HT with RT decision

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mr bill
Veteran Member

Date Joined Sep 2010
Total Posts : 707
   Posted 1/23/2011 9:52 AM (GMT -6)   
I am at a loss. My tendency is to analyze till I paralyze.  Throughout my journey I have gathered a great deal of information from the experience on this forum.  Now I have reached a critical point in my treatment. I have conferred with at least two members of the forum outside of the threads, now I need to once again call on the collective experience of the forum members. 
The issue is HT along with RT.  In December of 2010, after RP in September, 2010, the surgeon at the Cleveland Clinic advised me to have RT within a month.  I have been dragging my feet trying to decide where to go. I know I need RT with seminal invasion.  The radiation oncologist in Erie has recommended two years of HT along with radiation. He is at the Regional Cancer Center, and the director of this center which is affiliated with University Pittsburgh Medical Center (little bit competition between them and Clinic). 
What also amazed me is that my PSA still remains at < .03. That is at about 4 ½ months out.
I have heard some nasty side effects from HT.  I am 66 ½ - is it worth it?
I also read this regarding RT.
Summary of study.
The benefits of early radiotherapy in other paradigms have been established. There is level I evidence that ART has acceptable, well-tolerated transient toxicity, which dissipates with time. The best conditions for optimal results from radiotherapy occur when the serum PSA level is very low or undetectable, that is, in the true adjuvant setting. There is substantial evidence from nonrandomized series, almost unanimously in favour of ART for biochemical recurrence rates. There is robust level I evidence from well-executed randomized clinical trials reporting superior biochemical relapse-free and progression-free survival with early ART for patients at high risk for tumour recurrence. The previous argument that no overall survival has been demonstrated with ART has been invalidated by the recent results from a randomized controlled trial demonstrating that indeed there is overall survival advantage with ART compared with observation and delayed therapy. Thus the main criticisms and concerns regarding ART have been answered and there is convincing and compelling evidence to support the use of ART in patients at high risk of tumour recurrence after radical prostatectomy. Those patients at low risk for tumour recurrence should be vigilantly observed and at the first sign of biochemical or clinical failure, ART should be instituted to optimize treatment response.

Age 66
BPH since 1996. at least three negative biopsies Erie. Uro did not prescribe finasteride
2007 acute urine retention photovaporize Clev. Clinic prscb finasteride
8-9-10 PSA rose to 10.14 with finasteride positive biopsy gleason 9, cat & bone scan negative
9-8-10 RP at Cleveland. Biopsy 9 nodes 2 positive,
seminal & vas deferens +
PSA 3 wk .06, 6 wk <.03, 12wk 0.0

Jerry L.
Veteran Member

Date Joined Feb 2010
Total Posts : 3072
   Posted 1/23/2011 11:29 AM (GMT -6)   
Mr. Bill,

I am a year out from surgery/radiation. PSA is still not detectable, but I am considering HT at this time. I posed a similar question a few weeks ago: (If I'm reading your signature correctly it says you have 2 positive lymph nodes...if that is the case - I would go with the HT)
It is a tough decision.

Jerry L.
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

Regular Member

Date Joined Nov 2010
Total Posts : 102
   Posted 1/23/2011 11:30 AM (GMT -6)   
Mr Bill
I have been on Lupron for about 2 months and stay hungry all the time. Also I get emotional at the drop of a hat. Those have been my only side effects. I was to start RT now but an anastamosis and colon problems have put it off for a while. Given your signature of positive nodes, seminal vessel and vas defern invasion plus a gleason 9 score I personally would opt for HT. There are conflicting views when it comes to HT, but I took the suggestion of my surgeon and oncologist. I do not feel wise in advocating RT because that is a personal decision and one I am currently coming to grips with myself. I'm sure you will make the right decision since you are very knowledgeable about the options. I wish you the best.
Stay well and blessed
Age 67. Robotic prostatectomy 10/26/2010, due for RT in Janury 0f 2011. Eight of 12 lobes positive. Gleason Score 4+4=8, Margin envolvement was present with adipose tissue invasion and perineural invasion, glandular and stromal hyperplasia present,pT3 pNO and no evidence of metastatic adenocarcinoma. 1st psa after surgery Nov. 24, 2010 was .3
HT started Nov. 24, 2010.

Veteran Member

Date Joined May 2009
Total Posts : 2692
   Posted 1/23/2011 4:45 PM (GMT -6)   
Mr. Bill,

This is probably not a right or wrong answer, and it is impossible to tell if it will make a difference.

If we are doing the RT to kill of any cancerous cells lurking around, how will we know if we hit any or not? If we don't do the HT, we expect to see a drop in PSA. If we do the HT, along with the RT, we will never know what made the PSA drop.

I have not found a scientific argument for the combo. But when the time comes, i can't tell you what i will do. Depends how convincing thebRad guy is.

good luck on your decision, and once you make it, don't look back. Either way, it will be what it is.
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injection
No pads, 1/1/10,  9 month PSA < .01
1 year psa (364 days) .01
15 month PSA <.01
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