Just 6 Months Of Hormone Therapy Doubles Survival Chances When Added To Radiotherapy

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   Posted 3/25/2011 7:37 PM (GMT -6)   

Tony Crispino
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Total Posts : 8128
   Posted 3/25/2011 7:45 PM (GMT -6)   
LOL...Actually it was in this morning...

From the Infolink...


This is very good news...

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

Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

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   Posted 3/25/2011 9:07 PM (GMT -6)   
Mel is not going to be happy...

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Date Joined Oct 2008
Total Posts : 25355
   Posted 3/25/2011 9:34 PM (GMT -6)   
I think its a good article and view point, but I am amazed how many of us here even at HW were advised not to add HT to SRT in particular. Wonder what the professional difference in thinking is really all about?
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

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Total Posts : 3596
   Posted 3/25/2011 9:42 PM (GMT -6)   
Good point Dave..The Docs seem to have strong feelings about this, creating quite a bit of polarization in the ranks...

My own R-doc said there were two double-blind studies that nailed the lid on it..."I would not ask you to do this otherwise".....

That kind of ended the argument...
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

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   Posted 3/25/2011 10:30 PM (GMT -6)   
I'm already having problems with the SRT (side effects after only 4 tx!).
I'm not upset at the ADT/SRT article. I made my decision.

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Date Joined Oct 2008
Total Posts : 25355
   Posted 3/25/2011 10:54 PM (GMT -6)   
Fairwind, at my radiation clinic, and its not a large one by any standard, 2 of the 3 rad oncologists I spoke to , strongly felt not to mix the HT with the SRT, the 3rd - was the wishy washy guy - and said he couldn't prove I needed it, and couldn't prove it would help. Not that they are oncologists, but my longterm GP and my Urologist, strongly felt that when I needed the SRT, not to mix HT with it.

But, I know several of you have doctors that made just as strong an argument to include it with SRT.

And Mel, don't worry, I still think you made the right choice for you and your circumstances, I wouldn't look back it. Now that my own SRT has failed, I can say I know for sure that it failed, and not perhaps because of any HT mixed with it. Each of my 2 curative attempts failed on their own right.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 2/11 1.24
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/10,

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Date Joined Dec 2010
Total Posts : 3550
   Posted 3/26/2011 4:13 AM (GMT -6)   
My urologist, rad-onc, and med-onc all had separate discussions with me and simply stated that we start with ADT3 for a month before starting radiation (IMRT and HDR brachytherapy). All said I would be on ADT3 for at least one year. Their shared point was that hitting the cancer with diffrent tools concurrently is better than using the tools sequentially. The rad-onc deferred the details of the ADT3 to the uro and med-onc but stressed that in their experience combination therapy was better.
PSA 59 on 8-26-2010 age 60. Biopsy 9-8-2010 12/12 positive, 20-80% involved, PNI in 3 cores, G 3+3,3+4,and 4+3=G7, T2b.
Eligard shot and daily Jalyn started on 10-7-2010.
IMRT to prostate and lymph nodes 25 fractions started on 11-8-2010, HDR Brachytherapy 12-6 and 13-2010.
PSA <.1 and T 23 on 2-3-2011.

Regular Member

Date Joined Nov 2009
Total Posts : 485
   Posted 3/26/2011 5:13 AM (GMT -6)   
Medved pointed out in another thread that this particular study looked at the benfit of ADT with radiation as a primary treatment.  There are other studies that also support ADT with primary radiation.  Even my small town uros and radiologists recommend ADT with primary radiation.  But, they say there is a paucity of data to support ADT with SRT.  I think those were DR. Choo's words in his Mayo Clinic study.  Dr. Choo mentioned 5 ongoing Phase III clinical trials that are addressing the issue of ADT with SRT.  A study using Casodex reported some results but I don't know the status of the other four.
Dx 2/2008, age 71, PSA 9.1, G8,T1c. daVinci surgery 5/2008, G8(5+3), pT2c. LFPF, good QOL. PSA <0.1 for 2 yrs. PSA rose to .2 at 30 months, Completed SRT 2/2011. PSA 0.16 at 6 wks post SRT.

Post Edited (Carlos) : 3/26/2011 5:17:39 AM (GMT-6)

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   Posted 3/26/2011 6:25 AM (GMT -6)   

A few comments regarding combined HT with RT, and the article posted here:

1.    Please do note that there are multiple variations under study.  The articles initially posted by Chris and Tony are findings for primary treatment (no RP) of patients with locally advanced PC.  The conversation here blended in to HT with SRT (after RP), which Choo has studied and reported on...but Choo's study is a very different situation (I believe Carlos recognized this point in his last post; but the prior conversation blended together).


2.    Keep in mind the axiom to “treat the patient, not the cancer.”  In this situation further breaks down into (at least) two additional considerations. 

a.     Most, but not all, of the studies in this area are of clinically high risk patients (D’Amico Risk Stratification category)…in other words, one size does not fit all.  Your doctor might not have recommended HT with RT for you because it had a greater likelihood of “overkill.” 

b.     Any doctor would/should take into consideration a patient’s individual circumstances, and not treat everyone equally.  For one example, any patient coming in saying up front “I don’t want HT”, any good doctor is going to take that into consideration on how hard he pushes.  A patient’s age and other morbidities would also be considered in the back of the doctor’s head.


3.    Guys here are (naturally) commenting about the lack of a uniform, “best” standard of care in this area.  Chris’ opening post read “This just in…” which highlights the relative newness (it’s not brand new) of this approach (combined HT with RT).  The fact is that research, and knowledge for that matter, is really simply the “best information currently available.”  It is evolving…you are seeing new acronyms being created (that’s a “leading indicator” in my mind); for example one pair I’ve observed is STAD and LTAD for Short-Term and Long-Term Androgen Deprivation when talking about how long to administer HT with RT.  The point being that this is how knowledge evolves…the well-studied "change cycle" comes with a period of uncertainty before re-solidification and moving on...


4.    Even when science evolves, there is differing paces of acceptance.  Just look at the example of the benefits for all PC patients of pomegranate juice.  Some will say that until there is a prospective, double-blind, carefully controlled clinical trial with a large sample performed, then they are not going to embrace the benefits of the juice or extract.  Similarly, there are differing paces of acceptance of change of HT plus RT.  HT treatment for PC (with or without RT) is not well understood uniformly by all doctors...this is exactly why you hear the repeated recommendation (for those who need it) to find a medical oncologist who is experienced & well-versed in HT for PC.  Radiation oncologists will generally not be very thoroughly informed in the finer points of hormone therapy.



 edit:  fixed typos

Post Edited (Casey59) : 3/26/2011 9:12:29 AM (GMT-6)

Regular Member

Date Joined Jun 2010
Total Posts : 416
   Posted 3/26/2011 8:56 AM (GMT -6)   
"cuts the risk of dying from locally advanced prostate cancer by 50 percent compared to radiation alone at 10 years..."

If these were all primary treatment, do we know how they determined all 800 were locally advanced?

In 1996/2000, if you had 800+ pca positive patients, they would tend to be older or the pca more advanced than the same random field might be today, due to psa and awareness? The same guy dx with pca at 60 years old in 1996 might very well be dx at 50 today. My Wiki Link below suggests that by 2000 only about 1/3rd of men 50+ had a psa test in the prior year.

Point being, If this was primary treatment of a generally older and more advanced group of pca patients, it would make some sense that adt would therefore extend the survival of a percentage of that group? I assumed that's what it would be expected to do.

This seems to be an argument as to why being treated with BOTH rad+adt can provide a benefit to some.

I dont see the underlying statistics that says there is a benefit of being treated with both, at the SAME TIME.

These numbers might be better suited to make the case that 6 months of NADT are better than 3 months.

Can these results skewed by some RT only men getting ADT 6-7 years into the study? Or ADT men getting other treatments.

I'd be interested in seeing the criteria or makeup of the different groups. Not going to give most 42 y/o with a 6 RT and ADT right out of the box are they?

Regarding our primary or uro not always being timely informed of all the latest and greatest.. That's probably true, and logical. We deal with our dr as if it's all about US, the now, life and death - ours! They must look at it as a perpetual stream of patients and gradual changes in medicine.

If I just listed to my 1st uro, I would never had known that Davinci was an option. Seriously. Do you know how many pca patients simply will listen to their doctor, not question ANYTHING? I think that is likely an astounding number!

Think of this, ACS says there were 2,276,000 men IN THE USA ALONE with pca in 2007.
Yet this forum lists under 100,000 members - worldwide.

*I'm thinking that the vast majority of the 2 million+ men with pca in the US simply do what the Dr says, without much further inquiry, period.

In 2000, 34.1% of all U.S. men age ≥ 50 had a screening PSA test within the past year and 56.8% reported ever having a PSA test.

Sorry if I went of the reservation.. pos thoughts to all.

Cape Cod.

John T
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   Posted 3/26/2011 10:20 AM (GMT -6)   
I was told that 6 months of HT would be of benefit when undergoing radiation for a number of reasons.
1. Any combination treatment works better than a mono treatment when treating high risk PC.
2. HT shrinks the proatate by 50%. using simple math, the radiation dose is now hitting an area that is 50% smaller with the same dose providing 50% greater killing power.
3. The HT changes the DNA of the cancer cells making them easier to kill with radiation.
Cancer hates change, the more change you can throw at it the more difficult it is to adapt and mutate. HT, radiation along with a diet change provides a lot of change to cancer cells.
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.

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   Posted 3/26/2011 11:19 AM (GMT -6)   
there is a certain danger involved in listening to too many people.  around here we call that thinking harder rather than smarter...and many of us will hear only the guy that tells us what we want to hear.
what's the downside risk of six months of HT? no sex for awhile?  hot flashes? the biggest objection i've seen is the patient simply did not want HT.  when my life is at stake i'll gladly err on the side of caution. 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

Regular Member

Date Joined Jun 2010
Total Posts : 416
   Posted 3/26/2011 11:49 AM (GMT -6)   
For what it's worth, my commentary regarding the study was simply my impressions of the study itself. I'm not suggesting that HT shouldn't be part of anyone's plan or treatment.

Some might suggest that since HT treatment becomes less effective over time, that it is better used as a last resort. If this study were to have suggested NO INCREASED benefit by having HT and RT at the same time, then it would make perfect sense to me for waiting to see how RT went before trying HT.

Or turn it around, having HT 1st and THEN RT.. though it's perhaps telling that the reverse sequence is apparently what most uros suggest.

*I'm not sure that HT treatment is simply just a 6 mo inconvence to all people.
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