Ok - I promised an update on my oncologist's view as to when to start HT - just to add fuel to the fire in this emotional debate!!!
First, some preliminaries. I go to Columbia University cancer center. The oncologist I see has the credentials, that is not an issue. My latest PSA is 1.71. PSADT is 3 months. I had da Vinci in 2009 and IMRT in 2010.
Today is a day I have dreaded for a long time. Long story short is that I have been advised that it is time. My Oncologist's view has always been that you start HT at around 4, as there is no evidence that starting sooner has any benefit to survivability, as long as you start before METS. While he would have preferred to wait (since I am only at 1.71), the rate of doubling is troubling to him and lends an element of unpredictability to my scenario. In addition, the reoccurrence has happened so soon after RT, that the extra 3-4 months of being HT free is not worth the risk of METS. Since it will take a few weeks to do some baseline scans, by the time I get my first shot, probably in 2-3 weeks, I will likely be at around 3 or higher.
I am very sad and depressed. Had my share of tears since I left his office 2 hours ago. I feel like once I start I will never feel good again. I guess I need to say something to my kids.
I will be on Casodex and Lupron. 7 month cycle. You all know the SE's so I won't mention them here other than to relate that he told me that the change in my metabolism will result in my having to reduce my caloric intake (or increase the calorie burn) by about 1,000/day to maintain my weight.
By the way, his reaction to the notion that starting HT sooner rather than later is good because it kills Hormone sensitive prostate cancer cell before they mutate to the cancer resistant variety was that this was unsupported by scientific evidence. No-one knows why cells become refractory and in fact they may be completely different cells (not mutations from hormone sensitive cells) which get turned on at some point once T is reduced. The recent advances like MDV1300 and other drugs are designed to attack these cells, but they are still a few years away.
I got all the sobering statistics as to average survivability at this stage in the fight, and while I know they are averages and were generated by patients who began treatment 5-7 years ago (Can you figure out what the average is!!!!!!!) , I still dont like the numbers. I can't help but feel scared about what my scans will show and worried that I am in the 10% for which HT fails within the first year.
Its all very fresh so sorry for rambling. I knew HT was in my future, but its amazing the effect it had on me when I was told my future is now.
AGE 51 DX 49 GLEASON 4+3
NO FAMILIY HISTORY
MARRIED, TWO DAUGHTERS, 15 AND 16.
Da Vinci RRP 10/09- CORNELL
PATH - EXTRAPROASTIC, POSITIVE MARGIN, NEGATIVE LYMPH, NEGATIVE SEMINAL VESICLE. STAGE T3A
40 SESSIONS OF IMRT COMPLETED 4/10
PSADT CURRENTLY UNDER 3 MONTHS
BONE AND CT CLEAN SO FAR.