I am with John here and believe that with the positive nodes and high Gleason that it is probably better to strike early. We still really lack long term data on combined therapies but for relapse free disease adjuvant is performing well and if the PSA does not indicate a remission then there is no question that you need to address it as soon as the surgery heals.
But don't be too despaired. I have seen many cases of node positive disease do very well. Pelvic nodes are examined to determine the probability of metastatic spread but it can still be locally spread. This would indicate why many men do well with followup radiation. I would ask your RO about
the positive nodes and whether he is in tune with techniques to hit local nodes in the pelvic area.
On the HT part, in virtually every study I have seen, the use of HT ahead of salvage or adjuvant radiation has a positive profound affect on biochemical failure rates. There is very little data on the mortality in long term studies, but it stands to reason that early neo-adjuvant HT before radiation is a very reasonable approach.
You are a stage 4 case and I decided to move forward at stage 3B. While I have tests coming next week, I expect good results and should do well. I do not know what the long term SE's will be from radiation but the short term have been non-existent.
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
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.
"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) : 10/27/2010 3:47:10 PM (GMT-6)