ADT and SRT Journey Part 2

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Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4156
   Posted 2/18/2018 10:30 AM (GMT -6)   
This is the extension of this thread.

Jim

/www.healingwell.com/community/default.aspx?f=35&m=3952177
Forum Moderator-Prostate Cancer. Age 62 (71 now), G 3 + 4 = 7, T1C, PSA 4.2, 2/16 cancerous, 27cc. Brachytherapy 12/9/08. 73 Iodine-125 seeds. Everything continues to function normally. PSA: 6 mo: 1.4, 1 yr: 1.0, 2 yr: .8, 3 yr: .5, 4/5 yr: .2, 6-9 yr: 1. My docs are "delighted"! My journey:
http://www.healingwell.com/community/default.aspx?f=35&m=1305643&g=1305643#m1

Crazyick
Regular Member


Date Joined Apr 2012
Total Posts : 174
   Posted 2/18/2018 12:58 PM (GMT -6)   
Thanks Jim for starting a new thread!

Mike
Age 49 at Dx PSA 15 2/15/12
Biopsy 2/8/12 5 of 10 pos 50-80% volume Gleason all 3+4 Bone/CT Neg
DaVinci RP 3/23/12 Stoney Brook LI
Path Rpt Gleason 4+3 PT3ANoMx 36.4 Grams. Tumor 1.7x1.5 cm 10-15% of prostate
Focal EPE present, PNI+, SV- , lymph nodes right 0/3 left 0/7 negative, positive apical margin, nerves spared
No incontinence, minor ED.
70 month post surgical PSA Reading of .2

Noggin2u2
Regular Member


Date Joined Jul 2017
Total Posts : 28
   Posted 2/18/2018 6:58 PM (GMT -6)   
Thanks Jim.
DX @ Age 64 4-17; Fusion biopsy Gleason 7 Bone and CAT Neg
1999 PSA 3.0 enlarged prostate chronic prostatitus
PSA 4-2015 7.7
PSA 11-9-2015 8.9
Biopsy 12-2015 Neg
1-11-2017 13.7
2-3-2017 14.7
RALP 6-14-2017 Gleason 9 4+5; pT3a;pNO; + bladder neck
PSA 7-7-2017 .11
PSA 8-10-2017 .1
PSA 9-20-2017 .11
PSA 10-31-2017 .01
HT stared Casodex 11-27-2017; Lupron 12-7-17; Started RT 12-4-2017, 39 treatment

Saipan Paradise
Veteran Member


Date Joined Sep 2017
Total Posts : 631
   Posted 2/18/2018 7:29 PM (GMT -6)   
Spoke with my RO, Dr. Ko, this morning (Monday in Saipan & Guam) about the weird <0.05 PSA I pulled a week ago. His reaction was the same as TA's: it's either a medical miracle or a lab error -- he suggests the error may be in diluting/pipetting the sample. He's ok to wait to start treatment until after a retest if I want, but he's confident we'll soon see the value return to something like 0.1. I think I'll ask my PCP to write a script for a retest tomorrow, with every expectation that the <0.05 will turn out to be an outlier. After the blood draw, I'll start on Casodex, followed by Lupron injection and simulation 2 weeks later. Aiming to start my fractions in about 3 weeks.
I mentioned to Dr. Ko that Drs. Biagioli and Abramowitz proposed just 6 months on Lupron, compared to his recommendation of 9-12 months. He stuck to his guns but conceded, rather diplomatically, that the ultimate decision will be up to me. He thinks given my pathology at least 9 months would be prudent. Didn't mention any studies, and I didn't ask. TA, if you're reading this: any studies supporting longer course of Lupron for G8 pT3a N0 with salvage?
--SP
Age 60 at dx
Dx July 2017 after biopsy G8 (4+4), 5/13 cores, bone scan clear
RARP Aug 11, 2017 (Dr Patel)
Post surgery pathology: pT3a, tumor 30% of gland; EPE+, SV- and 3 lymph nodes clear
PSA 1/2016, 2.9; 4/2017, 7.2; 9/2017 (first post-RARP), 0.13; 10/2017, <0.05, 1/9/2018, 0.09, 1/31/2018, 0.10, 2/9/2018, <0.05(!?)

Skypilot56
Veteran Member


Date Joined Mar 2017
Total Posts : 646
   Posted 2/18/2018 7:36 PM (GMT -6)   
Thanks Jim, When I started this thread I never had any idea that this much interest would be generated. But with over 13,000 views it shows that people are asking questions whether they are facing these kind of treatments or have had them. My hope for this thread is to help people that are wondering about some of the experiences some of us have endured and our journey with ADT and SRT. We have had some great guys contribute to this post and some very knowledgeable guys and I thank each and everyone of them! Wishing everyone the best as they fight this beast we call PCA!

Larry
Male 61 DX @ 60
Father had PC
2002. Psa. .08 Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo in Mn
Path Report: Gleason 9, pt3b, SV + 1 nerve, N-Margins 35 LN removed clear
Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia
6-13-17 psa 0.13
7-19-17 psa 0.12 3TMRI with coil - clear
10-11-17 psa 0.16
10-12-17 Lupron
12-13-17 psa <0.10
12-18-17 SRT
2-7-18 SRT done 72gy

AZ Guy
Regular Member


Date Joined Feb 2017
Total Posts : 110
   Posted 2/18/2018 7:39 PM (GMT -6)   
I had asked my RO if he thinks it would be prudent for me to go longer than 6 months with ADT. He recommended that I don't, stating that ADT has its own longer-term negative side effects (cardiovascular and bone weakening among others). And this is with a higher Persistent PSA.
Age 49 at DX
DX 2/7/17: G6 2/12 cores <5% in each; one lobe
PSA 6.6 (doubling actual 3.3 due to Finasteride use)
RALP 8/24/17
pT2c R1
Gleason 7 (4+3 St. Joe's and Mayo) (3+4 by Mass General)
Margin Positive
-ECE; -SVI; +PI
Tumor <10% of gland
PSA .40 9 weeks out
PSA .40 14 weeks out
PSA .52 15 weeks out (new lab- Mayo)
6-Month Lupron shot on 12/4/17
SRT 12/18/17-2/5/18: 68 Gy, 34 treatments

Skypilot56
Veteran Member


Date Joined Mar 2017
Total Posts : 646
   Posted 2/18/2018 7:48 PM (GMT -6)   
AZ-
Is your RO from the Mayo also? Like I was saying my team wants me on 2 yrs for sure and possibly the rest of my life depending on what happens. My BCR psa wasn't as high as yours but my path report was a little worse it's interesting to see the different treatments that they have for patients.

Larry
Male 61 DX @ 60
Father had PC
2002. Psa. .08 Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo in Mn
Path Report: Gleason 9, pt3b, SV + 1 nerve, N-Margins 35 LN removed clear
Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia
6-13-17 psa 0.13
7-19-17 psa 0.12 3TMRI with coil - clear
10-11-17 psa 0.16
10-12-17 Lupron
12-13-17 psa <0.10
12-18-17 SRT
2-7-18 SRT done 72gy

Saipan Paradise
Veteran Member


Date Joined Sep 2017
Total Posts : 631
   Posted 2/18/2018 7:55 PM (GMT -6)   
AZ Guy said...
I had asked my RO if he thinks it would be prudent for me to go longer than 6 months with ADT. He recommended that I don't, stating that ADT has its own longer-term negative side effects (cardiovascular and bone weakening among others). And this is with a higher Persistent PSA.

Yeah, that's why I'm wanting to see the evidence for 6m v. 9m or longer.
Has anyone on ART/SRT consulted an MO about length of ADT? I'm wondering if an MO might have a better handle on this than an RO.

AZ Guy
Regular Member


Date Joined Feb 2017
Total Posts : 110
   Posted 2/19/2018 8:41 AM (GMT -6)   
Larry, yes I have an RO at Phoenix Mayo. Naturally I was alarmed at my high Persistent PSA and my reviewed pathology at Mayo stated I had "extensive" positive margin. I asked for a PET/bone scan before SRT/ADT but was told my "low" PSA would not yield anything on imaging. Dr. is confident about the SRT and 6-month Lupron, and says we'll hold additional ADT in reserve should I need it. It is curious to see different approaches and you can't help but wonder about your treatment when compare to others.
Age 49 at DX
DX 2/7/17: G6 2/12 cores <5% in each; one lobe
PSA 6.6 (doubling actual 3.3 due to Finasteride use)
RALP 8/24/17
pT2c R1
Gleason 7 (4+3 St. Joe's and Mayo) (3+4 by Mass General)
Margin Positive
-ECE; -SVI; +PI
Tumor <10% of gland
PSA .40 9 weeks out
PSA .40 14 weeks out
PSA .52 15 weeks out (new lab- Mayo)
6-Month Lupron shot on 12/4/17
SRT 12/18/17-2/5/18: 68 Gy, 34 treatments

garyi
Veteran Member


Date Joined Jun 2017
Total Posts : 798
   Posted 2/19/2018 9:04 AM (GMT -6)   
Saipan Paradise said...
...I'm wanting to see the evidence for 6m v. 9m or longer.
Has anyone on ART/SRT consulted an MO about length of ADT? I'm wondering if an MO might have a better handle on this than an RO.


As you know, SP:

1. There is NO hard evidence on 6 vs 9 months of ADT.
2. Yes, I've seen an MO, and asked the question.
3. Every MD will have an opinion, but a 'better' handle....nope. rolleyes

Why don't you just get a three month Lupron injection, and see how it goes. No need for committing to nine months, so don't fret about it? nono

Skypilot56
Veteran Member


Date Joined Mar 2017
Total Posts : 646
   Posted 2/19/2018 2:02 PM (GMT -6)   
I go back April 25th for psa check n 6 month injection of my favorite ADT LOL!!!
Male 61 DX @ 60
Father had PC
2002. Psa. .08 Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo in Mn
Path Report: Gleason 9, pt3b, SV + 1 nerve, N-Margins 35 LN removed clear
Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia
6-13-17 psa 0.13
7-19-17 psa 0.12 3TMRI with coil - clear
10-11-17 psa 0.16
10-12-17 Lupron
12-13-17 psa <0.10
12-18-17 SRT
2-7-18 SRT done 72gy

Cary1963
New Member


Date Joined Aug 2016
Total Posts : 14
   Posted 2/19/2018 5:41 PM (GMT -6)   
Currently 29 SRT treatments down, 6 to go. Relatively free of side effects except for fatigue from ADT, but another SE has been an issue lately.

We've had several warm spells lately, and I have hot flashes/sweating episodes, especially when in business meetings in warm conference rooms (I control the temp in my office, but not in meeting spaces). Sweat dripping down my face, etc. Even an issue at home during the warm spells. I do much better in cold weather.

Has anyone treated hot flashes effectively, especially the sweating portion?

Effexor and Neurontin are options my RO gave me. Didn't know if one was better than the other for sweating.

Thanks
Diagnosed: Feb 2016 at age 52
PSA: 15.1, 10/12 cores
Davinci RP: April 2016
T3bN0, Gleason 3+4, Tertiary 5 post surgery pathology
EPE+, SVI+, MAR-, PNI+, PIN+
May 2016 PSA 0.03
Prostvac V/F Clinical Trial - July to Dec 2016
Mar 2017 PSA 0.03
June 2017 PSA 0.04
Oct 2017 PSA 0.08
HT - Lupron Nov 2017 to April 2018 with SRT
SRT - Jan/Feb 2018, IG/IMRT 35 treatments, 70 Gy

Skypilot56
Veteran Member


Date Joined Mar 2017
Total Posts : 646
   Posted 2/19/2018 6:22 PM (GMT -6)   
Cary- I'm just living with them seems like i get them worse at nite

RobLee
Veteran Member


Date Joined Apr 2017
Total Posts : 703
   Posted 2/19/2018 7:11 PM (GMT -6)   
Cary1963 said...
Has anyone treated hot flashes effectively, especially the sweating portion?

Effexor and Neurontin are options my RO gave me. Didn't know if one was better than the other for sweating.

I take both. Effexor is the more effective, reducing the frequency, duration and intensity of hot flashes by half. Still get them though. Usually I'm good during the daytime, but they start up in the evening. That's when I supplement with the Nurontin.

My RO offered me Megastrol, but my GP did not want me taking hormones due to possible blood clots.

The Effexor has helped tremendously with mood swings from the HT. Previously I was a mess.
2014-15: PSA's 9, 12, 20, 25... Neg DRE's, false neg TRUS biopsy
6/16: MRI Fusion biopsy, Right Base, 2x40%+2x100% all G8 (4+4)
8/16: DaVinci RP, PNI, 6mm EPE, 11 LN-, 53g 25% involved Grp 4, BL SVI, T3B N0M0
1/17: started 18 months Lupron ADT, PSA's ~.03
5/17: AMS800 AUS implanted, revised 5/30
8/17: RapidArc IMRT 39 tx (70 Gy) Aug-Oct 2017
1/18: PSA 0.00, Now test every 3 months for a trend

Break60
Veteran Member


Date Joined Jun 2013
Total Posts : 1848
   Posted 2/19/2018 7:21 PM (GMT -6)   
I’ve said this n number of times but here goes: estradiol patches changed twice weekly dramatically reduce hot flashes particularly at night! I don’t know why this is such a mystery.
Bob
DOB January 1944
8/’12 PSA 2.7; 5/’13, PSA 6.6 (actually double due to finasteride)
7/’13 Bx GS 4+5=9 , 2 of 6 cores, 10%, 40%; stage Pt1c
9/’13 ORRP, pathology GS 4+5=9, EPE and margin+ at base (4mm, GS7), BLSVIs+, 10 lymph nodes resected (clear); stage upgraded to Pt3bN0M0
11/’13 - 5/’14, PSA 0.1 to 0.3
6/’14 SRT by IMRT/IGRT (68.2 grays/38 Fx) to prostate bed, ADT (6 months Lupron)
9/’14 - 8/’15: PSA: <.1, to 1.2
9/’15 MRI, CT-PET finds two iliac lymph nodes suspicious for PCa; started 13 months of ADT3 (Lupron, bicalutamide, dutasteride) plus plus metformin, cabergoline, estradiol patches, prolia , vitamin D3, calcium. IMRT/DART (75 grays/50 Fx) to pelvic lymph nodes. Stopped ADT3 11/’16.
11/’15 - 5/’17: PSA .03 to 2.3.
2/’17: Rx finasteride added
5/’17: F-18 Fluciclovine (axumin) PET/CT scan finds 9 mm femur met. Restart ADT3; start monthly Xgeva, stopped finasteride.
6/’17 SBRT via IMRT (27 grays/3 Fx) to femur met.
6/’17 - 10/’17 PSA .3 to <.1

RobLee
Veteran Member


Date Joined Apr 2017
Total Posts : 703
   Posted 2/19/2018 7:30 PM (GMT -6)   
Break60 said...
... estradiol patches ... I don’t know why this is such a mystery.

Sounds like a hormone to me.

Skypilot56
Veteran Member


Date Joined Mar 2017
Total Posts : 646
   Posted 2/20/2018 8:16 AM (GMT -6)   
This was on another thread so just pasting it here for the people that might have missed it.

A Systematic Review and Framework for the Use of Hormone Therapy with SRT for Recurrent PCa. European Urology 73 (2018) 156-165.
It includes some discussion of short-term v. long-term ADH:
"In localized high-risk prostate cancer, long-term hormone therapy (2–3 yr) results in improved oncologic outcomes compared with shorter-term therapy (4–6 mo), even in the context of dose-escalated RT.
However, this is yet to be established in the SRT setting, and the Radiation Therapy and Androgen Deprivation Therapy in Treating Patients Who Have Undergone Surgery for Prostate Cancer (RADICALS NCT00541047) trial seeks to investigate the importance of duration of hormone therapy on oncologic outcomes, in addition to assessing the impact on short- and long-term toxicity."

Larry
Male 61 DX @ 60
Father had PC
2002. Psa. .08 Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo in Mn
Path Report: Gleason 9, pt3b, SV + 1 nerve, N-Margins 35 LN removed clear
Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia
6-13-17 psa 0.13
7-19-17 psa 0.12 3TMRI with coil - clear
10-11-17 psa 0.16
10-12-17 Lupron
12-13-17 psa <0.10
12-18-17 SRT
2-7-18 SRT done 72gy

Zzarth
Regular Member


Date Joined Jul 2016
Total Posts : 196
   Posted 2/21/2018 3:49 AM (GMT -6)   
Skypilot56 said...
Cary- I'm just living with them seems like i get them worse at nite


I second the worst at night effect... Tonight for some reason, my hot flashes have been the worst ever!

I'm sweating perfusley .... maybe it was something I ate? I dunno... but I'm starting to think 6 months of ADT is enough for me... I've gained weight, constantly fighting depression, and just feel "yucky".

sad

Zzarth
Diag age 44
6/16/16: PSA=15.1
10/16: RP w Tewari, pT2c pN0, 1.8 cm, 3+4=7, 4 comp=20%
Positive R-APEX posterior (focal) identified and treated
-EPE, -SVI, -M, -LVI, -PI
Decipher 0.45
#2017
1.4 0.00
4.15 0.00
8.17 0.05
8.25 0.07
9.22 0.08
10.5 0.09
10.9 Lupron 6mth
10.27 0.09
11.17 0.02 (T=15)
12.11 <0.01 (T=14)
mid dec start radiation
#2018
2.8 end radiation 70.5 Gy's

garyi
Veteran Member


Date Joined Jun 2017
Total Posts : 798
   Posted 2/21/2018 5:24 AM (GMT -6)   
"Yucky" is a great description. Don't know why, but there it is. Only good news for me is two months into ADT, and no hot flashes.....yet.

Six months WILL be my limit. mad

AZ Guy
Regular Member


Date Joined Feb 2017
Total Posts : 110
   Posted 2/21/2018 7:37 PM (GMT -6)   
I feel like my hot flashes have eased a bit...either they are getting better or I just don't notice as much. Although I do get up to go to the bathroom once a night now. During radiation treatment, I didn't...now two weeks post treatment I do.
Age 49 at DX
DX 2/7/17: G6 2/12 cores <5% in each; one lobe
PSA 6.6 (doubling actual 3.3 due to Finasteride use)
RALP 8/24/17
pT2c R1
Gleason 7 (4+3 St. Joe's and Mayo) (3+4 by Mass General)
Margin Positive
-ECE; -SVI; +PI
Tumor <10% of gland
PSA .40 9 weeks out
PSA .40 14 weeks out
PSA .52 15 weeks out (new lab- Mayo)
6-Month Lupron shot on 12/4/17
SRT 12/18/17-2/5/18: 68 Gy, 34 treatments

Saipan Paradise
Veteran Member


Date Joined Sep 2017
Total Posts : 631
   Posted 2/23/2018 4:05 PM (GMT -6)   
Well, I’m on the road. Had blood drawn yesterday for a final pre-ADT PSA, took my first Casodex pill 45 minutes ago. So far, I feel the same: Pruned a bush that was blocking the driveway, didn’t cry when my wife played a wedding video someone had posted to her on Facebook. smilewinkgrin
Age 60 at dx
Dx July 2017 after biopsy G8 (4+4), 5/13 cores, bone scan clear
RARP Aug 11, 2017 (Dr Patel)
Post surgery pathology: pT3a, tumor 30% of gland; EPE+, SV- and 3 lymph nodes clear
PSA 1/2016, 2.9; 4/2017, 7.2; 9/2017 (first post-RARP), 0.13; 10/2017, <0.05, 1/9/2018, 0.09, 1/31/2018, 0.10, 2/9/2018, <0.05(!?)

Skypilot56
Veteran Member


Date Joined Mar 2017
Total Posts : 646
   Posted 2/23/2018 7:59 PM (GMT -6)   
just wait SP your turn will be coming! Ha ha. I lost it at my bell ringing the wife kinda started then another couple ladies and a guy then pretty soon all of us were crying. But they were tears of celebrations so I guess that's ok hey? It will be interesting what your psa shows this time.

Larry
Male 61 DX @ 60
Father had PC
2002. Psa. .08 Enlarged Prostrate
2014. Psa. 3.8
2016. Psa. 19
3-08-17 RP Mayo in Mn
Path Report: Gleason 9, pt3b, SV + 1 nerve, N-Margins 35 LN removed clear
Prostrate 45 grams
4-20-17 Incarcerated Umbilical Hernia
6-13-17 psa 0.13
7-19-17 psa 0.12 3TMRI with coil - clear
10-11-17 psa 0.16
10-12-17 Lupron
12-13-17 psa <0.10
12-18-17 SRT
2-7-18 SRT done 72gy

Crazyick
Regular Member


Date Joined Apr 2012
Total Posts : 174
   Posted 2/24/2018 5:29 AM (GMT -6)   
Hey Saipan, I’m slightly ahead of you. Six casodex pills downed and on March 6th I get my first one month Lupron shot. So far so good!

Mike
Age 49 at Dx PSA 15 2/15/12
Biopsy 2/8/12 5 of 10 pos 50-80% volume Gleason all 3+4 Bone/CT Neg
DaVinci RP 3/23/12 Stoney Brook LI
Path Rpt Gleason 4+3 PT3ANoMx 36.4 Grams. Tumor 1.7x1.5 cm 10-15% of prostate
Focal EPE present, PNI+, SV- , lymph nodes right 0/3 left 0/7 negative, positive apical margin, nerves spared
No incontinence, minor ED.
70 month post surgical PSA Reading of .2

garyi
Veteran Member


Date Joined Jun 2017
Total Posts : 798
   Posted 2/24/2018 10:13 AM (GMT -6)   
Sorry to tell you guys....the 'fun' doesn't start until about a month into Lupron. smhair

Crazyick
Regular Member


Date Joined Apr 2012
Total Posts : 174
   Posted 2/24/2018 11:04 AM (GMT -6)   
garyi said...
Sorry to tell you guys....the 'fun' doesn't start until about a month into Lupron. smhair


That’s what I was afraid of! shocked
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