HealingWell
Search Close Search
☰

Questions regarding HT and SRT

Support Forums
>
Prostate Cancer
✚ New Topic ✚ Reply
1 2
❬ ❬ Previous Thread |Next Thread ❭ ❭
Posted 3/6/2011 4:18 AM (GMT 0)
thank you, piano, excellent, that was the post i was trying to remember, there's weren't enough data points, so it falsely showed a worse situation. glad someone's memory is better than mine, lol

david
Posted 3/6/2011 5:13 AM (GMT 0)
That's interesting. Maybe it is a stat. anamoly. But I would think they have PLENTY of situations with those assorted GY.

It seems like even just within HW there is quite a range of SRT GY.

But it does seem odd that the exact 68.4 number seems to yield the highest percentage. Maybe my radiology doctor just uses the MSK nomograph to determine the dosage?

Also, maybe the adjust the GY after the set-up or perhaps as things go along.

I don't know.

Mel

Posted 3/6/2011 12:48 PM (GMT 0)
Mel,

This is what the autors of the MSK nomogram study had to say about dosage:

"We did not identify an association between radiation dose and the outcome of SRT, although the range of doses administered was relatively narrow, and few patients received doses greater than 70 Gy."

If you want, go to this link, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2670394/.  about half way down the report they have a nice graph illustrating the effects of all the variables in the nomogram.  You can see how PSADT, PSA prior to start and Gleason score are the most important stats.

Hope this helps.

Carlos

 

Posted 3/6/2011 3:19 PM (GMT 0)
My PSA did not come down from its pre SRT level 3 months after treatment. It caused me a lot of anxiety.  My 6 month PSA, however, was zero and it has remained at that number 18 months out.  I wouldn't worry too much until the next test.
Posted 3/6/2011 3:32 PM (GMT 0)
the guestion between HT and Srt ? the combination of the two seems to be the best The clinical trial I was in a Emory in Atlanta Ga. combined both with HT 30 days before SRT started and continued until SRT finished my psa was .55 when I started A foot note my prostate had already been removed andI had 8 mths before BCR . but just kept putting off HT and SRT. Ibelive SRT is a lot more serious than HT HT just slows down PC where SRT burns up every thing no matter what the Drs.say SRT is tuff on the body to take !!!!!!!!!!!! as David can atest to. I am now 15 mths out of SRT and HT all the problems are really starting So good luck on your decision there is no good decision just what ever you"re able to stand just know they are both tuff!!!!!!!!!!!!!
Posted 3/6/2011 3:53 PM (GMT 0)
I was given just RT after a post surgery BCR. I asked "why no HT at the same time?"
and was told that this was specifically to prevent the HT masking the effect of the RT.

However this decision was also on the basis of my own pre-op and post-op pathology, as there were
other guys having SRT who were indeed having HT at the same time. The choice related to
the question as to whether the BCR is due to cancerous cells in the prosatte bed or to cancerous
cells elsewhere. With me they said that my pathology suggested there was a very high chance
that the problem was in the prostate bed, hence no HT.
And as for how the decision was reached, well I didn't sit in on the discussions, but a team of RT docs
plus a doc from my uros department planned my SRT treatment together.

And for the record: my PSA was 0.1 three months after surgery and 0.4 seven months
after surgery so then came SRT, but three months after SRT my PSA was down to <0.1.

So for me the SRT-without-HT choice seemed to be the right one. This does not mean treatment
similar to mine will always be right for others though.

If my PSA starts going back up, then fine that means my SRT failed, but that is a bridge I do not
yet need to cross over a river I don't need to go looking for. I am feeing pretty good right now, so
I think that I can just get on with today.

Alf
Posted 3/6/2011 4:09 PM (GMT 0)
You are doing well,Alf, and sounds like your doctors knew what they were doing
Posted 3/6/2011 4:20 PM (GMT 0)
English Alf I agreed this decision is each persons on choice but most of us can only go on what the Drs. tell us my psa after surgery was .01 and steadly climbed my first uro dr said he hoped my psa would not show up for at least 2 yrs after surgery but it did not. HT was not suggested at first just Srt I change uro drs {wished I hadn't }I went to emory in Atlanta .where the uro dr did nothing finally i said we need to do something and he sent me to a med ono who agreed!!!!!!!!!PSA .55of course it somewhere else{cancer] you just half to be careful I was one of those who had 72 gy of radation 42 treatments I just say good luck to any one on this jouney expecially if the pc is not contained to the prostate and escapes out I.m just tired of people who say Pc wil not take you're life they just don't know what a battle this is !!!!!!!!!!!!!!!!!!!!!!! right
Posted 3/6/2011 5:29 PM (GMT 0)
Carlos:

Thank you so much for that link. It was a good refresher as I think I've read it before. What was most helpful was:
>>>>>>>>>>>>>>>>>>
In the setting of primary radiotherapy, dose escalation and combined therapy with ADT have been proven to increase local control, disease-free survival, and/or overall survival.44–46 No prospective study has evaluated the impact of ADT in the salvage setting. ADT administered before and/or during SRT was associated with improved PSA control in our study, although this may potentially be explained by the effects of prolonged ADT (up to 24 months in some patients) on masking PSA recurrence. ADT may improve the efficacy of SRT, but a randomized trial is required to test this hypothesis. We did not identify an association between radiation dose and the outcome of SRT, although the range of doses administered was relatively narrow, and few patients received doses greater than 70 Gy. Combined therapy with ADT, radiation dose escalation, and improved target localization using modalities such as endorectal coil magnetic resonance imaging may improve the efficacy of SRT.47
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>.

Now, this was written in 2007. I believe subsequent studies may indeed show a benefit of combining HT with SRT. I'm not sure. But at least this confirms that it was a gray area not too long ago. Also, the article does seem to reaffirm that even with my poor doubling time, there is still a 40%+ chance of success (although they actually just do a <10 months cutoff).

David -- if you are reading this -- my set-up right now is set for 3/15. IF Dr. Hussein strongly recommends HT, then I will probably (reluctantly) listen to her advice and the SRT might get delayed while I do some HT. But I'm not sure she will even respond to my email. If she does not, I will try and call her. I have time this week and now I am glad I am not going on vacation. I need to get some feedback on these issues. Also, speaking of feedback, I may ask Umich about SRT dosage and I will also again ask the radiology guy on the 15th if we are still on.

Mel
Posted 3/6/2011 5:51 PM (GMT 0)
Deerhunter,

I was not really saying that it is about each patient's choice, but that the doctors will make decisons about what to offer each patient based on each patient's history etc.
The only decision I made was thus to agree with what the docs suggested. I clearly needed something do deal with the BCR and I didn't want the HT do mask the SRT so I was singing from the same song sheet as the docs when that was what they offered me

Alf
Posted 3/6/2011 7:10 PM (GMT 0)
Mel, you ultimately will have the make the choice: SRT alone, or SRT with HT. You have gathered a lot of opinions and your own doctors have their views for you. It will be your call in the end, and the gang at HW including me will honor your decision.

I keep thinking of the words the rad. oncologist said to me, he was pushing HT with my SRT, the only one out of 3 rad. docs, but when I pushed him for proof or evidence, he backed right down, and freely admitted that he couldnt prove I needed the HT and he couldnt prove that it would help. So for my case, and my case only, that was the same as if he had said no HT, like the other 2 docs said. They both said the HT had a distinct masking effect. I think San Carlos talks about the same thing on another thread going currently.

You got to do what is right for you, that is for sure

David
Posted 3/6/2011 7:53 PM (GMT 0)
David:

It doesn't get easy, does it?

I really do NOT want HT (as opposed to all you guys who just can't wait to get it! <g>).

But if there is compelling evidence ... then I'll have to consider it. I have yet to be "compeelled."

But I need to decide this week.

Mel

Posted 3/6/2011 7:55 PM (GMT 0)
Agreed, and I wasn't compelled before my SRT, and I am not compelled now, even though it has failed.
Posted 3/6/2011 10:09 PM (GMT 0)

compiler said...
But if there is compelling evidence ...

What did you learn from Dr. Charles "Snuffy" Myers' book "Beating Prostate Cancer:  Hormonal Therapy & Diet"?

 

 

Posted 3/6/2011 11:32 PM (GMT 0)
There's a lot going on in this thread.

1st. Cure defined for any radiation is either low and stable psa or psa that rises only slighly from the nadir and stops rising.

2nd. Most oncologists say that you should start HT as early as possible. There is no cancer being treated where the protocol of starting chemo is better later than sooner. The idea is to hit the PC cells while the tumor burden is low and before any of the cells have time to mutate to androgen independant.

3rd. In radiation the higher the dose the greater the killing power. This is a well established fact and any nonograms that show differently are due to statistical abberation.

4th. By delaying HT you are not saving anything. HT kills the andogen dependant cells and the androgen independent cells keep growing at the same rate. By delaying HT you do not buy anymore time; starting it early can kill some of the cells that in time may mutate to androgen independent.

JohnT

Posted 3/6/2011 11:57 PM (GMT 0)
John T: Regarding delaying HT. Let's say one has just SRT and it fails (David's case). I have still seen arguments that say wait until the PSA hits 10 or even 20 and other arguments that say hit it immediately with HT. I've posted this question elsewhere and it seems there is not quite uniform agreement on the answer. Then we get the question of HT before SRT. Once again, you can say whatever you want with authority, but there is no uniform answer. My doctors at Ford and Umich said no HT when I asked them, but this was before my last doubling, so I will try and ask again.

Casey, I have not read his book, but I have seen his tapes. His tape on BCR after RP really did throw me into a depression. Basically, my PSADT of 2 months is "highly lethal." He definitely questions whether or not SRT should be done at all and he does advocate strong HT. That is his opinion and one I have to consider!

Still, the MSK nomograph gives me a 45% chance of a 6-year BCR. Myers probably ascribes almost a  ZERO chance.

There are clearly NO ABSOLUTE ANSWERS. You have very learned medicos saying different things

Mel

Posted 3/7/2011 12:04 AM (GMT 0)

>>There are clearly NO ABSOLUTE ANSWERS. You have very learned medicos saying different things,,

my doctors were all in agreement about HT.  sounds like to me you'll hear what you want to hear.  in  your shoes i'd definitely err on the side of caution.  that's the last i'm going to say about except i hope you know i have your best interest at heart.

ed

Posted 3/7/2011 12:16 AM (GMT 0)
And my doctors said NO HT (at least when my PSA was 0.13).

So, am I hearing what I want to hear??

I will readily admit that I do NOT want the HT/SRT combo so I will lean towards that unless I am convinced otherwise. I still might be (convinced otherwise).

I appreciate everyone's concern. We all are fighting this battle.

Mel

Posted 3/7/2011 12:42 AM (GMT 0)
Mel,

You are doing your homework. Ultimately it is your decision. You are the one who needs to be comfortable withn the decision. I don't believe that waiting another 2 or 4 weeks will ultimately change the outcomes.

If you need days or weeks to be sure that you are comfortable with the ultimate solution. These are big decisions. You don't need to be second guessing 4 weeks from now.

I am confident that you will get to the point where you will be able to proceed confidently.

Goodlife
Posted 3/7/2011 1:22 AM (GMT 0)
Question ? has no oneheard about the clinical trials going on where HT and SRT are used together to fight PC after failed surgery?
✚ New Topic ✚ Reply
12