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Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2010 3:44 PM (GMT -6)   
One of the seldom talked about side effects of ADT and EBRT is the effects of radiation and hormone therapy on the pelvic bones. But with EBRT the risk of hip fractures increases 10% just at year 10. The risk of hip fracture with EBRT + ADT is as high as 30%. I have had both treatments adjuvant and while the success is there, so is the risk. We don't have a lot of hip fractures in my family, in fact I don't know of any, but it may be a worth while consideration if you do have family history of hip fractures or even hip replacement surgeries to consider this seriously before you decide on a treatment with EBRT or ADT. When I spoke to a radiation oncologist recently, I was an invited guest to see the Calypso technology, she said she would not perform radiation for prostate cancer on a 44 year old man (48 now) unless there was mitigating circumstance. When I asked why, she said bone damage was the #1 reason followed by residual cancer risk. The attached article and study supports the 1st reason.

www.medpagetoday.com/MeetingCoverage/AUA/20395

This represents a counter point to my argument that adjuvant therapy (ART) is best for the Stage 3 guys. I still believe that it is a best option, but it would have given me hesitation had I been informed about this possible side effect. I now hope it does not become a factor for me later in life.

So far, so good.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 47 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 7/14/2010 4:14:47 PM (GMT-6)


Opa N
Regular Member


Date Joined Sep 2009
Total Posts : 150
   Posted 7/14/2010 4:19 PM (GMT -6)   
My mediccal oncologist has done blood work each time I have seen her to track my Vitamin D levels. Vitamin D, esp. D3 at the higher end of the normal range (70-80 ng/ml) will help to prevent osteoporosis (which leads to fractures), and to prevent metastasis to the glands (according to her, and she has a PhD in this stuff). Taking D3 at 3000-4000 IU daily can help accomplish this.
I am/was Stage 3 (T3B) and did both ADT Lupron and Radiation Therapy, both Adjuvant, and am glad I did. First psa post-Lupron came back today at <0.01, undetectable.
Roger
Age 67 at diagnosis. Treated for coronary artery disease (CAD) since 1998, and under control with medications.
2/6/09 Routine physical, with DRE and PSA Test. PSA 4.02. Referred to Uro
4/20/09 TRUS w/needle biopsy
4/23/09 Diagnosis PCa with Gleason 4+3 in 2/2 cores, Gleason 3+3 in 5/10 cores.
CT scan and Bone Scan both negative. Stage T2C.
8/27/09 DaVinci RP at WakeMed Cary NC with Dr. Tortora. Discharged 8/28.
9/8/09 Catheder removed. Path post-surgery confirms PCa, with Gleason 3+3 with scattering of 4. Positive margins in L & R posterior, R and L seminal vesicles, with perineural invasion. Stage T3b.
9/30/09 PSA Post-Op <0.01. Met w/Uro/Surgeon to review surgery and path report. Referred to Medical Oncologist and Radiation Oncologist. Appointments set for 10/8.
10/8/09 Met w/ both oncologists. Adjuvant Combination Therapy to begin ASAP.
10/21/09 First Lupron injection. 30 mg dose (4 month)
11/2/09 PSA 2-month <0.01. Cystoscope w/calibration and dilation to remove scar tissue from urethra. Big relief.
12/18/09 psa 4-Month <0.01 undetectable. MRI/CT scan set for 1/5/10 for IMRT planning. RT to begin week of 1/11/10. Anticipate 64-66 grays over 32-33 treatments.
1/14/10 Start RT with 32 treatments # 2 gys per.
2/26/10 IMRT completed.
3/1/10 Second Lupron injection, 30 mg dose (4 month)
5/10/10 PSA 8 month and 2 month post RT <0.01 undetectable

Initial incontinence pretty bad, starting w/6 Depends pants/day. Gradual improvement, with dramatic reduction in leakage around 9/20/09, to 1 pad during the day and 1 at night (for security). Actually totally dry at night. After 1/16/10 down to a female regular pad. Barely felt. 4/30/10 threw pads away. Dry at last.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2010 4:26 PM (GMT -6)   
Good points Roger,
A good oncologist will insist on Vitamin D supplementation, and also Sodium Alendronate (Fosamax or equivalent) when on ADT. Some believe that Calcium supplementation is a good preventive step. Some will also insist on Zometa in place of Fosamax. One has to caution with the latter two because of necrosis of the jaw for example. But clearly there are things you can do to improve the SE's from ADT but I am not sure how well they work with radiation damaged bones.

I am also uncertain if these steps were included in the above study...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/14/2010 4:49 PM (GMT -6)   
Since I am on that poster child risk list (ADT3- 2yrs. and heavy dosed radiations) (LOL) I will have to be awatch for any issues. So far no problems known to be addressed, which has amazed me thus far.
Youth is wasted on the Young-(W.C. Fields)


BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 7/14/2010 4:53 PM (GMT -6)   
TC- Remember Little Caesars where Paris is now? I dealt craps there for several years. We were arranging life to get back there to live when "this" stepped in our way. Anyhow, so I get this right, you saying that with EBRT.. such as IMRT - there is an increased risk of hip fractures? I had Legg Perthes desease for 5 years as a kid - A decaying of the hip socket.. had it in both hips.. somewhat rare. But it leaves you with arthirtis and can be an issue as one ages.. and I am aging :).

I met with a Rad Onc just this week, now had the opportunity to speak with 3 of them.. all well informed and very helpful. And all three know (or should) of my medical history. You would think all three, if not two, or even one would mention that this might be a factor to consider. But none of them have. What do ya think?
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain!


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 7/14/2010 5:44 PM (GMT -6)   
Bobcapes,

1st I like your signature but it is missing one thing? What stage were you given after surgery? I'll assume pT3a for future reference.

Yes IMRT, and to an extent any radiation than will extend to areas of pelvic bone exposure. Since the study is primarily focussed oh RBRT, I will say for now that I don't know the effects from Brachytherapy and Proton, Cyberknie or Calypso (Sterostatic) radiation. While precise as these methods are, there is still potential bone exposure to radiation. I think this is the key thing to remember...

I seriously doubt any of these RO's have extensive experience with Legg Perthes. I admit to just learning a small bit about it from your post.

I have no regrets about my decision to move forward with ADT and IMRT. But then I still have no lingering SE's. I do have a couple men in my UsTOO group that have had just a terrible go of things with ADT and/or EBRT. While rare, incontinence caused by radiation tends to be permanent with no corrective procedures available. These men had been treated oner a decade ago with radiation and I do know that radiation delivery has improved immensely.

Don't expect your RO's to say it, but you should keep researching it. I would ask the specific questions given your history.

1> Does radiation exposure in the bones weaken the bones? (this answer has to be yes, this is a proven fact)
2> Does the damage to bones exposed to radiation have the potential to manifest itself into a more serious condition?

You can mention the Elliott study that was reviewed by Harvard. I am curious if they hesitate to do their own research on it. I had a conversation with my RO about it, but i really didn't completely understand it. But he did make me feel at ease when he commented about the rareness of it. The problem was that I was still 44 at the time. i have to live 40 years post radiation. He didn't have that chart, I'm certain...

You've been out of Vegas quite a while. I sold the phone system for the Paris in 1999 while construction was still early...

Peace to you!

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
LARP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino


BobCape
Regular Member


Date Joined Jun 2010
Total Posts : 416
   Posted 7/14/2010 7:47 PM (GMT -6)   
Hi TC, and thanks for the info... written on pathology as PT3... but goes on to say ith extraprostatic extension, microscopic invasion of the bladder neck.. which I understand to indeed be PT3A. I since updated my sig showing same. I will have to ask about that then... while i'm at it, I broke my pelvis in a car accident 34 years ago... so I imagine that's a mess too (actually they say the healing of bones often makes them stronger)... But I guess i'm just falling apart. Too bad, I quit smoking in Jan, and now walk 3 miles a day min... I otherwise feel better than I have in years. And for the record... I have been back to LV many many times.. Stardust was the haunt, then Oreans... sometimes Paris because they give me the suite. Making myself homesick here. Good wishes go out to you all this evening.
First ever PSA test Jan 2010 @ 51 years old. 4.0.
Digital exam in March 2010 showed 1 side hard, other soft.
Biopsy, positive in 3 of 12.
Davinci @ Boston Medical Center, May 17, 2010.
Was suggested prior to it was likely contained.
June 1 advised 3+-4 was really 4+3 per pathology. Pos margins.
Listed on patholgy as PT3, but with extraprostatic extension,
microscopic invasion of the bladder neck, PT3A is perhaps the case.
Catheter removed June 1.. 1 pad/day, doing ok. ED, but not in rush.
Sore as heck down there, but doing much walking with my wife.
To meet with my Uri (1st meeting since) June 17 - 1 mo point, to discuss.
BMC already has me setup to meet with radiology.
Felling a little better each day. Cant tell if my expectancy just went from 10-15 down to 5-7, the information out there appears to be all over the place. I WILL NOT radiate my insides to the point of being a veg for the sake of a few years. QOL is primary to me. Selfish I guess. I pray for all of you as I do for myself, but must remember that i've had a pretty good 50+ years, and know others who have lost their children to disease.. so I dont have the nerve to complain! Update 7/14/2010: When I tried changing this sig a few days after creating it, system was broken. My new rad oncologist are discussing IMRT.. though he says he can see why waiting a bit and watching the PSA on super sensitive basis might make sense. I am leaning towards IMRT.. thinking is my body is pretty strong now, i'm 51, and if I can rid my body of this while trying to minimize the side effects.. I dunno. No really Good answers. When I said I didnt want radiation to the point of being a veg.. I really meant there is a limit as to where I wish to go in order to realize only a small increase in life expectancy.. and not that I am an unreasonable person. I do, after all, have an obligation to my wife and kids.

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