Hormone and radiation post robotic

you sure you didnt mean 1.0, not 10.0?

that is frightening if the 10.0 is correct.

you would not find a single US source that would even remotely agree, a 10.0 would be considered a run-away situation.

david in sc

Your surgeon is in the Walsh School of Thinking...

Which is basically, "Why suffer the effects of HT any longer than you have to?? Studies have shown that survival time is the same whether you start HT early or late so take all the "good time" you can get....

The opposing view is more recent studies seem to show that adjunct HT and RT started as soon after surgery as possible improves outcomes even in high risk patients..

I asked my R-doc this: If my post surgery PSA drops to zero, why should I start any further treatment until and if my PSA begins to climb?? His answer was "With Gleason 9 the sooner you start followup treatment the better.." I asked How much better. His reply was 10-15% better.. I checked with a University cancer research center and they said the same thing, Gleason 9, doing all three gives you your best chance and the sooner the better..

Now that you mention it I did say something to the effect that is how Dr. Walsh approaches treatment. He did ackowledge that. It was the high number that confused me more than I already am.  I just thought it was to long of a wait.

Why would anyone take a recommendation on HT from a surgeon. Would you go to a urologist if you had lung cancer? PC that has matastized is a different ball game from pc that is contained in the prostate. Surgeons understand the 1st and are usually clueless regarding the 2nd. I would never have an oncologist operate on me, nor would I ever have a surgeon give me HT. There are completely different skills and training involved; one is mechanical and the other is biological. Walsh is a surgeon, and most of his information about HT is 15 years old. If you want to learn about HT read Strum, Myers or Scholz and not Walsh.
Dr Strums rule #3 is find the best artist for the treatment you have chosen. This means that if you think you need HT then see an oncologist specializing in PC and not a surgeon.
With a gleason 9 and 2 lymphnodes positive you have matastized PC and any further treatment is well beyond your surgeon's skill level and training.
JohnT

john, i think you just gave the best advice here.

you logic is perfect john. if, my srt fails, and i am in the next zone, there is nothing my beloved uro/surgeon can do for me, or even offer in the way of substantial advice. i would be seeking the very skilled medical oncologist that i had 11 years back, advanced pc was one of his specialties. my uro wouldnt presume to know anything about the radiation side of treatment, let alone advanced issues. however, i am glad he stuck with me through all the horrors i dealt with post srt, as they still directly effected my urinary system, even now.

david in sc

In Canada some docs believe psa of 20 is a magic level to add hormone therapy, some US docs are in the school of 10 to 15 range (arbitrary within it as to when to start). I got this from my radiation oncologist in a recent frank discussion on such, his words not mine.

I do believe Dr. Strum to be amongest the wisest docs ever on PCa issues(if you followed him over a few years you would get it), then some of the others Myers, Sartor, Scholz, Leibowitz, Lam, Volgelzang and some others. Considering your life and/or quality of life is  on the line, perhaps one should know those huge differences as John T had pointed out, that are really common sense.  Welcome to the twilight zone of PCa, makes fiction look believable.

Mr Bill

I'm in about the same boat as you. I know a PSA of 10 is about the time urologists do a biopsy for diagnosing CaP. But a PSA greater than 0.15 after RRP is considered failure. Cleveland Clinic is well known for great CaP specialists, but John T has it right. Get both a medical oncologist and a radiation oncologist from Cleveland. Get a second opinion from other med and rad oncologists.

I'm now 3 months post op and will be starting RT and ADT in two weeks. But my PSA post op is 0.50. You want to wait as long as the oncologists will let you, because the level of urinary and sexual function you have at the start of RT is about where it will remain for most men.

The sum of research I've read recently says there is still some debate on the advantage of adjuvant versus salvage therapy after RP, but there does seem to be an edge in favor of adjuvant (soon after RP, like between about 3 and 5 months), rather than waiting until biochemical failure. Since your PSA is already detectable but quit low, I suspect a good oncologist would tell you to get started sooner rather than later. If your functions have already recovered, there is no reason to wait. On the flip side, if there has been little progress of ED/urinary recovery since RP, there is little reason to wait. But if you are recovering at a good pace, get as much time as your oncogists will give you.

Best wishes

Julios

I have a somewhat opposite problem. How long does one remain on the HT after a failed RRP and an SRT treatment? My Rad doc says three years, my Onc says one. Go figure. There is no research I could find on HT treatment in conjunction with SRT.

Julios,

Thanks. I will get another med oncologist opinion. My current doctors have told me that there is no overwhelming evidence that adding HT increases odds. Do you or your doctors have any data supporting the use of HT early?

Also, how are we supposed to know if RT is helpful if HT is also used (which affect PSA)?

Thanks again,
Jerry

Hi guys, it looks like this thread has been going on for a little while and I'm jumping in late, but I thought I would comment on the last few posts here regarding HT treatment (Jerry and Julios).  I don't have direct, first-hand knowledge on this, but in a separate thread, earlier today I posted a few links to some sites with relevant info. I will re-post two of the links here: “Nine Decisions To Make Before Choosing Radiation Therapy After Prostatectomy”   PCRI, 2010   http://www.prostate-cancer.org/pcricms/sites/default/files/PDFs/Is13-2.pdf    Decision #6 is "Adjuvant Radiation Therapy is decided — Should hormone therapy be included?" The discussion reads:  "No large, randomized clinical trials have examined adding hormone therapy, also called Androgen Deprivation Therapy, to adjuvant or salvage radiation.   Choo reported on several small studies that showed benefit, including his own about 75 men who were treated with two years ADT after salvage radiation.   After median follow-up of 6.4 years, freedom from PSA relapse was 91.5% at 5 years and 78.6% at 7 years.   That is one of the highest success rates reported." The Choo paper discussed on the PCRI site is here:    “Salvage Radiotherapy for Patients with PSA Relapse Following Radical Prostatectomy: Issues and Challenges”; discusses toxicity for both ART & SRT.   2010   http://e-crt.org/Synapse/Data/PDFData/0036CRT/crt-42-1.pdf      There is a section of interest in this paper titled, "Salvage Radiotherapy plus Androgen Ablation Therapy for PSA relapse."   I hope that this might be a little helpful...as it says, there is no random clinical trials proving out the HT + SRT approach, but some data indicates it improves cancer control outcomes.

Casey:

I will be seeing Dr. Hussein at Umich on Nov 1st. She is a top-notch medical oncologist specializing in PC. One of the reasons for this appointment is to get the latest information and map out a plan. HT/SRT combo is one of my questions.

I suspect the answer will be no HT, given my very low PSA.

In fact, I am hoping they do NOT do a PSA test for this appointment. My next one is scheduled for 12/21. I'll probably do that one 2 weeks later in time for my next appointment at Ford on 1/7/11.

I'm afraid if they do it on Nov. 1st. it will tell me for sure that the game is up (regarding BCR). I would prefer to be in ignorance for a few more months!

Mel