HT after Radiation

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howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 8/6/2010 10:09 AM (GMT -6)   
 Hi all and thanks for the board.
 
I am finishing up EBRT and want to find out what the prevailing opinion is as to when to start HT. Do I start right after radiation or should I get a couple of PSA tests first. As you can see by my signature I have high risk PCa. Thanks for any input.
DX age 58
PSA 5.4
Gleason 5+4 = 9
City of Hope Clinical Trial (punch protocol). 6 sessions textore every 3 weeks + lupron
PSA .1
RP Oct 2009. Seminal Invasion positive margins. Lymphnods clear.
1 month PSA post op undetectable.
4 month PSA undetectable.
7 month PSA .5
Bone scan and CT scan negative. Prosticint scan mild activity in prostate bed.
EBRT May 2010. 39 sessions 70gy. On number 37.

don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 8/6/2010 10:25 AM (GMT -6)   
Hello Howard,

I believe it depends on the cancer. In my case I was diagnosed as "advanced" and I received HT concurrent with the radiation and for a two year period. I am on HT holiday at present. There is a good bit of research that HT combined with EBRT has a better outcome than EBRT only in advanced cases. If your PCA was local my research indicates that EBRT and surgery have about the same cure rate with a slight edge to surgery for recurrence ten years out. You may want to wait and see if the EBRT finished the bugger off.

Regards,
Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
Started Casodex on May 2 and stopped on June 1, 2008
Two years on Lupron completed 01/2010.
Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled
First 25 were full pelvic for a total dose of 45 Gray to lymph nodes.
Last 20 to prostate only. Total dose to prostate 81 Gray.
Completed IMRT/IGRT 09/11/08.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones
PSA 06/09 .36 or .30 depending on who did the test
PSA 09/09 .33 one year after IMRT and 16 months into hormone
PSA 03/10 .32 18 months after IMRT Still on hormones
PSA 05/10 .42 Rising a little as the lupron wears off. Last lupron shot 01/10.
PSA 06/10 .322 Maybe the .42 reported in May was in error?
PSA 07/14/2010 0.1

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 8/6/2010 11:28 PM (GMT -6)   
Howard:  In most instances if HT is used wth SRT it is started a few months before the radiation to weaken whatever cancer there may be left.  Since you didn't do that I'd go ahead and get a PSA test done to see where you stand and take it from there.  Do you know if you had full pelvic radiation basically that means that they targeted the seminal vessels also,it means just a bigger area radiated.  You can equate it to wider margins during surgery.
 
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

3/02/09-PSA <0.02 Nine months after surgery

5/02/09-PSA .10

8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.

12/31/09- SRT completed, still on HT and will be for 2 years, PSA is <0.01

7/30/10- PSA still <0.01, on HT 1 year with 1 to go.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/6/2010 11:43 PM (GMT -6)   
Hi Howard,
Welcome to HealingWell. First thank you for your participation in a clinical trial. That's good stuff for all of us. My RP was done by Tim Wilson there at CoH. I assume you are done with the trial and free to do what you want. Your Gleason grade was very risk, and your disease progression was already where mine was. If you continue your rise, I see you back on HT quickly. The question is what protocol? There are many alternatives to ADT, ADT3. Several centers can help you with that, but you will have to ask about them. Your PSA is still low, so until you know what the velocity is, you have time to decide for yourself. Given your grade and progression, I would work hard at it now because the decision is likely near if there is movement.

Stay positive though. Michael Milken, the billionaire, was a G9, stage 4 man and he made many changes in lifestyle and kept good doctors near him. He was diagnosed in 1993 and he is doing well even today.

Peace and hope 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:
RALP ~ 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

Sleepless09
Veteran Member


Date Joined Jul 2009
Total Posts : 1267
   Posted 8/7/2010 8:55 AM (GMT -6)   
Hello Howard, welcome to the forum. I'm not at the stage where I need either of the treatments you ask about, but I'm keenly aware that my future remains a question mark with each PSA test. Accordingly, I read with interest the question you've asked and the answers above. While I'm not in a position to offer any advice or wisdom I did want to welcome you and wish you success.

Sheldon AKA Sleepless
Age 67 in Apil '09 at news of 4 of 12 cores positive T2B and Gleason 3 + 3 and 5% to 25% PSA 1.5
Re-read of slides in June said Gleason 3 + 4 same four cores 5% to 15%
June 29 daVinci prostatectomy, Dr. Eric Estey, at Royal Alexandra Hospital Edmonton one night stay
From "knock out" to wake up in recovery less than two hours.  Actual surgery 70 minutes
Flew home to Winnipeg on July 3 after 5 nights in Ramada Inn  ---  perfect recovery spot!
Catheter out July 9
Final pathology is 3 + 4 Gleason 7, clear margins, clear nodes, T2C, sugeron says report is "excellent"
 
Oct 1st 09 -- dry at night, during day some stress issues.
Oct 31st padless 24/7 
 
First post op PSA Sept 09  less than 0.02
PSA on Oct 23, 2009 less than 0.02
PSA on Jan 8, 2010  less than 0.02
PSA on April 9, 2010 less than 0.02 
PSA on July 9, 2010 (one year) less than 0.02
  

howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 8/7/2010 12:22 PM (GMT -6)   
 
 Thanks for all your input. I already have made an appointment with my Onc for the end of August. If I start HT immediately he wants to use Firmagon in place of Lupron. Firmagon offers no flair so I would not need casodex. It also acts withion 3 days as opposed to 2 weeks.  I still am seen by the CoH and remain in the trial although I am considered a failure. They still think that the trial we benefit me on this journey. My Onc has what he calls an umbrella and has a good in with Dr. Scholtz in Marina Del Rey. As all of you I will continue to fight the good fight.
 
FIGHT ON.
DX age 58
PSA 5.4
Gleason 5+4 = 9
City of Hope Clinical Trial (punch protocol). 6 sessions textore every 3 weeks + lupron
PSA .1
RP Oct 2009. Seminal Invasion positive margins. Lymphnods clear.
1 month PSA post op undetectable.
4 month PSA undetectable.
7 month PSA .5
Bone scan and CT scan negative. Prosticint scan mild activity in prostate bed.
EBRT May 2010. 39 sessions 70gy. On number 37.

deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 250
   Posted 8/7/2010 7:59 PM (GMT -6)   
Howard. I to was in a clinical trial at Emory in Atlanta HT treatment along with SRT and 2 shots of Lupron I took casdex for 4 mths but i didnt understand when you mentioned flairs with casdex would you mind explaining that.My PSA so far has been ,<0.05> since March and I finished the trial in DEC,09
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. psa the last of 7/09was .55 onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see 3/10 psa.05 5/14/10  family doc done blood work at my request her lab psa .01  
6/17/10 saw rad.onc. having problems with hips and muscles {bone density test sch, 6/25/10 wait and see

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/7/2010 8:11 PM (GMT -6)   
Hey affilated with Scholz, looks mighty fine to me, the advice should flow that is amongest the best. Let us know more on Degarelix (Firmagon)has no flare issues and is called (GnRH)? not an LHRH, works little differently and maybe even be superior for other reasons. All other LHRH drugs if given to a patient without casodex or flutamides prior for like up to 14 days, will cause flare up in T levels and can feed PCa....naturally worse for high stats people whom could get utures blocked and other bizarre things. (Dr. Strum has one guy example of a death because of complications with a flare issue...bizarre deal). Note Dr. Strum says no patient should ever be exposed to a flair scenario...it happens all the time still...uro-docs giving Lupron and such without casodex prior. (ignorance is alive and well, sorry to say). What does this say about other things that they don't know or do correctly???? (clue time)
Youth is wasted on the Young-(W.C. Fields)

howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 8/9/2010 12:23 PM (GMT -6)   
 Dee Hunter
 
Casodex prevents the flair caused by Lupron it does not cause the flair it self. According to what I know casodex is given 2 weeks prior to Lupron . All material I have read states thT Firmagon causes no flair an d will begin to drop T levels within 3 days as oppsed to Lupron which takes 2 weeks.
DX age 58
PSA 5.4
Gleason 5+4 = 9
City of Hope Clinical Trial (punch protocol). 6 sessions textore every 3 weeks + lupron
PSA .1
RP Oct 2009. Seminal Invasion positive margins. Lymphnods clear.
1 month PSA post op undetectable.
4 month PSA undetectable.
7 month PSA .5
Bone scan and CT scan negative. Prosticint scan mild activity in prostate bed.
EBRT May 2010. 39 sessions 70gy. On number 37.
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