Hormone Therapy before PSA rises

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Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3072
   Posted 1/10/2011 4:01 PM (GMT -6)   
I am seriously considering starting HT before PSA rises given my g9 and t3b.  I am very intersted in your opinions.  Thanks

Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 1/10/2011 4:19 PM (GMT -6)   
Why??? Do you have some crystal ball that allows you to see into the future..? I would save the HT for IF and WHEN you NEED it....PSA 0.2 is soon enough. Some would say too soon...

You're 44 years old..What kind of sex life do you have now?? Lupron, it's gone...

Why start the "Hormone Refractory" clock ticking now when you have undetectable PSA and zero symptoms?? Just my opinion....HT is your last trump card...Hold it until the last hand....
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 NOW

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/10/2011 4:37 PM (GMT -6)   
I think that adjuvant hormonal therapy was the the right choice for me. While I chose to begin the therapy before adjuvant radiation, there is good data for men with stage 3B and later disease when it comes to biochemical failure rates. Ongoing studies at Stanford and Harvard Universities are approaching year 9 with up to 90% success rates without recurrence for the 3B guys. These studies were for Post RP ~ pT3b (seminal vesicle invasion) men who start the program BEFORE any relapse, with immediate HT and adjuvant radiation as well.

I consider my success to date to this program. My PSA history has been zeros now approaching 4 years post RP. I am no longer undergoing any therapy at this time.

Fairwind ~ The studies still need time. But a recurrence rate for 3B men is over 50% after 5 years when no adjuvant therapies are applied. However under this program it's up 90% success after year 9. This is a 75% improvement.

Now before anyone goes off on me for siting a study, please note the true gauge is prostate cancer specific survival of which data is not available today. I fully recognize that but I have no regrets having completed this protocol.

Tony
Disease:
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

Treatments:
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.

Status:
"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

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 1/10/2011 4:52 PM (GMT -6)   
I agree with Tony. The PCRI recommends adjuvant HT for all patients with very high risk stats.
JT
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.

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 1/10/2011 5:26 PM (GMT -6)   
If it was me, I would do it. I have see the same data that Tony cites. I am a proponent of hitting it early and hard.
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

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3997
   Posted 1/10/2011 5:46 PM (GMT -6)   
i say hit it.  hit it good.
 
ed
 
 
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

cyrus1
New Member


Date Joined Dec 2010
Total Posts : 17
   Posted 1/10/2011 8:08 PM (GMT -6)   
finished 44 imrt today and 4 months of lupron that sent me for a lupe. Thought of ceasing ht but after feedback from this site in congruance with dr, i took my 5th 30 day shot today. Hate this stuff but have 11 year old twins toi fight for. Gleason 8, psa 19.5, hot on all 10 biopsies, want off ht but not at cost of loosing the fight. Would appreciate pro and con feedback to pulling up to 2 years of this stuff. Thxs cyrus1

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/10/2011 8:43 PM (GMT -6)   
Hi Cyrus,
I didn't catch your age but I would assume a young guy with 11yo twins. That would be me, too. I was 44 when my experience began. I was on HT for 28 months and you could say longer as it took 6-8 months for the stuff to wear off. Pro's and con's for me were typical. No libido, hot flashes, weight gain were present and on the pro side ~ no relapse.

Tony

Post Edited (TC-LasVegas) : 1/10/2011 6:49:00 PM (GMT-7)


Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3072
   Posted 1/10/2011 8:50 PM (GMT -6)   
Tony,

Do you plan on going back on HT at some point?

Thanks,
Jerry
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3997
   Posted 1/10/2011 8:58 PM (GMT -6)   
>>I was on HT for 28 months and you could say longer as it took 6-8 months for the stuff to wear off<<
 
that's a good point, Tony. 
 
i'm four months past my last 90-day shot.  i do feel better but i'm finally having hot flashes and i've been sleeping alot.  were you sleeping more?
 
ed
 
 
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/10/2011 9:06 PM (GMT -6)   
@F8,
Yes I did sleep more. I had some serious fatigue for quite a while but both myself and my doctors thought it to be reasonable because I went through surgery, radiation and started radiation within 4 months. My understanding is that with working out and walking you can help fight through the fatigue but it didn't quite work 100% that way for me. Even today I lack the energy that I had pre-treatment but I believe it would be reasonable to attribute that to the 25 pounds I keep around as a souvenir---:-(. My new years resolution is to lose that weight but I face an uphill battle being Italian and loving to cook. Ugh...or yum depending on how you look at it...

Tony

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3997
   Posted 1/10/2011 9:23 PM (GMT -6)   
Tony -- my energy is better -- i almost feel "normal" -- but i really get tired and of course my strength has not returned.  lately i have been sleeping 10-12 hours a day.  on saturday i slept 10 hours and then took a two-hour nap but i did exercise the previous three days and it was a "rest day" for me.  still that is a lot of sleep for me.
 
i also have that 20-something pound mantle of fat that, for the time being, i'm just trying to keep from expanding.  it's also been really cold here so maybe my body is try to hibernate.
 
ed 
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/10/2011 9:34 PM (GMT -6)   
@ Jerry,
I didn't see your question slip in there, Jerry. The question was do I see returning to HT? Only if I have to. I certainly would not take a break and restart for no reason to do so. It is my intent to use HT on relapse. And when I cross that bridge when and if I get to it...

@ F8. Good luck on losing the weight. Right now it's a good plan to stay away from my dinner table. But i think it's a good plan to address it. This for far more reasons than our cancers...

Tony
Disease:
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

Treatments:
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.

Status:
"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

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 7085
   Posted 1/10/2011 10:00 PM (GMT -6)   
Jerry,

I did DaVinci (post-op G 4+5, EPE) and adjuvant IGRT, but no HT. There were mixed opinions from the doctors on HT.

I can't say I am fired up about the possibility of HT, but ...
DaVinci 10/2009
My IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808

Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 1/10/2011 10:25 PM (GMT -6)   
Jerry, I agree with Fairwind.  My Mayo docs did not start HT until my PSA hit 1.0.  The HT not easy because of side effects.  The Old Sailor

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 3072
   Posted 1/10/2011 10:32 PM (GMT -6)   
Tony,

Can you email me the Stanford and Harvard info.?

Thanks,
Jerry
Nov. 2009 Dx at Age 44
Dec. 2009 DaVinci Robotic Surgery
Jan. 2010 T3b, Gleason 9
Feb. 2010 Adjuvant Radiation

PSA History:
-----------------
Nov. 2009 4.30
Feb. 2010 <.05
May 2010 <.05
Aug. 2010 <.05
Nov. 2010 <.05

cyrus1
New Member


Date Joined Dec 2010
Total Posts : 17
   Posted 1/10/2011 10:36 PM (GMT -6)   
142 would you mind sharing the mixed opinion by drs on ht. thxs cryus1

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/10/2011 10:42 PM (GMT -6)   
The posts by 142 and Old Sailor do sum it up well.

Stage 3 is a very controversial stage in prostate cancer. But even these posts leave open controversy. When I was assessing my options, I first had to decide if moving forward with adjuvant radiation was reasonable. Most signs pointed to yes. And when I looked into that piece, I was told the use of hormonal therapy could improve the performance of radiation. My RO cited a well known study in RTOG9413 as well as the Stanford study. So for me it was reasonable that if I was going to undergo adjuvant radiation it was going to be with adjuvant hormonal therapy.

I believe that there is a major difference from pT3a and pT3b where local mets are clearly defined from being just a possibility. If we were talking about clear stage 4 disease I think Mayo would be all over the use of HT even without a rise in PSA. In fact stage 4 has much less controversy than stage 3.

That stated, good luck on this decision, Jerry. It's not an easy one. I'll be in your fan club either way...

Tony

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 1/11/2011 2:09 PM (GMT -6)   
I agree HT should be combined with radiation (like they are doing to me) for high risk patients..But Jerry had adjunct radiation without the HT..His PSA is undetectable..

Is there any benefit in starting HT NOW?? I thought it was used because it makes the radiation more effective...Jerry's radiation was completed a year ago..
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 NOW

ralfinaz
Veteran Member


Date Joined Jan 2011
Total Posts : 735
   Posted 1/11/2011 10:19 PM (GMT -6)   
Jerry L,
No man likes to be castrated. Androgen deprivation has side effects many of which can be reversed, but still it is a therapy that is very difficult to accept. That said, is there a benefit to make this decision at the proper time? Is early better than delayed. One study (a randomized trial) could answer your question. In a more recent follow (2006) after 11 years the results still hold. Read on:

RESULTS: After a median of 7.1 years of follow-up, 7 of 47 men who received immediate antiandrogen treatment had died, as compared with 18 of 51 men in theo bservation group (P=0.02). The cause of death was prostate cancer in 3 men in the immediate-treatment group and in 16 men in the observation group (P<0.01). At the time of the last follow-up, 36 men in the immediate-treatment group (77 percent) and 9 men in the observation group (18 percent) were alive and had no
evidence of recurrent disease, including undetectable serum prostate-specific antigen levels (P<0.001). In the observation group, the disease recurred in 42 men; 13 of the 36 who were treated had a complete response to local treatment or hormonal therapy (or both), 16 died of prostate cancer, and 1 died of another disease. The remaining men in this group were alive with progressive disease athe time of the last follow-up or had had a recent relapse. Except for the treatment group (immediate therapy or observation), no clinical or histologic
characteristic significantly influenced the outcome.

CONCLUSIONS: Immediate antiandrogen therapy after radical prostatectomy and pelvic lymphadenectomy improves survival and reduces the risk of recurrence in patients with node-positive prostate cancer.

Source:
Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D.
Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer.N Engl J Med. 1999 Dec 9;341(24):1781-8.
PMID: 10588962 [PubMed - indexed for MEDLINE]

It is a very personal decision and more so for a young man. Wish you the very best possible outcome
Surviving prostate cancer since 1992. RP; Orchiectomy (OUCH!)
GS (4 + 2); bilateral seminal vesicle invasion; tumor attached to rectal wall. Last PSA September, 2010: <0.1 ng/ml
Laughter is the best medicine!

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 1/11/2011 10:34 PM (GMT -6)   
I recognize that masked man.

Ralph welcome to HealingWell. As a survivor and fellow group leader I have a great deal of admiration of your work through the years. Terry Herbert has also started posting he along with Will Henderson and having you guys here really is a blessing.

As you know I followed a program of adjuvant therapies hoping for the results seen in the study you posted. So far so good.

Again welcome. I hope you stay with us.

Tony
Disease:
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

Treatments:
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.

Status:
"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

will1
New Member


Date Joined Dec 2010
Total Posts : 15
   Posted 1/13/2011 8:50 PM (GMT -6)   
Jerry already knows how I feel about the issue.  With a gleason of 9, you must hit it hard, and try to kill it all off.
 
about any treatment leaves some cancer cells in place.  So If you do several treatments you just might kill it all off, and cure your self.
 
Not fun to be on hormonal therapy, but I have been on it 16 years straight, gleason 9, in lymph nodes, but never had a rise in psa.  Still under .01.
 
No brag, just thankful.
 
Best,
 
Will H

leeanglo
Regular Member


Date Joined Dec 2010
Total Posts : 191
   Posted 1/14/2011 5:42 AM (GMT -6)   
Jerry L, we are of similar ages and i was diagnosed last year with pc .....
T3a n2 m1 ,we have posted on threads before.I started on the ht injections and it has been 11 weeks or so now.Some strange things happen to our bodies when we start this stuff but none of them i find unbearable just b----y annoying !!!!
my experiences are.......LIBIDO ___gone!! Erections can be achieved but takes some serious persuasion___Fatigue ? so far so good,hot flashes well its been a cold winter here in the uk but im not looking forward to the summer..LOL.... so far i have a little more belly fat than i did but do alot at the gym so im fighting it.....muscles have reduced but luckily i dont have moobs yet (man boobs) and if i do get them at least i will have something to play with on them cold winters nights...LOL
MORE seriously though Jerry.........My psa as dropped from 144 down to 20 in approx 11 weeks so zoladex does what it says.
If i had the choice at this moment i would not volunteer to take ht but youve gotta make your own disicions cus its your Desease and one thing im learning about pc is that no two of us are the same...(GOD that makes me feel special LOL!) The pre-ht injection drug cosadex stops pc cells absorbing androgen so has a similar effect to ht injection and when i was given this to start my traetment i did not loose libido which for me as a 44 yr old is the worst thing.
                                                      BEST OF LUCK JERRY.

Skate
Regular Member


Date Joined Oct 2010
Total Posts : 424
   Posted 1/14/2011 8:38 AM (GMT -6)   
leeanglo:
I have been on zoladex for seven weeks now also with the pre injection dose of casodex. I felt worse on the four weeks of casodex than I do on the zoladex.  Hope the lack of side effects continues for me.  Or do I still have that to look forward to?  How long was it before these SE arrived for you.  My first results will not be done until mid Feb and then my second injection Feb 24th when I will find out my results.
Just thinking out loud as this HT stuff is all new to me.
Age 59 at Diagnosis
01/08 PSA 4.17 DRE showed node
03/08 RP - Nerve Sparing, margins clear, no invasion
Continent 3 weeks post surgery / ED
06/08 until 08/09 PSA 0.01
08/09 PSA .14
09/09 RT / 36 treatments
01/10 PSA .13
08/10 PSA .6
10/10 PSA 1.67
08/11/10 PSA 3.44
16/11/10 Casodex Blockade
14/12 /10 Finished Casodex
30/11/10 Zoladex ADT
ED only SE

leeanglo
Regular Member


Date Joined Dec 2010
Total Posts : 191
   Posted 1/14/2011 1:26 PM (GMT -6)   
Hi skate,to start with i had some very minor bone pain on the cosadex but this is due to tumor flair which is the bodys response to having its testosterone taken away.This was within the 4 weeks on cosadex.I would say that was probably my worst se to date as far as worry is concerned as it made me realise for the first time that i had pc mets.Whilst on cosadex i thought i was superman.....on the nest every night,i was naieve cus i thought this would make me loose libido.Then i started on the zoladex and i was still like a little bunny rabbit anoying the life out of my lovely wife.Then one day i realised that we hadnt made love for 3 weeks and it saddened me terribly.Next i was wondering about the hot flushes cus i had no sign of them so i posted the question on healing well about when they started and low and behold i had my first one that very night.I would say the flushes started after about 6 weeks and libido had bottomed out at 4 weeks,however we now make a concious effort to make love at least once every week.Erections no longer happen automatically and i have to find a place in my head and make it happen,its all to easy to not bother but if your married then there are two of you in this deal!.Also as regards muscle loss,yes,i have noticed some shrinkage but thats not the end of the world so i work with what ive got.Ive always worked hard at the gym so putting on weight is a big concern of mine so ive addressed this by doing more cardio excercise and paying less attention to weights.I believe it is possible to minimise weight gain but i think it is inevitable that it will happen.I now eat only a bowl of porridge for breakfast,usually a tuna jacket spud at lunch and then a full meal at night....OH and about 4 bottles of beer per night.I should swap the lunch time light meal for the full one and have little food after 6.00 pm when the body slows down.
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