Did not understand oncologist comment re: HT therapy

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mr bill
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Date Joined Sep 2010
Total Posts : 688
   Posted 1/23/2011 4:51 PM (GMT -6)   

Trying to watch the game, not having much luck with that. Too many other things going through what little bit of my brain is not fried. When I visited the rad onc. Last week I asked him what if I waited for HT till PSA rose? His reply was that side effects and treatment would be overwhelmingly worse. Anybody have an idea what he meant?

I should have asked him, but I was just kind of set back from his comment.


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

BB_Fan
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Date Joined Jan 2010
Total Posts : 1011
   Posted 1/23/2011 7:19 PM (GMT -6)   
Not exactly sure what he meant. I would think that SE's of SRT w/HT would be worse. But I understand that SRT with HT is more effective in driving PCa into remission.
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

don826
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Date Joined May 2008
Total Posts : 1010
   Posted 1/23/2011 9:50 PM (GMT -6)   
Mr Bill,
 
I can not tell you what the doctor's remarks meant but you should make an inquiry. As for the SE's of radiation or HT being made worse by combining the treatments that was not my experience. I had radiation as primary so maybe it is different with salvage. The HT, concurrent with the RT, was more bothersome than the RT. RT side effects were some minor diarrhea and urinary difficulty around number 25. Both handled by immodium and flomax. Cleared up within days of completing the therapy. SE's from HT were tolerable for the first year. I managed to keep the weight gain off until the second year and then put on 20 pounds. I am still working to get them off a year after the last Lupron shot.
 
Best of luck to you.
Don
 
Diagnosed 04/10/08 Age 58
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan and chest x ray clear
CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
PSA:
02/08 21.5
07/08 0.82
10/08 .642
09/09 0.32
03/10 0.32
06/10 0.32
07/10 0.10

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/24/2011 5:09 AM (GMT -6)   
Good you question everything, I sure wonder about that statement because of my history, not exactly the same but comparable if you went with going,  HT first and then radiations if you went that way. Did 5 mons. of ADT3 and then radiations and continued ADT3 after (2 yrs. total), in this case HT before or after, the side effects still the same.  In your situation radiation could freeze urinary symptoms where they currently stand, it is said. Anyway question it and this the same doc whom was piling $$$ on, with the colonoscopy and PET scans, correct???
 
See what some others have to say, cases do vary.

Post Edited (zufus) : 1/24/2011 4:21:43 AM (GMT-7)


mr bill
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Date Joined Sep 2010
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   Posted 1/24/2011 11:07 AM (GMT -6)   
Zufus
 
one in the same.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/24/2011 11:22 AM (GMT -6)   
Not to be confused with Dufus....hey I chose the name for fun...not afraid to be humble or less than an expert.

Remember Saturday Night Live t.v.? Oh no Mr. Bill!!! (claymation gig) ......Your namesake too, but  is probably not related to this Mr. Bill??? :-)       How about Church Lady.....never mind!  

Post Edited (zufus) : 1/24/2011 12:34:37 PM (GMT-7)


F8
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Total Posts : 3800
   Posted 1/24/2011 11:27 AM (GMT -6)   
i'd have a hard time having faith in being "cured" if i suspected everyone treating me was out to line their pockets.
 
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

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/24/2011 1:44 PM (GMT -6)   
F8 - exactly why I fired the uro-doc after 2 yrs. of Lupron, with no options or end in site, my Soup N_zi wanted totalitarian control until I croaked or insurance ran out. Turns out I was correct too and have the results to confirm all my suspecions and other docs agreed with my decisions. Saved Blue Cross around $13000 a year for the last 6+ years, but no thank you cards to date! Andrew-Ohio State (past forum member) has been on casodex only for like 1 yr. plus, recently went off he was doing so good, none of his docs would prescribe it, zoladex or lupron would have been a yes, he didn't want all the effects, his choice entirely. So far has worked well in his risky case. He may chose a different drug down the road if and when it is needed. My uro-doc switched me from Zoladex originally to Lupron, I was against it basically, I noticed the billing was $700 higher per shot, must have been all for my best interests?
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

F8
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Date Joined Feb 2010
Total Posts : 3800
   Posted 1/24/2011 2:26 PM (GMT -6)   
zufus -- i have no doubt that doctors are in business to make money, and i too am a cynical ****** cool .  for my emotional and mental health i have to assume my doctors are working in my best interest, and i do question them and am probably considered a high-maintenance patient.
 
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
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/24/2011 2:50 PM (GMT -6)   
It is too cynical to say it, but it is likely more true than not. Doctors don't go to school for 8 years and become residents for a few more to become poor. There is a lot of money in this business and it does not matter which doctor you are speaking about, the temptation is always there. Doctors go on to start private practices, write books, go on TV, join elite groups ~ always while making business decisions. There are many doctors who will even dump government subsidized assistance because they limit what what can be charged.

However...it could be a poor decision to allow this system alone to influence our decisions. The best I can grab out of mr. bills post is the following:

"His reply was that side effects and treatment would be overwhelmingly worse."

From what I understand the phrase is not able to be proven as anything more than opinion. If the use of the term "would"was exchanged with "could" it would better validate the advice. It is possible that early HT intervention could outperform delayed intervention. Of course the opposite could also be true.

It is becoming more and more obvious to me when opinion gets interlaced into facts. We do it here, doctors do it in their practice, and researches do it as well. I am always still learning but a recent lesson is to try to not using definitive statements when "maybe's" are possible. It would be great to see more of it from the medical community as well...

Tony

daveshan
Regular Member


Date Joined Jan 2010
Total Posts : 363
   Posted 1/24/2011 2:53 PM (GMT -6)   
mr bill said...
<span lang=EN>

Trying to watch the game, not having much luck with that. Too many other things going through what little bit of my brain is not fried. When I visited the rad onc. Last week I asked him what if I waited for HT till PSA rose? His reply was that side effects and treatment would be overwhelmingly worse. Anybody have an idea what he meant?

I should have asked him, but I was just kind of set back from his comment.


Bill,
When I first read this I wondered if you meant RT instead of HT as you were talking to a rad' oncologist.

Taking that line of thought your guy sounded exactly like the first rad' Dr I talked to. This was after 6 months of 0.0X tests, my surgeon wanted me to talk to the Dr and consider adjuvant (late) just in case.

When I asked him about side effects and percentages he looked me straight in the eye and said "Would you rather be dead?" Needless to say I hit the door running and went back a few weeks later to talk to his partner who was much more honest and low pressure.

The gist of that long and involved story is some Dr's will use scare tactics to get patients to undergo treatments, whether for the patient's own good or to line the Dr's pockets it really doesn't matter. To me this is what your conversations with the Dr sounds like. You deserve an honest and open conversation, if you don't get it from one guy fire him and move on.

Best of luck to you
Dave in Durango CO (not a lot of options for moving on up here)
Diagnosed 12-09 age 55
07-06 PSA 2.5
01-08 PSA 5.5 (PCP did not tell me of increase or schedule follow-up!!!!)
09-09 PSA 6.5 Sent for consult with Urologist
11-09 Consult, scheduled for biopsy, found out about PSA from '08 (yes I was pissed)
12-09 Biopsy, initial Gleason 9 (4+5) later reduced to 8 with tertiary 5, ain't much but I'll take it.
01-10 Bone Scan, "appears negative"
03-01-10 RRP in Durango CO by Dr Sejal Quale and Dr Shandra Wilson, no naked eye evidence of spread, Vesicles and lymph nodes taken for microscopic exam.

03-16-10 Removal of cath' and pathology results of samples.
Multifocal carcinoma with areas of Gleason pattern 3, 4 and 5, Overall Gleason grade 4+4 with tertiary 5, Bilateral involving 21% of left lobe, 3% of right lobe, Invasion of left Seminal vesicle, Tumor focally present at left resection margin, 9 lymph nodes removed all negative, Tumor staging pT3b NO MX

04-23-10 PSA <0.04....... 06-07-10 PSA <0.04..... 08-03-10 <0.04
05-03-10 1 week without pads
06-28-10 ;-)

tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 487
   Posted 1/24/2011 3:06 PM (GMT -6)   
B
There is no way that LHRH treatment "later" will have worse side effects than "now" if that was the question or answer. Whatever effects a man falls heir to are what they are, and are not determined by a calendar.
If you and he were referring to whether the radiation effects are magnified by hormone therapy then I have never heard of that. Never. The effects are due to different mechanisms entirely.
It is true, however that radiation may have a beneficial effect in your case. Trial SWOG 8794 showed that. Your zero psa has been a windfall and allows you time to consider. Perhaps another radiologist will provide information.

mr bill
Veteran Member


Date Joined Sep 2010
Total Posts : 688
   Posted 1/24/2011 5:50 PM (GMT -6)   
The big problem is that this rad. Onc. is the only game in town.  Right now I cannot wait.  I did check with the uro surgeon at the clinic who said no on the HT with RT. The med onc. Told me last December I did not need HT right now. The rad onc. At Cleveland tells me he can go either way.  This Dr. tells me I need both at same time.  No wonder I am a basket case.  I could travel to and from Cleveland for RT, but Lake Effect snow storms on I-90 can be downright life threatening.
For a real kicker the rad. Onc. In Erie told me that PC was a disease, a big disease, and that it was also a business.
Oh yes, I am cynical also.  I am so cynical that if someone told me that Dr.’s monitored or paid someone to monitor these sights I would not be surprised. Additionally, we can not put all those in the medical profession in the same barrel.  So many are sincere, they want to do a good job, they want to help.  Sure they want a salary that is commensurate with their investment, but who doesn’t. It’s the one who are in it just for the bucks that bear watching.  However, we do have to set that off to the side and move ahead with our treatment, and beat back that which has threatened us.  It may not be perfect, but it is all we have for now.  
 
Zufus: The name Mr. Bill does come from clay-mation "OOOh no Mr. Bill," not from William "Mr. Bill" Faulkner.
 

Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 1/24/2011 5:58 PM (GMT -6)   
Mr. Bill,
There is compelling evidence that HT before radiation will enhance the performance of radiation. There are studies out there do indicate longer PSA control. The overall survival also appears improved when the cancer has advanced beyond the prostate as in yours and mine cases. I elected to go with HT prior to starting radiation because of a few studies I read. I don't place so weight into studies as I used to, but certain studies that do represent overall survival during their term carry more weight with me. One study in particular was started at Harvard ~ RTOG9413 where the comparison was made for RT alone or RT with ADT. This one was started in 1994 and we still see results from it today. It's not a perfect match for post RP but it does show that ADT significantly improves the performance of radiation.

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

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/24/2011 6:03 PM (GMT -6)   
It remains good questions Mr. Bill I still question everything I ever heard on PCa, just trying to look out for newer guys....so that later you aren't later saying...OOOOOh Noooo! :-)
PCa happens over a number years, a little patience in decisions is likely priceless for your overall health.
Great input so far from the other brothern of the 'prostate'- LOL! I don't envy your dilemnas.
 
 

Post Edited (zufus) : 1/24/2011 5:06:12 PM (GMT-7)


mr bill
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Date Joined Sep 2010
Total Posts : 688
   Posted 1/24/2011 6:17 PM (GMT -6)   
I have read that HT does enhance RT. I believe Dr. Walsh advocates that avenue of treatment. It is really confusing. The surgeon who did my Robotic is supposed to be one of the best.

I don't know, maybe it is like grandchildren, ours are always the cutest.

We do the best we can.
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

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/24/2011 6:24 PM (GMT -6)   
Mr. Bill I agree and years ago it was called the Bolla Study Abstracts, google search and read that also. I believe that is one of the main reasons I am alive at this juncture...if you noticed my stats....unreal....many others with even lesser stats than mine lived maybe half as long. So, your case is not even close to comparable to mine, except we fight the same enemy in PCa.

I doubt you want to trade places, but future decision making that we both may have to contemplate on choices to make. I still maintain some humor in spite, so far this journey has surpassed my original expectations, of course I know what the future can bring in this. Talk about psa anxiety, after almost 9 yrs. of that you get alittle more mellow on in, I think.

Post Edited (zufus) : 1/25/2011 7:06:26 AM (GMT-7)

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