 0.1
10/15/09 PSA 0.3
10/26/09 surgery to remove 3 clips in bladder neck  
11/16/09 PSA 0.3
12/14/09 PSA 0.4 
12/28/09 PSA 0.5
Start salvage radiation treatments on January 18th. 
Finished IMRT
First PSA after 3 mos. 1.5 not good news


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 6/20/2010 10:29 AM (GMT -6)   
You are most welcomed, Jerry, we are in these fights together, and none of us has any guarantees or promises. All we can do is the best we can each day, and in between bouts, try to enjoy the thing we call life.

David in SC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


logoslidat
Veteran Member


Date Joined Sep 2009
Total Posts : 6048
   Posted 6/20/2010 10:37 AM (GMT -6)   
Good post David, I wont say I'll never have it, nor did you, but it would not be just to bring a .1 or .2 down to undetectable. I would need to be convinced, and i have a hard head, based on knowledge and gut feeling, which I give equal status to,by a top prostate oncologist. Even then I would wait till untill psa got into double digits. Having said that, I continually update information, and will never say never. But It will not be a trip wire effect ,I assure you.
age 67 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 Washington 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.

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