Treatment thoughts in cases of Advanced Prostate Cancer in the form of BCR

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Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/10/2011 3:14 PM (GMT -6)   
The following is an excerpt of an article I read just today, below is a link to the entire article, which I found interesting :
 

Stage D1.5 (Biochemical Failure)
Stage D1.5 prostate cancer represents a unique opportunity in human oncology in that the patient has minimal tumor burden and that there is a marker, PSA, that can be used to ascertain progression and response. A diversity of opinions exists regarding treatment of these patients. Options include local radiation for prostatectomy failures, salvage prostatectomy for radiation failures, cryotherapy, observation and various types of hormone therapy. Most clinicians agree that once this state of rising PSA occurs, death from prostate cancer is inevitable if the patient is young and/or healthy (<50 years old or has a >10-15-year life expectancy). The patient exhibiting this type of PSA-only recurrence is usually offered one of the above-described treatments but many fail again with a rising PSA. This is the second challenge, a rising PSA in the face of hormonal therapy referred to here as Stage D2.5. This patient may have a negative bone scan and no symptoms, yet he has progressive hormone refractory prostate cancer (HRPC).

Early Hormonal Therapy
The clinician and patient are thus faced with the challenge of this common and threatening stage of prostate cancer—biochemical failure (D1.5)—and its natural progression to the hormone refractory state (D2.5). Hormonal therapy can produce dramatic but relatively short-lived responses in metastatic hormonally sensitive disease (D2), and chemotherapy is showing promise in inducing significant responses in the refractory state. Is there any evidence that aggressive intervention such as hormonal therapy, with or without chemotherapy, can improve the outcome of patients with biochemical failure? The honest answer is no.

The link:

http://www.prostateconditions.org/immediate-versus-delayed-therapy-prostate-cancer-earlier-better

 


Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 6/10/2011 5:15 PM (GMT -6)   
Further down the the Early Hormonal Therapy paragraph the author says:

"There are a number of studies whose results indicate that early disease detection and/or early hormonal therapy extend life and may cure some patients."

Then he goes on to discuss the other studies and concludes:

"The trials described in this article all support a survival advantage or decrease in co morbid events when hormonal therapy is administered early. The advantage is more pronounced in patients with lesser tumor burdens. These results suggest that early hormonal therapy administered to patients with a rising PSA after failed local therapy might provide the same benefit."

So there seems to be a contradiction.

My take is that "The honest answer is no" part should apply to advanced PCa only (D2.5, mets and rising PSA) ~ then aggressive treatment is too late.

Reading it literally, you could apply that "no" to the D1.5s as well who also have biochemical failure. But that directly contradicts the discussion of the trials and the conclusion.

So I think the article needs a bit more editing, both to resolve the seeming contradiction and other minor issues such as missing figures.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but then rose to 0.4, doubling time 7 months
Following diet change, PSA static at 0.4...

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 6/10/2011 6:53 PM (GMT -6)   
So it won't improve the outcome. If you are young enouph and live long enouph you die of PCa. But if you can get 5 more years from agressive HT, started yearly. I'll take iut every time.
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11 PSA < .01

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/10/2011 7:03 PM (GMT -6)   
I didn't say I agreed or disagreed, just said I thought it was interesting.
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 margin
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, 4/11 3.81
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

dkob131
Regular Member


Date Joined Apr 2008
Total Posts : 364
   Posted 6/10/2011 7:10 PM (GMT -6)   
David:  This was in the Introduction part of the article:
 
"The use of hormone therapy in most patients with advanced adenocarcinoma of the prostate produces a dramatic positive response followed by a disappointing progression. One reason for this is that in many cases, the treatment is with held until late in the disease known as advanced prostate cancer."
 
It seems to me the gentleman is saying do it early if you want it to work.
 
As you say its a personal decision.
 
Good luck
 
David

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 6/10/2011 7:11 PM (GMT -6)   
This also assumes that all PC will become hormone refactory eventually. This is dead wrong. There are a good percentage of patients who respond very favorable to HT and require only one treatment course to go into long term remission. This is expecially true for G6's and G7s that have a reoccurrance.
It is impossible to make a generalization about a patient's response to HT. Some are "cured", others last for decades and others may last only a few years. If psa while on HT drops to <.05 and stays there for at least 3 months there is a very good chance that that patient will live another 15 or 20 years or more.
JT
66 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, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 6/10/2011 7:26 PM (GMT -6)   
"Stage D1-Positive Lymph Node Disease
The number of patients who present with positive lymph disease is decreasing. This is attributed to early detection efforts and better patient selection for local therapies. There has been debate regarding the benefit of early hormonal therapy in patients who are found to have positive lymph node disease as the only site of spread of their prostate cancer. Most prostate cancers will spread to the pelvic lymph nodes as the first step of their progression. In many cases this spread precedes bone disease. To address this question, a cooperative group trial was implemented comparing immediate vs deferred hormonal therapy in men who had lymph node involvement and had had a radical prostatectomy and pelvic lymphadenectomy. This intergroup clinical trial demonstrated marked improvements with immediate hormonal therapy vs delayed in both prostate cancer-specific survival (30.8% vs 4.3%) and progression (75% vs 18.8%) Figure 3-insert here

This study, like the VA and MRC studies already discussed, shows a clear survival advantage resulting from early therapy. The tumor burden of these men is likely less than or at least equivalent to that of men who have stage D1.5 disease (PSA-only recurrence).

Neoadjuvant and Adjuvant Studies

With Radiation Therapy
Bolla and colleagues have provided documentation that the combination of hormonal therapy and radiation therapy is superior to radiation alone in the management of T3 prostate cancer.

In the Bolla study, 3 years of hormonal therapy in combination with 6-7 weeks of external beam radiation therapy (EBRT) resulted in a significant therapeutic benefit over radiation therapy alone. Estimates of survival after 5 years were greater following combined therapy vs EBRT (79% vs 62%). Furthermore, 85% of patients receiving combined therapy remained disease free, compared with 48% of patients receiving EBRT alone. Some have questioned whether radiation therapy contributed significantly to these outcomes and whether it is clinically necessary. Thus, a randomized trial is now underway in Canada to test the impact of hormonal therapy alone. This important trial will randomized men with locally advanced prostate cancer to hormonal therapy alone versus hormonal therapy and radiation therapy."
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

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 6/10/2011 7:42 PM (GMT -6)   
In the opening post of this thread, David (Purgatory) quotes two paragraphs from Dr. Crawfords article.. But he crops the second paragraph, twisting it's meaning considerably..Here is the missing portion of that paragraph..

"Is there any evidence that aggressive intervention such as hormonal therapy, with or without chemotherapy, can improve the outcome of patients with biochemical failure? The honest answer is no. However, these treatments have resulted in some impact in patients in stages of disease with similar characteristics.. And so the germane question then becomes, can any meaningful information be obtained from current trials that will aid in the decision of how to treat biochemical failure? Can hormonal therapy not only prolong time to progression but also extend life? There are a number of studies whose results indicate that early disease detection and/or early hormonal therapy extend life and may cure some patients. "

One can only guess as to why David edited that paragraph...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/10/2011 8:08 PM (GMT -6)   
Fairwind, you are once again wrong. If I intended to "crop" it like you claim, I would hardly left the link fully available in its full content. Had enough of conspiracy theories. "One can only guess as to why David edited that paragraph" - what is that suppose to me, what are you insinuating. Don't appreciate your slur.

My doctors are deeply concerned about my entire situation, from the very start of this journey with the extreme PSA velocity issues I had in the year prior to my dx. Even the new oncologist realiizes that this particular cancer case is taking a path of its own. What I found interesting, and I pasted the part that interested me, was it seems exactly like the situation I am right now.

HT doesn't always do the wonders you think its doing. Both my doctors feel with the other issue, i..e. velocity, that HT might (key word: might) not be very effective under my circumstances, and then what? This is why the new oncologist is not eager to pull the HT gun at this time, he doesn't think its a time to act out of fear, but to keep holding off on the trigger until (and only if I agree of course) the timing is right where the HT might give me the best shot. Both doctors agree that if we did it now, of course it would drop the PSA right down, but neither feels its worth it for the side effects that would be piled on top of a patient that has already been dealing with side effects for almost 3 years now. Couldn't imagine fatigue on top of what I am dealing with now.

Study up on PSA Velocity in the year prior to dx, its pretty sombering to read. My doctors happen to subscribe to that general thinking.

I don't need you making false accusation about my intent, etc. You don't know my intent, or my mindset, or even exactly what I am dealing with.

The entire article is there for anyone to read. I thought it was interesting, its that simple. Didn't appreciate the tone of your post towards me. If you think you know more than my doctors, will be glad to e-mail you their names and phone numbers, and you can debate them.

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 margin
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, 4/11 3.81
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

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/10/2011 8:11 PM (GMT -6)   
piano,

i know what it says further down, what caught my eye was the paragraph in particular on the D1.5 category in general. Had never seen it written that way. I am just over the fence into the world of advanced PC. The doctor said the type that is directly BCR related, as opposed to lymph nodes, direct metastisis, etc, can be much more difficult to slow down and control.

again, that is why i posted a link to the full story, so that others could glean as they please.

david
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 margin
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, 4/11 3.81
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

BB_Fan
Veteran Member


Date Joined Jan 2010
Total Posts : 1011
   Posted 6/10/2011 9:18 PM (GMT -6)   
Piano, Dave, Fairwind and John, Thanks for digging into this study and bringing up these issues. I didn't have the time to look at it myself and would have come to a very wrong conclusion from just reading Purg's initial post. BB
Dx Dec 2008 at 56, PSA 3.4
Biopsy: T1c, Geason 7 (3+4)
Robotic RP March 2009
Path Report: T2c, G8, organ confined, neg margins, lymph nodes - tumor vol 9%
PSA's < .01, .01, .07, .28, .50. ADT 3 5/10. IMRT 7/10.
PSA's post HT/SRT .01, < .01
End ADT3 5/11 PSA < .01

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3748
   Posted 6/10/2011 9:38 PM (GMT -6)   
MANY people will not take the time to read the entire linked article..

Purgatory STARTED this thread and he did the cut and paste job on the first two paragraphs, an intentional edit that completely changed the complexion of the article, which fully and openly supports the early use of hormone therapy as a tactic to extend the lives of prostate cancer victims..

If I had not pointed this out, someone else would have...If I have offended you David, I'm sorry but you have to play the game by the rules...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/10/2011 9:49 PM (GMT -6)   
not playing any games, get off my a**. i was interested in the first part of the article as it pertained to my situaton, i included the entire article so that anyone could read or not read the rest. why is that so hard to understand? no one is requiring anyone to read or not read the article.
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 margin
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, 4/11 3.81
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

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 6/10/2011 10:13 PM (GMT -6)   
I had read that article before even reading this thread. The CLEAR IMPLICATION of that article is that sooner offers a much better prognosis than later (RE: when to do HT).
 
David, your chop job implied just the opposite.
 
Perhaps it was not consciously done as we all have this great need to justify our choices.
 
In fact, the title of the article is:
"

Immediate versus Delayed Therapy for Prostate Cancer: Earlier is Better"

 

(They are talking about HT)

 

Mel


Fairwind
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Date Joined Jul 2010
Total Posts : 3748
   Posted 6/10/2011 10:48 PM (GMT -6)   
Dave, the entire article pertains to your situation, not just the first 1.5 paragraphs....You are between a rock and a hard place but please don't be lashing out at us, your brothers, we are here to help and support you, not break your cajones..There is great conflict inside you, you know it and we can feel it...Ease the mainsheet brother and take some strain off the rigging..

We are all on the same train ride, we just get off at different stations..You will get through this Dave, as will we all...

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/10/2011 10:59 PM (GMT -6)   
if you don't want to be "lashed" out at, then don't make accusations. i have a right to respond to them. there are two sides to the early vs. late ht intervention. lately, only one side is being presented here at hw, and typically, some choose to be dogmatic about it, when they are not qualified to be so. i will be talking to my oncologist soon, and one of the topics is his justification for the late intervention. there are plenty of doctors that feel that way, not just my current doctors, and it must be for a reason. its' not black and white like you and some others want it to be. if i knew that someone like you would react the negative way you did, i wouldnt have bothered posting it in the first place.

and as i stated further up the thread, i plainly said i wasn't agreeing or disagreeing with the article, so there is no reason for you to decide for me, what i think or don't think.
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 margin
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, 4/11 3.81
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

Piano
Veteran Member


Date Joined Apr 2008
Total Posts : 847
   Posted 6/10/2011 11:24 PM (GMT -6)   
I would love it if delayed HT gave the same results as early HT ~ delay the evil day for as long as possible! But this and other studies give a very clear indication that early is better, at least for longer survival time.

Also there is the point that John T raised, that in some cases one course of treatment is enough to put the PCa into long term remission. Clutching at straws a bit here, but let's clutch :-)

My uro told me that he would put me on HT when my PSA reached 10, and also said that it would "make me into an old man" ~ as if I'm not already! So he is clearly of the school that says "delayed is better". However next time I see him, I will ask the question about a course of HT well before 10.

No mention of QOL so far though ~ what is the point of longer survival time if the QOL is lousy? That is a decision that we each must make for ourselves.
No symptoms; PSA 5.7; Gleason 4+5=9; cancer in 4/12 cores
Non-nerve-sparing RRP 7 March 2008 age 63
Organ confined, neg margins. Gleason downgrade 4+4=8
Fully continent
Bimix worked well; now using just VED
PSA undetectable at first but then rose to 0.4, doubling time 7 months
Following diet change, PSA static at 0.4...

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/10/2011 11:35 PM (GMT -6)   
This study clearly outlines that the level II studies assembled show that earlier hormonal therapy is showing survival benefit over later intervention. David Crawford in his conclusion is requesting that this data be put to the test in a randomized level I clinical trial to remove doubt. Crawford is a respected prostate cancer physician who works with an elite group of researchers including Vogelzang who is my oncologist and is a frequent speaker at our UsTOO group. There are no dogmatics involved when Dr. V. is also a keynote speaker frequently at the American Society of Clinical Oncology, the Prostate Cancer Research Institute, the American Urologic Association and many other recognized. Nick Vogelzang is very clear in his presentations that his findings are that the earlier the better for HT intervention. Not all cases respond the same but when applying HT when the PSA is below 4 provides the best survival benefits.

I have said that I will no longer question David's decisions and I respect him for all he has been through. But I would like to point out other members trying to decipher the hordes of data out there that this study by Crawford is well balanced and the study indicates clearly that early intervention with HT is better than later intervention from a survival perspective.

Tony
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:
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

Post Edited (TC-LasVegas) : 6/10/2011 11:38:25 PM (GMT-6)


Fairwind
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Date Joined Jul 2010
Total Posts : 3748
   Posted 6/11/2011 12:31 AM (GMT -6)   
When I was faced with persistent PSA after surgery, It was Dr. David Crawford who, in a brief telephone conversation, convinced me that accepting HT along with my looming SRT was the way to go. He said something like "your numbers are bad, you need to do everything you can as soon as you can"....So I quit fighting with my R-doc about it (I was STRONGLY resisting the HT) and took the Eigard shot in the gut....

So far, so good....
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

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 6/11/2011 4:41 AM (GMT -6)   
Dear Guys and Gals – posting an entire article is frowned upon here. Copyright issues can come into play etc... bla bla bla.
 
Coping a couple of paragraphs to get peoples attention to an article and posting a link to the article is the norm.
 
Guessing at people’s intentions for their choice of paragraphs is also frowned upon. Most stories and articles have good and bad – pros and cons to them.
 
If I start a thread about Viagra and ONLY post the PROS about it, it would not be correct to assume I’m a sales person for Phizer. Nor would it be appropriate for anyone to accuse me of slanting the story.
 
An appropriate reply would be something along the lines of: “Please note the side affects in Steve’s link as some of them are quite serious.”
 
The moral of the story is “let’s play nice.”
Moderator - Prostate Cancer
Age 56 - 5'11" 215lbs
Overall Heath Condition - Good
PSA - July 2007 & Jan 2008 -> 1.3
Biopsy - 03/04/08 -> Gleason 6
06/25/08 - Da Vinci robotic laparoscopy
05/14/09 - 4th Quarter PSA -> less then .01
11/20/09 - 18 Month PSA -> less then .01
05/18/10 - 24 Month PSA -> less then .01
Surgeon - Keith A. Waguespack, M.D.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 6/11/2011 5:27 AM (GMT -6)   
Dr Crawford is an excellent doctor, but he is also a surgeon, not a trained oncologist. Just about everyone who has read the complete article agree that he is saying that early is better, except David.
David, you are filtering information selectively to get the outcome you want to hear. You have posted this question in several different ways asking for advice and have consistantly received the same answers from this forum. Yet you choose a different way or argue with posters that present the latest thinking from the most experienced doctors.
To me you are looking for a justification and not unbiased advice.
You have made a decision to proceed in a certain way, so stick with it. We have beat this dead horse to death and there is nothing more to be gained by continuing to ask the same question every week in a slightly different way. Some of us may not agree with your course of action, but we will always support your decision and wish you nothing but the best.
JT

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 6/11/2011 6:19 AM (GMT -6)   
John, you are doing the same thing that Fairwind tried. Are you saying if someone doesn't take your advice or Fairwind's advice, they are wrong or lesser informed. You have pretty dogmatic opinions yourself. I don't see you being open minded to views other than your own.

My new doctor made it clear, there is no magic number to pull the HT trigger. Depends on a lot of factors, depends on the patient, etc.

Lately, only one view is being presented here. I am looking for a balanced view, in order to contemplate any kind of decision. Obviously the bias here by a select view might make that impossible.

Casey - don't you have anything better to do than to dig up lists of posts from the past? Many here over the years have come up with some pretty conspiracy theories, so if you are inclined, why don't you dig them all up and make a digest for yourself.

-------------------------------

My point of interest in the article I linked, had to do with the different categories of advanced PC. Of course I read it all and its emphathis on early HT use. I am not stupid. Trying to get a handle on why my cancer is acting so agressive. And I am trying to live with very bad lingering side effects and damage from the curative attempts that didn't even remotly help.

This is the last time I will even remotely post a study or report, will keep any of my future research to myselfl. This place is so much better when we don't have resident "doctors" and academic "geniusess" trying to decide what the rest of us can know or not know, and how we should interept their wisdom.

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 margin
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, 4/11 3.81
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

James C.
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Date Joined Aug 2007
Total Posts : 4462
   Posted 6/11/2011 6:47 AM (GMT -6)   
Part of one rule of the forum is agree to disagree, I'd also add treat every member's position with respect. Let's not take it personal, ok?

Ok, all you all who are in this argument: Let's stop the cranky and the looking for any little possible or suspect slight to get disturbed about. Either have a studied and polite discussion or get away from the computer and do something else until you are able to type here without getting upset.
James C, 64, East TN
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% inv, lf. lobe, GS6
9/07: Nerve Spar. open RP, Path: pT2c, 110 gms., clear except:
Prob. microscopic inv.-left apical margin -GS6
3 Years: PSA's .04 each test until 4/10-.06, 9/10-.09, 12/10-.09, 2/11-.08, 5/11-.08
Bimix .30

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7205
   Posted 6/11/2011 9:08 AM (GMT -6)   
David:
 
You said "John, you are doing the same thing that Fairwind tried. Are you saying if someone doesn't take your advice or Fairwind's advice, they are wrong or lesser informed. You have pretty dogmatic opinions yourself. "
 
Actually, John said nothing of the sort. He said "David, you are filtering information selectively to get the outcome you want to hear."
 
So, you are not only filtering the article, you are also greatly distorting the posts here.
 
You also claim you are looking for a balanced presentation because lately they seem to be one-sided. That is a very good point, but I submit they are one-sided because more and more recent studies are pointing to the "sooner is better than later argument."
 
I also eschewed earlier (ie: doing HT before even SRT). Based on the research, that may have been a big mistake. But I am still fighting some pretty severe SE from the SRT (or it may be something else), so given the misery that HT itself causes, I don't feel any regret from my decisions. But, again, that may not have been the wisest decision on my part.
 
I have a great interest in your situation as a fellow HW PC sufferer, but also because if SRT fails I will be in that same decision boat as you are.
 
Mel

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3804
   Posted 6/11/2011 10:15 AM (GMT -6)   
>>I have said that I will no longer question David's decisions and I respect him for all he has been through. But I would like to point out other members trying to decipher the hordes of data out there that this study by Crawford is well balanced and the study indicates clearly that early intervention with HT is better than later intervention from a survival perspective. <<
 
to point out the facts is the responsible thing to do.  we all know David likes to stir up a little controversy to support his beliefs and treatment path but that's just human nature.  like you i respect David's decision on treatment and it's my goal to support him mostly by keeping my mouth shut.
 
my doctors believe in hitting prostate cancer early, hard and with every weapon at your disposal.  and that's my belief too.
 
ed
 

 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl
6/8/11 PSA .2, T = 540 ng/dl!
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