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Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 10/18/2010 10:33 PM (GMT -6)   
After my radiation tx the Rad Onc surprised my by saying he wants me to be on HT for three years (he was saying six months prior to tx). It took me a while to get used to that thought. I've been visiting Sloan Kettering quarterly for over a year now. Last time my Radiologist must have had enough of me and said I should follow up with the Onc. (Both are from Sloan Kettering). Today was supposed to be my Lupron shot, so I saw my Onc doc.

She surprised me again by saying in her experience for younger men like myself, the risks of staying on HT (PCa becoming hormone resistant) are higher than the risks of limiting the treatment to a year after the radiation. She said there is no evidence that three years is better than one or two. (There is evidence of that in the case of primary rad treatment). She also said that should the cancer return after my T levels rise to normal, she would treat me with Casodex intermittently.

On one hand, I am pleased to be off the HT (the end of hot flushes and all), but on the other hand, I am uncertain which path is better.

Can you guys chime in with your thoughts?

Thanks!

Greg

P.S. T and PSA are still undetectable
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10

Post Edited (Geebra) : 10/19/2010 1:43:46 PM (GMT-6)


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 10/19/2010 10:06 PM (GMT -6)   
John T, Zufus and others - I am really counting on you guys to share your wisdom. I was planning to bargain with the Onc to reduce three years to two, but when she pre-emptied me with one, I am confused. What is the right thing to do?

Thanks for your help
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10

MistyCoffee
Regular Member


Date Joined Oct 2010
Total Posts : 39
   Posted 10/19/2010 11:21 PM (GMT -6)   
Aloha Geebra,
This is not easy. My primary treatment was EBRT/IMRT with ulta-sound guidance. Started Lupron Depot June 07, Rxt Sept/Oct 07. After one year of 3 mth shots my hips at the shot site hurt so much, I asked to quit. I was reminded that I was hi-risk for PCa return, but it was my choice and they agreed. Have since read that there is not much difference between 1 yr & 3 yr ADT with primary EBRT. If you can do the one mth shots. See how it goes for a year. Perhaps more studies will be completed and you can re-evaluate your choice.
If your hips hurt, cortizone shot does wonders, helped me get back on my off road bicycle.
Hang in there,
Have you read the stories on yananow.net? Perhaps find one that closely matches your stats and e-mail and chat with other men.
My EBRT side affects have made life very difficult. I guess I got more dose than my health tissue could recover from.
Hope you travel a different different path,
Joe
Late 06 presented with night voids, PSA 8
Diagnosed May 07, PSA 14, 12 of 12 cores, 4 to 70%, G9 started ADT
EBRT/IMRT Sept 07 four wks pelvic cavity, Oct 07 four wks to prostate
Feb 08, hemorrhoidictomy + staple job, start of bleeding, mucus, incontenance, two Argon laser treatments, still blood, clots, mucus
Aprl 08 last 3 mth shot of Lupron Depot

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 10/20/2010 7:49 AM (GMT -6)   
Misty, how are you doing now? Is PAS drill undetectable?

Best of luck and thanks dir reply.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 10/20/2010 12:10 PM (GMT -6)   
Geebra,
From what I have read in treating with HT you have to make a plan based upon how the HT is working for the individual instead of just giving a standard protocol of Lupron for a set number of years. The goal is to get a complete blockade and get the psa to .05 for a period of at least 6 months.
A good source is the prostate pointers p2p archives. Look at the posts answered by Dr Strum to get a feel of the testing and blood markers he used to see how the HT is working. Also his book "Primer on Prostate Cancer" is a good source. I know psa and testestorone and other bloood markers are tested monthly at first to see how the HT is working.
I think that treating with HT is more of an art than a science and you have to adjust the protocol as to types of drugs and time depending on what you are seeing that wors and what doesn't.
If I were ever to go on long term HT in the future I would get a consult from Dr Myers or Dr Scholz and get my treatments from a local doc with periodic follow ups from those docs. I think an initial consult costs about $1000 and covered by insurance and phnone consults for follow up from Dr Scholz are $45 which may or may not be covered. I think there is a benefit to have a doctor that has treated 10s of thousands of patients looking over the shoulder of my local doc and spoting things he may have missed or recommending a better course of action depending on testing.
I don't think that anyone can tell if one, two or three years is the correct time with out first seeing how your cancer is reacting.
Hope this helps,
JT

Casey59
Veteran Member


Date Joined Sep 2009
Total Posts : 3172
   Posted 10/20/2010 2:49 PM (GMT -6)   
Geebra,

Just a brief comment that the 3-year target seems to be arbitrary. The typical objective of HT is to drop the PSA down to below 0.05ng/mL. Maybe the doc was saying that it might take as long as 3-years, but that sounds longer than typical.

PCRI has an excellent paper posted here: http://www.prostate-cancer.org/education/andeprv/Strum_IADT.html

hope this helps...

Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 10/20/2010 6:57 PM (GMT -6)   
Thanks, guys. My PSA has dropped to below 0.05 after two weeks on Casodex and remained there for the last 16 months. So, by that criterion I should stop HT.

I do agree that a consult is a good investment.
Father died from poorly differentiated PCa @ 78 - normal PSA and DRE
5 biopsies over 4 years negative while PSA going from 3.8 to 28
Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8
Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere + Avastin)
PSA prior to treatment 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60
RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins
PSA undetectable for 8 months, then 2/6/2009 0.10, 4/26/2009 0.17, 5/22/2009 0.20, 6/11/2009 0.27
ADT (ongoing, duration TBD): Lupron started 6/22/2009
Salvage IMRT to prostate bed and pelvis - 72gy over 40 treatments finished 10/21/2009
PSA 6/25/2009 0.1, T=516, 7/23/2009 <0.05, T<10, 10/21/2009 <0.05, T<10

livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 10/20/2010 7:08 PM (GMT -6)   
I have not read what the others wrote so this is just my opinion. I too was on ADT3 for two years. One doctor I had suggested three years and another said I should stick with two. After doing my own research I concurred with two years. That was nearly 18 months ago and my PSA is just now detectable at .71, and I plan to let it go until it reaches 2 or 3 before I make any plans. So my unprofessional opinion is to go with two years not three.

peace to you
Dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009. I am currently (7-22-2010) not on any medication.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
PSA July 22nd of 2010 is .71
Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
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