Hormone Therapy before PSA rises

Why??? Do you have some crystal ball that allows you to see into the future..? I would save the HT for IF and WHEN you NEED it....PSA 0.2 is soon enough. Some would say too soon...

You're 44 years old..What kind of sex life do you have now?? Lupron, it's gone...

Why start the "Hormone Refractory" clock ticking now when you have undetectable PSA and zero symptoms?? Just my opinion....HT is your last trump card...Hold it until the last hand....

I agree with Tony. The PCRI recommends adjuvant HT for all patients with very high risk stats.
JT

i say hit it.  hit it good.

ed

 

Hi Cyrus,
I didn't catch your age but I would assume a young guy with 11yo twins. That would be me, too. I was 44 when my experience began. I was on HT for 28 months and you could say longer as it took 6-8 months for the stuff to wear off. Pro's and con's for me were typical. No libido, hot flashes, weight gain were present and on the pro side ~ no relapse.

Tony

Post Edited (TC-LasVegas) : 1/10/2011 6:49:00 PM (GMT-7)

>>I was on HT for 28 months and you could say longer as it took 6-8 months for the stuff to wear off<<

that's a good point, Tony. 

i'm four months past my last 90-day shot.  i do feel better but i'm finally having hot flashes and i've been sleeping alot.  were you sleeping more?

ed

 

Tony -- my energy is better -- i almost feel "normal" -- but i really get tired and of course my strength has not returned.  lately i have been sleeping 10-12 hours a day.  on saturday i slept 10 hours and then took a two-hour nap but i did exercise the previous three days and it was a "rest day" for me.  still that is a lot of sleep for me.

i also have that 20-something pound mantle of fat that, for the time being, i'm just trying to keep from expanding.  it's also been really cold here so maybe my body is try to hibernate.

ed 

Jerry,

I did DaVinci (post-op G 4+5, EPE) and adjuvant IGRT, but no HT. There were mixed opinions from the doctors on HT.

I can't say I am fired up about the possibility of HT, but ...

Tony,

Can you email me the Stanford and Harvard info.?

Thanks,
Jerry

The posts by 142 and Old Sailor do sum it up well.

Stage 3 is a very controversial stage in prostate cancer. But even these posts leave open controversy. When I was assessing my options, I first had to decide if moving forward with adjuvant radiation was reasonable. Most signs pointed to yes. And when I looked into that piece, I was told the use of hormonal therapy could improve the performance of radiation. My RO cited a well known study in RTOG9413 as well as the Stanford study. So for me it was reasonable that if I was going to undergo adjuvant radiation it was going to be with adjuvant hormonal therapy.

I believe that there is a major difference from pT3a and pT3b where local mets are clearly defined from being just a possibility. If we were talking about clear stage 4 disease I think Mayo would be all over the use of HT even without a rise in PSA. In fact stage 4 has much less controversy than stage 3.

That stated, good luck on this decision, Jerry. It's not an easy one. I'll be in your fan club either way...

Tony

Jerry L,
No man likes to be castrated. Androgen deprivation has side effects many of which can be reversed, but still it is a therapy that is very difficult to accept. That said, is there a benefit to make this decision at the proper time? Is early better than delayed. One study (a randomized trial) could answer your question. In a more recent follow (2006) after 11 years the results still hold. Read on:

RESULTS: After a median of 7.1 years of follow-up, 7 of 47 men who received immediate antiandrogen treatment had died, as compared with 18 of 51 men in theo bservation group (P=0.02). The cause of death was prostate cancer in 3 men in the immediate-treatment group and in 16 men in the observation group (P<0.01). At the time of the last follow-up, 36 men in the immediate-treatment group (77 percent) and 9 men in the observation group (18 percent) were alive and had no
evidence of recurrent disease, including undetectable serum prostate-specific antigen levels (P<0.001). In the observation group, the disease recurred in 42 men; 13 of the 36 who were treated had a complete response to local treatment or hormonal therapy (or both), 16 died of prostate cancer, and 1 died of another disease. The remaining men in this group were alive with progressive disease athe time of the last follow-up or had had a recent relapse. Except for the treatment group (immediate therapy or observation), no clinical or histologic
characteristic significantly influenced the outcome.

CONCLUSIONS: Immediate antiandrogen therapy after radical prostatectomy and pelvic lymphadenectomy improves survival and reduces the risk of recurrence in patients with node-positive prostate cancer.

Source:
Messing EM, Manola J, Sarosdy M, Wilding G, Crawford ED, Trump D.
Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer.N Engl J Med. 1999 Dec 9;341(24):1781-8.
PMID: 10588962 [PubMed - indexed for MEDLINE]

It is a very personal decision and more so for a young man. Wish you the very best possible outcome

Jerry already knows how I feel about the issue.  With a gleason of 9, you must hit it hard, and try to kill it all off.

about any treatment leaves some cancer cells in place.  So If you do several treatments you just might kill it all off, and cure your self.

Not fun to be on hormonal therapy, but I have been on it 16 years straight, gleason 9, in lymph nodes, but never had a rise in psa.  Still under .01.

No brag, just thankful.

Best,

Will H

leeanglo:

I have been on zoladex for seven weeks now also with the pre injection dose of casodex. I felt worse on the four weeks of casodex than I do on the zoladex.  Hope the lack of side effects continues for me.  Or do I still have that to look forward to?  How long was it before these SE arrived for you.  My first results will not be done until mid Feb and then my second injection Feb 24th when I will find out my results.

Just thinking out loud as this HT stuff is all new to me.