continue with ht???

stage t3b. my psa report yesterday i.e 2 months after 40 sessions of imrt is .003. i will be completing 6 months of HT (loreilin) on 10 nov 15. the problem is whether to continue HT or stop. two hospitals involved differ vastly. One says six months is enough as the pc is non aggressive and "intermediate". the other doctor suggests continuing for two to three years!!! it seems that i will have to decide which approach to adopt. half hourly hot flashes are pretty bad and fatigue is irritating but bearable.
I respect the knowledge and caring attitude of the senior members on this forum.
comments/advice will be highly appreciated please

i updated my profile but the signature is not added to my post. I must have made a mistake somewhere!!
facts as follows:
Age – 64
apr 2015 psa 10.517 Gleason 3 +3 = 6
mri apr 15 confirmed sv involved
bone scan- negative
HT started 10 may 15 lorelin 11.25 3 monthly. 2nd injection on august 10
pre radiation psa 0.5
Imrt 40 sessions june 15
6 nov psa .003

Just passed the 3 year mark on ADT, the rest is in my sig line. My condolences that they could not cut it out for you.

I also am 'still young', though I am older than you by a tad.

The G6 is low risk, but the cT3b puts you into a high risk category. Where else did it show up locally (seminal vesicles, lymph nodes, etc.). Just to comment on another's comment, it's a little misguided I think to say "too bad they couldn't cut it out". That's not the only choice, and not always even the best choice. Radiation has advanced a great deal in the last 15 years or so, and surgery is about the same it's ever been. Old studies comparing radiation to surgery are based on old radiation techniques and exposure levels. To me, your choice of radiation was a good option. It's especially good in a locally advanced situation.

I'm approaching 3 years on HT, but mine was a very high risk case and warranted that. Whether or not your staging warrants longer HT is a good question, and I don't recall the study conclusions about that. Our good forum friend Tall Allen may have links to specific studies to help you.

Three years of HT is no picnic, believe me. I miss my testosterone, and the prospects of recovering it after going this long are not very encouraging.

monty786 said...
stage t3b. my psa report yesterday i.e 2 months after 40 sessions of imrt is .003. i will be completing 6 months of HT (loreilin) on 10 nov 15. the problem is whether to continue HT or stop. two hospitals involved differ vastly. One says six months is enough as the pc is non aggressive and "intermediate". the other doctor suggests continuing for two to three years!!! it seems that i will have to decide which approach to adopt. half hourly hot flashes are pretty bad and fatigue is irritating but bearable.
I respect the knowledge and caring attitude of the senior members on this forum.
comments/advice will be highly appreciated please

Hey Monty786,
I had a similar dilemma back when I was first DXed. My URO(very early in the game) recommended 2-3 years and my Brachy ONO didn't want to comment on that recommendation but strongly recommended that I stay with HT for the a 1 year to work in conjunction with the Brachy treatment.

Hello, Monty.

I had RT as primary therapy with concurrent HT. I am also deemed intermediate risk due to suspicious (now confirmed) lymph nodes at diagnoses. In 2008 the recommendation was two years of HT and was increased to three around 2009. There have been studies on localized cancers that indicate 6 months is enough. I do not think yours is local. (?) I stopped the first round of HT in two years with PSA of .03 or therabouts. Six months later, just as I was losing the weight and regaining my strength, the PSA started upward rapidly. Been an up and down proposition ever since. Mets to my lungs last year so new oncologist said stay on Lupron until failure. Failed earlier this year and started trial at NIH with Xtandi and have had good results but still on lupron. I am no ball of fire but I have enough energy to do gardening and going out. That's my story such as it is. I also take avodart and that seems to help with the fatigue (could just be my imagination too).

As for your situation I would take the two or three year option as it appears you have this stuff beat down to a reasonable size based on PSA. Smack it while it is small. Chemo concurrent with HT early in the game has shown some promising results too. I think some of the other drugs Xtandi, Zytiga require you to be hormone refractory.

Just one more thing. For years I felt like the RT did not get all of the cancer in the pelvic nodes. The trial I am in does regular scans and shows no activity in the original area of treatment which makes me feel good about my choice at the time. I can only conclude that I had micromets in the lymph system and that it how it got to my lungs.

Good luck,
Don

I have been on this forum for about 2 months and have learnt a lot more than i was told by the doctors. viz my reports say stage t3 and that is all. found here that is t3b. thanks for the all the support too.
Don- appreciate the feedback. mine is not restricted to local since seminal vesicle is involved. as regards lymph nodes, I am not sure. the report says "altered ill-defined high signal on t2w and low on t1w post contrast is note adjacent fat along side measuring 7.8 x 8 mm may represent ? lymph node. small subcentimeter lymph nodes are also noted in inguinal area. I will check with my oncologist too.
I am on duodart too. my prostate size was 125 gms at the time of diagnosis. reduced to 71 pre radiation and 38 as of yesterday. reduction is due to duodart? HT? imrt?

I was part of a "protocol" at the National Institute of Health in Bethesda, Maryland. My PCa was localized, but highly aggressive. All three doctors said the standard treatment is radiation with two years on ADT. (However, for some patients with high PSA, 30+, they go three). I wanted to go longer than two years, because I wanted to keep my PSA "undetectable." But the doctor said there were no studies showing increased survival for more than two years of adjuvant therapy. However, I reminded him I had ADT three months before starting radiation and 21 months after, "so why can't I have another 3 month shot?" He said I could have the shot if it would help me worry less, but insisted there were no studies supporting anything longer than 18 months, in cases like mine.