What's the magic number for HT

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waterloo
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Date Joined Jan 2009
Total Posts : 100
   Posted 1/25/2011 3:28 PM (GMT -6)   
Hello Everyone
What is the the magic number to start HT and how long can you stay on HT and dose it stop the pc from growing and is it considerd a cure treatment or just holding it off.I'm still doing lot's of reading but would like know from the guys who have been on HT or waitng to go on HT.The DR said this is his silver bullet so not to rush in to it .His last psa went up from 0.8 to 1.27 in 3 month.
Thanks Deidre (waterloo)
    My Husband age 54 at diagnosis
   Radical prostateectomy  in Sept 2006
  • Original Gleason 3+4=7 post op 4+3=7
  • Post Op .004
  • May08 psa 0.05
  • July08 psa 0.09
  • Oct08 psa 0.16
  • Jan09 psa 0.24
  • start"s radiation on March 12/09(33) in total
  • July 09 psa 0.4  TESTOSTERONE 15
  • SEPT 09 PSA 0.55  TESTOSTERONE 13 
  • Bone Scan Oct 19 09  CLEAR (YA HOO)
  • dec 09 PSA .52 Testosterone 13
  • March 2010 PSA .7 Testosterone 11

Post Edited (waterloo) : 1/25/2011 2:48:22 PM (GMT-7)


F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3800
   Posted 1/25/2011 3:38 PM (GMT -6)   
Waterloo -- the effectiveness of HT varies quite a bit.  may  i ask why your husband's testosterone is so low?
 
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

waterloo
Regular Member


Date Joined Jan 2009
Total Posts : 100
   Posted 1/25/2011 3:47 PM (GMT -6)   
We live in BC canada I have ask the Dr and he said it is still in the normal range, so differnt testing in the U.S. I guess.
    My Husband age 54 at diagnosis
   Radical prostateectomy  in Sept 2006
  • Original Gleason 3+4=7 post op 4+3=7
  • Post Op .004
  • May08 psa 0.05
  • July08 psa 0.09
  • Oct08 psa 0.16
  • Jan09 psa 0.24
  • start"s radiation on March 12/09(33) in total
  • July 09 psa 0.4  TESTOSTERONE 15
  • SEPT 09 PSA 0.55  TESTOSTERONE 13 
  • Bone Scan Oct 19 09  CLEAR (YA HOO)
  • dec 09 PSA .52 Testosterone 13
  • March 2010 PSA .7 Testosterone 11

livinadream
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Date Joined Apr 2008
Total Posts : 1382
   Posted 1/25/2011 5:53 PM (GMT -6)   
Beings that he has already had surgery and his PSA is elevating, I would say if the next test also shows an increase that is time for action. HT in most cases is not curative however most people live for years on it. I was on ADT3 for two years and have now been off for two years and I am still doing great.
Let us know how things go

peace to you
Dale
I was 45 at diagnosis with PSA of 16.3
http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) was 4+4=8
I had 44 IMRT's. Scheduled to have a radical on July 11th, 2007, surgery was aborted when it was discovered it had spread to the lymph nodes.
I was on Lupron, Casodex, and Avodart for two years with my last shot March 2009.
My Oncology hospital is The Cancer Treatment Center of America in Zion IL
PSA July of 2007 was 16.4
PSA May of 2008 was.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01
PSA OCt 15th 2009 is .11
PSA Jan 15th 2010 is .13
PSA April 16th of 2010 is .16
PSA July 22nd of 2010 is .71
PSA Sept of 2010 is .71
cancer in 4 of 6 cores
92%
80%
37%
28%

Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 1/25/2011 6:06 PM (GMT -6)   
Deidre

The trigger for starting HT after RT is usually taken as a PSADT <9 months, once biochemical failure has been established (third rise of PSA after nadir). Your husband’s PSA in the signature in your post and the last two PSA tests show a fast rise of PSA with no nadir, indicating is case as systemic. He should start ADT the soonest.

In my case, my PSA from 3.80 pre-RT got to a nadir (0.05) on the 13th month pos RT and recurrence was verified on the 29th months. The trigger for HT never come because my PSADT was greater than 9 months but my doctor decided to have me on HT once I got to PSA=1.0.

ADT is a palliative treatment that do not cure but can keep the advance of the cancer “at bay”, in some cases for long periods of time over ten years.
There are several protocols in hormonal treatment (surgery castration or chemical castration), but they all aim at lowering the testosterone in our body because cancer cells feed of testosterone. The principle is to kill the cancer by “starvation”.

All treatments have side effects and your husband should be aware of them.
You should discuss in detail with your husband’s oncologist about ADT options and also regarding any other health condition or medications that could interact with the drugs in ADT.
Two good informative books for cases like your husband’s which I recommend you to read are; "Beating Prostate Cancer: Hormonal Therapy & Diet," by Dr. C. Myers, and "A Primer on Prostate Cancer - The Empowered Patient's Guide” by Dr. S. Strum & D. Pogliano

In this site (NCCN Guidelines "Prostate Cancer" V.3.2010) you can read about the protocols followed by the professionals as the standard care for prostate cancer.
http://www.nccn.org/professionals/physician_gls/f_guidelines.asp

Wishing you both the best.
Baptista
Age: 50 at Dx on May/2000; PSA=22.4;
6x cores biopsy positive; Gleason score (2+3=5)
RP in Aug/2000, PSA=24.2
Negative S-vesicles & lymph node (9); capsular penetration
Voluminous Adenocarcinoma, well-differentiated, Gs (3+2=5); pT3apN0
Post-op lowest PSA=0.18 on Oct/2000; Classified as Micro Metastasis
Jan/2001 PSA=0.26 Biochemical recurrence
AS (Watchful W.) until PSA=3.80 on Oct/2006; MRI & Bone scan negative
Nov/2006 SRT (3D IMRT; 68Gy / 37 fractions)
Feb/2008 lowest nPSA=0.05
May/2009 PSA=0.26 Biochemical recurrence
Oct/2010 PSA=0.95 (doubling at 9.6 months)
Nov/2010 ADT Cyproterone 100mg/day + Eligard 45mg 6-month depot
Asymptomatic, never incontinent, ED since RP

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4223
   Posted 1/25/2011 6:14 PM (GMT -6)   
Waterloo,
There is a lot of disagreement on HT and will find doctors with opposing views. I would tend to side with the more experienced doctors like Strum, Myers and Scholz who all have a great deal of experienc with HT. They all say the earlier you start the better because it can do a much better job at killing cells while there is a low tumor burden and the cells haven't yeat had a chance to mutate. Other doctors say to wait until your psa reashes 10. I believe in dealing with cancer hitting it hard and early results in the best outcome.
HT is not curative but can delay the growth of PC cells for years and even decades. In about 30% of the cases one term on HT results in long term remission.
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.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3738
   Posted 1/25/2011 11:44 PM (GMT -6)   
"Normal levels of testosterone fall between 250 and 800 nanograms of testosterone per deciliter of blood."

This is from a Canadian web-site...Sames as U.S. measurement system..

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 1/26/2011 6:54 AM (GMT -6)   
Waterloo that has been the million dollar question for decades now. Here is some PCa history to shed some light on this. Drug therapy on PCa has been going on for 60+ years now on PCa, the PSA era and Lupron/LHRH drug era are around 25 yrs. old now and docs still don't have clear answers. It is very complex and PCa has more variables envolved than you probably wish to know about, I could give you a list that would blow your mind.  The wisdom of Dr. Strum et al might be the best collective thinking on this as they have the most experiences.

(revised-shorter)

Post Edited (zufus) : 1/26/2011 6:59:19 AM (GMT-7)


Skate
Regular Member


Date Joined Oct 2010
Total Posts : 424
   Posted 1/26/2011 7:31 AM (GMT -6)   
Prior to the administartion of Zoladex (HT) to me, my baseline T level was 25 and my doc said that 19 to 66 is the normal range. I have read on this site something like 150 to 600 can be a normal range???  What's the inconsistency here with T level baseline results as I like to be able to compare apples to apples?  I am from Canada as well.  Based on the measurement units being the same Deidre, 11 would appear to be on the very low side of what is the normal range.  But what do I know other than what I know about me. 
As a matter of fact I don't even know yet what I don't know about Pc.
 
J
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
08/11/10 PSA 3.44
30/11/10 Zoladex ADT

Arno
Regular Member


Date Joined Apr 2010
Total Posts : 54
   Posted 1/27/2011 1:55 PM (GMT -6)   
Skate said...
Prior to the administartion of Zoladex (HT) to me, my baseline T level was 25 and my doc said that 19 to 66 is the normal range. I have read on this site something like 150 to 600 can be a normal range??? What's the inconsistency here with T level baseline results as I like to be able to compare apples to apples? I am from Canada as well. Based on the measurement units being the same Deidre, 11 would appear to be on the very low side of what is the normal range. But what do I know other than what I know about me.
As a matter of fact I don't even know yet what I don't know about Pc.



J


What about 'units-of-measure' ? You might find nmol/l in stead of ng/dl. 1 nmol/l = 29 ng/dl. (testosterons molecular weight is 288.43 g/mol).
Normal range of testosteron is 250 to 800 ng/dl, but the so-called 'castrate level' is about 1.7 nmol/l or 50 ng/dl. I actually had just 9 ng/dl with 3 monthly Zoladex, well below castrate level, but, as your doc said, this might vary, maybe between 19 and 66 (make that 9 to 66, as far as I am concerned). I think the range mentioned is valid for the castrate level of testosteron using Zoladex or another LHRH agonist.

By the way, the worst Gleason scores ( 8 to 10) have been found with men who had relatively low testosteron levels before biopsy.

And now there exists a treatment called TRT (Testosteron Replacement Therapy), where they enlarge the testosteron level to over 1000 ng/dl and this stops the prostate cancer (in about 40% of the cases), and it does so over a long time, unlike the castrate level of testosteron, which always ends up in CRPC (castrate resistent PCa).

Post Edited (Arno) : 1/27/2011 1:26:38 PM (GMT-7)


waterloo
Regular Member


Date Joined Jan 2009
Total Posts : 100
   Posted 1/27/2011 3:24 PM (GMT -6)   

If this helps his's test as typed

12.7 (8.4-28.7)  nmol/L

Testosterone coll. 0840   h

Note New Methodology June 7/10

(roche- elestrochemiluminescence)

_________________________________________________________________________

 

My Husband DX at age of 54 in 2006

09/2006-RP

Original Gleason 3+4=7Post OP 4+3=7

PSA PO RP .004

Everything going good till May 2008

05/08 PSA 0.05

07/08 -0.09

10/08 -0.16

01/09 -0.24

RT March 2009 33 in total

07/09 PSA 0.4 Testosterone -15

09/09 -0.55 T -13

10/09 bone scan Clear

12/09 PSA 0.52 T-13

03/2010 “ 0.7 T-11.8

06/10 “ 0.61 T - 9

09/10 “ 0.8 T -11.4

01/2011 PSA 1.07 T -12.7


Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 1/27/2011 3:30 PM (GMT -6)   
Waterloo,
It helps alot. Thanks
Age: 50 at Dx on May/2000; PSA=22.4;
6x cores biopsy positive; Gleason score (2+3=5)
RP in Aug/2000, PSA=24.2
Negative S-vesicles & lymph node (9); capsular penetration
Voluminous Adenocarcinoma, well-differentiated, Gs (3+2=5); pT3apN0
Post-op lowest PSA=0.18 on Oct/2000; Classified as Micro Metastasis
Jan/2001 PSA=0.26 Biochemical recurrence
AS (Watchful W.) until PSA=3.80 on Oct/2006; MRI & Bone scan negative
Nov/2006 SRT (3D IMRT; 68Gy / 37 fractions)
Feb/2008 lowest nPSA=0.05
May/2009 PSA=0.26 Biochemical recurrence
Oct/2010 PSA=0.95 (doubling at 9.6 months)
Nov/2010 ADT Cyproterone 100mg/day + Eligard 45mg 6-month depot
Asymptomatic, never incontinent, ED since RP

Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 1/27/2011 3:35 PM (GMT -6)   
Arno
Could you substantiate about TRT stopping the prostate cancer? Is there any abstract I could get about those findings (40%) ?
Thanks in advance.
Age: 50 at Dx on May/2000; PSA=22.4;
6x cores biopsy positive; Gleason score (2+3=5)
RP in Aug/2000, PSA=24.2
Negative S-vesicles & lymph node (9); capsular penetration
Voluminous Adenocarcinoma, well-differentiated, Gs (3+2=5); pT3apN0
Post-op lowest PSA=0.18 on Oct/2000; Classified as Micro Metastasis
Jan/2001 PSA=0.26 Biochemical recurrence
AS (Watchful W.) until PSA=3.80 on Oct/2006; MRI & Bone scan negative
Nov/2006 SRT (3D IMRT; 68Gy / 37 fractions)
Feb/2008 lowest nPSA=0.05
May/2009 PSA=0.26 Biochemical recurrence
Oct/2010 PSA=0.95 (doubling at 9.6 months)
Nov/2010 ADT Cyproterone 100mg/day + Eligard 45mg 6-month depot
Asymptomatic, never incontinent, ED since RP

Arno
Regular Member


Date Joined Apr 2010
Total Posts : 54
   Posted 1/28/2011 4:10 AM (GMT -6)   
Baptista said...
Arno
Could you substantiate about TRT stopping the prostate cancer? Is there any abstract I could get about those findings (40%) ?
Thanks in advance.


I saw this mentioned in the John Hopkins Prostate Bulletin (don't know the issue anymore):

"Important prostate issues to consider if you're contemplating testosterone replacement therapy. The good news: most urologists now recommend replacement therapy for men with low testosterone levels -- provided careful follow-up examinations are maintained."

An abstract of the publication of it in the BJU International journal can be found here:

onlinelibrary.wiley.com/doi/10.1111/j.1464-410X.2009.08980.x/abstract

"We reviewed the records of 96 patients who received TRT after initial management for prostate cancer from 2000 to 2007. In all, 31 men remain on TRT with no PSA or radiological progression at a median of 36.7 months; nine men stopped TRT for reasons other than progression."

and from Leibowitz's clinic report:

compassionateoncology.org/pdfs/HDTestUpdate.pdf

"What the sweetest of all is that this approach, which I have used on well over 200 patients, provides hope and the possibility that a potentially new and effective treatment approach for some prostate cancer patients may soon be offered to many more men who until very recently have believed that they would never again be alllowed to experience the effects of testosterone. And men on high-dose TRT almost always feel incredibly well."

The 2011 Johns Hopkins Prostate Disorders White Paper has, however, the following statement:

"Why you should think twice about using testosterone replacement therapy"

Post Edited (Arno) : 1/28/2011 3:29:09 AM (GMT-7)


Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 1/28/2011 4:26 PM (GMT -6)   
Thanks Arno,
I will have a look on the information.
Regards
Baptista
Age: 50 at Dx on May/2000; PSA=22.4;
6x cores biopsy positive; Gleason score (2+3=5)
RP in Aug/2000, PSA=24.2
Negative S-vesicles & lymph node (9); capsular penetration
Voluminous Adenocarcinoma, well-differentiated, Gs (3+2=5); pT3apN0
Post-op lowest PSA=0.18 on Oct/2000; Classified as Micro Metastasis
Jan/2001 PSA=0.26 Biochemical recurrence
AS (Watchful W.) until PSA=3.80 on Oct/2006; MRI & Bone scan negative
Nov/2006 SRT (3D IMRT; 68Gy / 37 fractions)
Feb/2008 lowest nPSA=0.05
May/2009 PSA=0.26 Biochemical recurrence
Oct/2010 PSA=0.95 (doubling at 9.6 months)
Nov/2010 ADT Cyproterone 100mg/day + Eligard 45mg 6-month depot
Asymptomatic, never incontinent, ED since RP
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