I think that Fairwind makes a good point. I know of many people with high risk stats that have just gone immediately to HT and all have had good results, 10 or more years. The biggest difference between HT and castration is that you can take a holiday from HT for a few years between sessions and everything returns to normal during the time off. Casteration is permanent, but the least cost method.
Acccording to the most experienced Oco docs, the earlier you start HT the better, as it works the best when the cell popluation as at its lowest and hasn't had a chance to mutate. I know there is some disagreement about
this, but it makes a lot of sense and there is data to back it up.
I think there is a major difference in protocols. Mono therapy, Lupron alone, may not be as effective as triple blockage. The key to HT is the monitoring. You have to get psa to a level of .05 and keep it there for at least three months. Most doctors just give you a lupron shot and see you again in three or 6 months. You have to be tested monthly and testerestone levels checked to see if it is working or dose needs to be adjusted or new meds added. I just see too many patients just take a lupron shot and go on their way. This is not the way to administer HT. Especially for older patients this is a very accetable option as you don't have to deal with the side affects of surgery and salvage radiation along with HT. This is the triple wammie given that most high risk cases will reoccurr.
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.