How to delay hormone-resistant cancer ?? Intermittent or continuos hormone shots--which is better ??

I'm debating whether to go to intermittent or keep on continuous
hormone shot and would welcome suggestions, comments, info, etc
(perhaps this have been discussed previously);
recent research suggest that intermittent might
be better --along with reduced side effects (see
http://www.businessweek.com/lifestyle/content/healthday/636870.html

If this evidence is correct, and applies to human, then the more contact
you have with hormone, the more likely hormone-resistant cancer will
develop.

3 choices :
(1) Continue on every 3 month Trelstar LA (Lupron surrogate)
(2) Stretch to 4-5 months
(3) Go intermittent (resume only when PSA > 10+)

I'm leaning towards (2) --4-5 month depending on test results due to

(a) Treatment almost always are over-treat (they have to be
effective for 99%/95% of patients, so the dosage is higher
than needed for the majority of people, especially if they
are not overly large in size) --I am a great believer on
under-treatment--so, by stretching to 5 months, the average
hormone dosage is reduced, and, if the article is right, the
chance of developing hormone-resistant cancer is reduced also.

Regular Every 3 months --
Jan 1--first shot;
March 29 PSA test,
Apr 1 2nd shot..
repeat

Stretched 5 months--
Jan 1 first shot;
April 1 PSA test (to confirm that hormone is still effective)
April 29 2nd PSA test (to see if hormone/PSA has gone up--if so,
get shot on May 1; if not delay shot till June 1)


----------more info on my advanced prostate cancer (PSA level did not
go down after prostate surgery)

5 months after Robotic prostate surgery update (3/11/10)

PSA trend
Pre-biopsy (Apr 09) 4.2 (this triggered the July 09 biopsy 4+3=7
Gleason prostate cancer)
Pre-surgery (Oct 09) 6.7
DaVinci surgery 10/9/09 (Gleason 4+3=7; T3c; right seminary vesicle
cancerous; has to remove that AND "way beyond the prostate" to get
negative margin)
6 weeks post surgery 7.0/6.4
10 weeks post surgery 9.2 (doubling time 2+ months)
13 weeks-taking Trelstar (Lupron surrogate)-12/16/09
22 weeks PSA (3/3/10) <.1 (testoserone 13)

Both the Bone scan and the Prostascint/MRI scans (12/09) were
negative (the uro says that most of the time, one would
not see cancerous modules in these scans until your PSA is ~40+.

March 11, 2010 update
PSA taken 3/3/10, and is <.1, so, hormone treatment is working
Getting frequent (1-5 times per day) hot flashes, though endurable
(have to take my shirt off to cool down on some occasions)--
often (perhaps 1/2) happens most frequently during meals.
This started occurring around end of Jan (6 weeks after shot) and
has become more frequent lately.
(note : my 3-year older brother since age 20's have frequent
sweating (face and chest--so, like hot flashes) while eating,
especially if he gets excited--so, this could be genetics--he
does not have prostate problem AFAIK)
Back to singles tennis (though I try not to run too much) with no
problems--and sweating (which I consider a success) --plus
frequent long walks (minimum 1000 steps in 10 min= 1 health point,
some longer)--target it 20 health points per week, but I am
managing only 10-15 these days. (1 hour singles tennis= 4-6 health
points, and I do 1-2 times tennis per week).
Incontinence --getting better--from 6-10 pads (+ diaper) for the first
month, now down to 1 pad + 1 diaper per day (could probably
get by without diapers, but I have plenty). Still steady dripping
(though small amount) plus more leakage when body is in unusual
position or during exercise. Only massive leakage occur during
sleep--if I sleep for more than 2-3 hours stretches (often, I still
wake up once per hour for peeing, and those nights, leakage is minimal)
Diabetes --Getting worse (prior to prostate surgery, I was pre-diabetic
with morning/fasting reading of 110-130); Early Jan, I'm getting
170 (3 days in a row; 150 wed morning after Tuesday's tennis
session). Fortunately, a few reading at 5PM before dinner shows
170-200, not too high--so, at least I'm still Diabetes II. Taking
2 metformin pills (one morning meal, one evening meal). Note that
I have been eating more than I should since I feel hungry--that
might have contributed--(also to weight gain--back to before surgery
weight--I was down 10 lb just after surgery--I'm on the margin between
overweight and obese)
so, I need to watch my diet and carbs.
Other problems :
Sleeping --getting some insomnia, but not too bad.
possible other items --feel lightheaded (this occur before surgery too)
and unsteady (especially climbing stairs). Night vision in dim lights
seems to be much worse than before--but driving at night is okay.

John:
What does your doctor recommend?
After responding to that question, then the issue of intermittent treatment, of any kind and for any condition, is to allow the body to recover from drug main and side effects and allow stasis to remedy any salient conditions created by the treatment. Thus a low psa may allow for a period of indeterminate length before re-starting whichever treatment you and your doctor decide upon. It appears that your treatment has reduced your testosterone sufficiently for the psa to be undetectible by a standard assay. The effects of low testosterone can only be reversed with a period of testosterone recovery. Going from a quarterly shot to one every 4 or five months is unlikely to allow for T recovery and thus will not alleviate side effects of treatment. Only a longer period with T recovery will accomplish this. Intermittance is rarely recommended after just 3-6 months of treatment for men in your situation. One year or more is generally the period. If you are trying to reduce the cost of your treatment then the 4-5 month period between quarterly shots may answer but this is not what you are seeking.
The psa re-starting threshold is entirely arbitrary depending on you and doctor, your history, your comfort with potential progression, emotional anxiety, expense of treatment and many other factors.

JohnK11 'if' you are wishing to stay on Trelstar longer, which you have alot of choices, FDA just approved the 6 month shot on this today, it was not available before, looks like in May it will be offered to the public thru your docs.  *no endorsement from this budget messenger whom attempts to inform and tries to educate others on the real world of PCa, less sugar coated cause that is what this topic deserves.

John

  get all the opinions you can

about 2 months after my DX I iwent on 50mg of Casodex every day and the expensive (zoladex?) shots every three months for 13 months before prostate was removed at Sloan kettering...my local NM urologist was a big believer in the hormones and my PSA went to virtual zero....Dr. Guillonneau my surgeon at Sloan kettering (where my local urologist studied) was not a big believer in hormones and would not have suggested it but he had a neither here nor there view since I had started the treatment...I went off the hormones two weeks before surgery and intentially about my quarterly shot a month before surgery...one thing I learned is that it was difficult to do pathology work on the removed prostate because it had become "mushy" and easily damaged while they pull it out of your body because the hormones basically killed the prostate...which was their job...

I had hot flashes and wild mood swings every night....cried easily, and even some breast enlargement...obviously zero libido and they can fancy it up in any medical terms they like but basically you have been chemically castrated.....post surgery catheter removed in 9 days and incontinence for about 3 weeks and stopepd using any pads after about a month...the flashes and mood swings have lessened, but libido is still gone....both docs say there can be a residual dose of the hormones which in some people take a year or more to "clear" the body cells.....I am thrilled that my two poast surgery PSAs were virtual zero and the new mice studies say nothing about what systemic changed occur which even when you are "clean" with no sign of spreading, could result in a recurrence of other types of more aggressive cancer cells...I think, truly, this is a case where an informed layman asking good questions can spurn reseachers to "real world" consequences after a course of treatment...

 Also, I think these "new" findings were in theliterature, if you looked for more than two or three years...lots of debate on wheter on and off hormones worked better than sustained treatment.. other studies showed that the "average" zero PSAs after sustained hormone therapy lasted on average two years but in some cases many, many more years....

In my case at age 62 now, and five months after surgery, I  feel my personal priority to get rid of my prostate while Gleason scores were still 6 and 7 and pass up radiation and other measures was the right one....no one likes to go from a fairly macho guy to a eunich, but having friends who have died horrile deaths from various cancers made up my mind...the fairly normal urinary function is a bonus after reading many horror stories and there is a 50-50 chance that the libido issue is somewhat resolved over time...

Finally, I think your posting and the responses show the great  benefit of Healing Well and is the type of exchange which is a positive force for your future health and full life....

all the best

mbshine

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I dontknow where I stgored all my DX stuff but you have tghe gist of it...LOL!