Basic HT question

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Veteran Member

Date Joined Nov 2009
Total Posts : 7213
   Posted 10/23/2010 1:42 AM (GMT -6)   
Having read posts about HT, something has always confused me.

There is something I don’t understand about HT. Specifically, when does one start it?

Consider the following scenario. One has surgery and unfortunately gets BCR.

Then one does SRT. Let’s suppose that fails as evidenced by a rising PSA soon after SRT.

Let’s further suppose the PSA is at…say…5.0.

So, I can see two arguments:

  1. Start HT immediately to knock things down while they are relatively quiet.
  2. Don’t start HT. It will eventually fail, so you want to stretch things out as long as you can. Wait until the PSA goes to 10 or 20 or even 30.

OK, I might be oversimplifying matters. Is one answer above correct or are there various schools of thought on this question?




PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. First post-op PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06

Regular Member

Date Joined Mar 2007
Total Posts : 460
   Posted 10/23/2010 10:17 AM (GMT -6)   
I think you will find there are different views on the subject of just when to start HT.  I am in that group 9 months after surgery my PSA began to rise I was in the zero club for almost a year.  Then I did the SRT which also failed.  My PSA last count was 2.4 doubling
time a little over 3 1/2 months (not good).  However, I feel good play tennis everyday and have no problems.  My oncologist suggests HT but agrees there is no proof that starting sooner rather than later will give me any longer survival rate.  He agrees that since I feel good we can wait until the PSA is 10 or above or unless something is seen on a scan.  I  to feel good for as long as possible and since the odds on doing HT sooner or later are no different I will hold off for now.  I go for my nest PSA on Tuesday so we will see what is going on, I am sure it will be up again since I am not doing anything to stop it but hopfully it did not double. 
Age 71 DX 8/13/08, PSA 4.0 Biopsy 14 samples , 1 positive, Gleason 4+4 - Da Vinci 10/17/08 organ confined, no positive margins or lymph nodes, both nerve bundles taken. Gleason 4+4, PT2A
Cath out 10/29/08 dry 11/19/08
First PSA 3/6/09 >0.1- 3/6/09 0.0, 6/3/09 0.1, 10/15/09 0.3, 12/14/09 0.5. IMRT 1/18/10 First PSA 1.5, 7/8/10 1.9, (not good IMRT a failure)
9/3/10 2.4 next PSA end of Oct

Veteran Member

Date Joined Dec 2008
Total Posts : 3149
   Posted 10/23/2010 11:05 AM (GMT -6)   
Depends upon which 'experts' you have your discussions with (LOL)! I have heard it in many fashions, I am more likely to lean towards the thinking that John T has mentioned in the past on this and what alot of the leading independent oncologists whom treat many such failed patients are saying.

Nothing is basic in PCa and each case is actually unique. Dr. Samadi was on T.V. and in the news telling about the other effects now disclosed about using LHRH (Lupron and such) as to diabetes or heart issues related(not even mentioning the others we know about which are big deals when used over time). We have this disclosure about after 20-30 years after Lupron has been on the scene, wonder what else we will learn in such a fast time frame (LOL).
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35, ct and bone scans look clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off 1+ yr., controlled well, resumed, used intermittently, resumed useage

Regular Member

Date Joined Aug 2010
Total Posts : 154
   Posted 10/23/2010 1:43 PM (GMT -6)   
Let me see if I understand this right.  A GS 8, with a fast DT of PSA, who is not considering HT, and going to wait until the level reaches 10, 20, 30 or something is seen on a scan, before anything is done, because he feels good????????????????  How about bone pain in the spine, hip, ribs, or skull?  Something show up on a scan?  Now what?  Its play catch up time with HT, spot radiation or chemo?  Not my choice.  I want in the game during the first quarter, not the final 2 minutes of the 4th.......................  The most points on my side of the score board is how I'm going to play.  If I get beat up a little, (HT) I'm still ahead of the other side.  The other side feels good, but I'm around for the play offs................. 
PSA at Dx 105 at age 68, 4/04. ADT (Lupron only), RRP, 5/04. Gleason 4+5=9, Staged pT3c N0 MX, 3D rad, 40 treatments, 8/04. PSA 1/05 <0.01. ADT till 7/07. PSA 0.03 12/08, 0.07 4/09, 0.13 8/09, 0.19 12/09, 0.30 4/10, 8/10 0.41. Will start ADT3 after PSA reaches 1.2.

Regular Member

Date Joined Mar 2007
Total Posts : 460
   Posted 10/23/2010 3:42 PM (GMT -6)   
The problem is starting now or starting later is not going to give me any more time.  At least that is what the experts say if I knew it was different I would be on HT now!!  My feeling is why feel like crap on HT and get all the other nasty things that go with it like high blood pressure, loss of muscle mass, bone loss, etc., if I can put it off for as long as possible.  I am not a young guy perhaps I would think different if I was but right now this is what I feel.  I have gone to some of the best doctors and we all know HT is not a cure it only works for a while I have a lot of time to feel lousy I would like to enjoy the time I have left that I feel good.  To me at my age quality of life not quanity is very important. 
Believe me at the first sign that my cancer is forming tumors or if my PSA goes crazy I will be on HT because there is nothing else.  I was told after my surgery that I was a Gleason 6 and no positive margins that I was great then nine months later came the opps I guess maybe you were a 8 and looks like the cancer is back.  Life can deal you many crazy hands and we need to enjoy the good days.  I did everything they told me to do for a cure but that did not work there are no more cures so we all have to make the choices that are right for us. 

Veteran Member

Date Joined Apr 2008
Total Posts : 1382
   Posted 10/23/2010 3:59 PM (GMT -6)   
Great discussion and there are obviously more opinions than there are answers. For me I think I am going to wait till me PSA is 3 before starting back. There is no science to that other than my own thoughts.

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

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

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4237
   Posted 10/24/2010 12:25 AM (GMT -6)   
Most of what the doctors say about starting HT later was the most prevelant thought 10 or 15 years ago when most patients were dXed with late stage PC and most failed within a short period of time. This is where the common misconception about HT only working for a short period of time started.
Oncologists like Liebowitsz, Strum, Scholz started using HT on patients much earlier in thier progression cycle and had great success because they caught the cancer cells before they had a chance to develop and mutate. about 30% of their advanced PC patients only needed one treatment period of HT to get long term remission. There is no cancer in which chemotherapy is better given later rather than sooner, why some doctors believe this is true with prostate cancer is beyond me.
Hit it hard and hit it early and this will be the best chance of it working.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

Regular Member

Date Joined Aug 2010
Total Posts : 486
   Posted 10/24/2010 10:04 AM (GMT -6)   
John T; That is exactly what my uro doc says. And that's what I'm doing. I'm not looking forward to the next two years of lupron, but when it came down to decision time, there was more reasons TO do it, than not.

You and Putt stated it very well.

The shame of all this discussion is that no one really knows for sure. My uro frequently comments on how breast cancer research took center stage for so many years, and only recently have research dollars been devoted to PCa. He stated recently that I shouldn't pay attention to any data prior to 2008. He said to confine my research to 2008 and later. That's not very long ago.

Age 57 at Dx
5/09 PSA 2.26
6/2010 PSA 3.07 FPSA 18% DRE +
6/2010 Bipsy, 7 of 12+, >60%, 4+5=9
7/21/2010 - RRP
Nodes neg,Ves neg
tumor contained, still 4+5=9
pni ext.
9/3, 2010 PSA - 0.04
9/3/2010, I'm 99% continent
10/14/10, PSA still 0.04, and lupron #1, now 99.9% continent
Total ED, 3 caverject failed, pump sux
10/20/10 OD'd on trimix, after 3hrs, neo synephrine shot

Regular Member

Date Joined Feb 2010
Total Posts : 385
   Posted 10/24/2010 12:28 PM (GMT -6)   
This is a hard thing to study--how do you randomize people between early and late HRT?

Who knows which approach is the right one? If the hormone resistant cancer cells arise early, HRT timing doesn't matter, they will show up when they show up. If they arise later from the hormone sensitive cells, or if they can arise at any time, then you would want to hit the PCa hard and early to eliminate as much PCa as possible in order to reduce the number of cells than can transform to HRT resistant Ca.

Seems like the best bet is all of the above, which means that John's advice of early HRT makes the most sense. But does any one really know?

John T
Veteran Member

Date Joined Nov 2008
Total Posts : 4237
   Posted 10/24/2010 5:25 PM (GMT -6)   
I think that a large part of medicine that is being ignored lately is Medicine as an art and not just mearly a scence. Insurance companies, large institutions and the fear of lawsuits have put the science part of medicine into the forefront in the past few years.
I think HT falls somewhat into this catagory as some doctors are just plain smater than others and pick up small differences that may be missed. Also someone that has treated thousands of advanced cancer patients has developed the art based on experience in seeing how certain medications react on different individuals at different stages and recognize when to change to something else or adjust dosage.
You just can't put all the variables that exist in treating an individual into a study. How do you explain a paient that has a psa of 2500 going into remission with HT while another with a very low psa dieing in two years.
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.
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