When do you start HT

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compiler
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Date Joined Nov 2009
Total Posts : 7205
   Posted 11/17/2010 10:33 AM (GMT -6)   
OK, in my readings I am confused about this issue. Right now, it is just academic for me; I'm not even at the post-op BCR/SRT phase (but I might be there soon).
 
Suppose I start SRT with a PSA say of 0.25.
 
What happens with PSA post SRT? My understanding is that it may stay at 0.25 or even go a bit higher at the start but it should go down in a few months if it works. Is this correct?
 
Finally, let's say it fails. When does one start HT?
 
I've read reports about waiting until the PSA goes above 10. (Stalling as much as possible?).
 
I've read other reports about hitting it hard immediately while the PSA is still low.
 
Is there an answer?
 
Mel
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

SubicSquid
Regular Member


Date Joined Oct 2009
Total Posts : 252
   Posted 11/17/2010 11:14 AM (GMT -6)   
I guess it will vary with the doctors.  I started radiation when my post surgery PSA reached .21.  My 90 day post radiation PSA was <.10.  Hopefully the six month test will be the same or lower.  My radiation oncologist has never mention HT in my case.  Squid.

Fairwind
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Date Joined Jul 2010
Total Posts : 3744
   Posted 11/17/2010 2:19 PM (GMT -6)   
Many radiation oncologists feel combined RT and HT work better than RT alone. The higher your risk factors, the more they seem to feel that way..For Gleason 9 guys with positive margins, it's STANDARD....But for less aggressive cancer, quality of life issues sometimes win out and they hold off on the HT (ADT)..

PSA and radiation can be tricky..Not much happens at first, then the PSA slowly drops until it reaches "nadir" its lowest point which is seldom undetectable..This can take two years..If you are "cured" it will stay near its nadir for many years...

If you have not read Dr. Walsh's book, you will find much detailed information there...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 11/17/2010 2:37 PM (GMT -6)   
Fairwind:
 
I asked about the HT pre-SRT and the expert at Umich said no.
 
Perhaps that's due to my pathology? (Not bad enough?)
 
Mel
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

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3744
   Posted 11/17/2010 3:11 PM (GMT -6)   
There are two schools of thought on this..When they combine RT & ADT, it muddies the water as to whether the radiation was effective..The ADT will almost certainly lower the PSA to near zero so how do you tell if the RT was effective? Sure makes the R-doc look good (for a while at least).. By keeping them separate, you can better evaluate how effective they each are...

For high-risk cases, the strategy is hit it as hard as you can as soon as you can with everything that you have...Don't worry about what works, just hope that something works!

Individual doctors, over the years, have developed treatment protocols that they feel work best..If you try to argue with them, you won't get very far...If you REALLY disagree, you have little choice but to find another doctor who will bend to your wishes..

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 11/17/2010 3:31 PM (GMT -6)   
I had HT prior to and during SRT. Every doctor I went to recommended it: Uro, 3 medical oncologists and one radiation oncologist. They all felt it would make radtiation more effective. I got different optinions on how long to stay on HT. Uro and one medical oncologist said just until SRT is over. The other two medical oncologists and radiation oncologist said 1-2 years. All 3 said that there is some evidence that it may provide a better outcome for high risk patients.

It seems to me that the presumption for high risk patiets is that it is very likely PCa is systematic. So the objective is to attack it on both fronts in the hope that if you are not cured perhaps you can drive the PCa into remission for some period of time.
Dx PCa Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4) - 8 cores, 4 positive, 30% of all 4 cores.
Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%, nerves spared, no negitive side effects of surgery.
PSA's < .01, .01, .07, .28, .50. HT 5/10. IMRT 9/10.
PSA's post HT .01, < .01
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