Length of time on HT

I'm on my second lupron shot. My original treatment plan called for two lupron shots. Was hoping that the shots would end this coming November. Am I being too optimistic?

Had a followup appointment yesterday with my RO. He is recommending 18 to 24 months because of the gleason 8.

What is the current thinking on length of time to be on HT?

What should I consider when November rolls around and my Urologist recommends additional Lupron shots?

Has anyone had just two treatments of HT in conjunction with Radiation therapy?

I don't know yet how long I will be on it, but have been since 31st March. 2 months and 2 weeks so far. The plan is 4 months. We'll see if that changes later I guess.

My RO has me on two years because of the Gl 8. I think that is fairly normal. By the way, I get my last shot next week. Hooray.

Carl

In my opinion, there is a catch 22 when using ADT as an adjunct to radiation treatment...If the treatment is successful and a cure is produced, then going through the side-effects produced by the ADT is certainly worth it....But if the radiation treatment + ADT is NOT successful, you will have endured the 2 years on ADT for nothing and worse, you are now that much closer to becoming hormone refractory when you go back on ADT as you most certainly will......

So the question remains: ADT improves the effectiveness of radiation treatment by some percentage...Is this percentage worth the major quality of life issues associated with Hormone Therapy ?? Only the individual patient can answer that..

I did a 12 month stint while my URO recommended 2-3 years. I'll tell you the whole story if you're interested.

Manfred -

The best info we have for high risk men treated with escalated radiation dosing like you received is that 28 months of adjuvant ADT is better than 4 months.

Androgen deprivation therapy and escalated dosing in radiation therapy

(This confirmed RTOG 9202)

We also learned that 18 months is as good as 36 months:

18 months of ADT as good as 3 years when combined with radiation

So we can say with certainty that short term ADT is inadequate for high risk men. My best guess is that the optimum duration of adjuvant ADT is probably somewhere in that 18-28 month range.


ronjt - I think you misread that reference. It says "2 years of HT for high risk patients." Manfred is high risk (GS8).

Thanks all for the input. 10 months of ADT seems optimistic. I'll plan on 18 months.

TA, I read the references that you recommended.

My RO was pretty adamant that 18 months was a minimum in my situation.

They definitely factor in more then the gleason score when figuring out the length of time and definitely different Docs choose what they think is best. Since other factors are added in with your gleason score to determine your overall risk category that will play a big part in the overall length of time of HT. I think sometimes some of us are not fully aware of what risk category we are actually in because we focus so much on the gleason score alone. I know I was confused a lot and maybe still am a bit, but I think my overall risk was initially thought to be low intermediate because of the 3+4 but then because of the high volume it bumped me up to high intermediate and then with the findings on the MRI with the possible SVI and ECE I was considered high risk. But since the SVI and ECE was not conclusive and the gleason on new biopsy was 4+3 different Docs would say high intermediate and others would say High risk. But for my treatment plan they based it on high risk so really I think that is all that matters. I felt better being classified in a higher risk category and taking a cautious approach rather then a lower risk category and be under treated.

When I was initially diagnosed as a 3+4 with high volume cancer the Uro offered me the HDR with external beam for 5 weeks + 6 months of HT as one of my options. Later after the 3tMRI showed possible seminal vesicle invasion and possible ECE the new Docs I was seeing at NIH said I would clearly be on HT for 2 to perhaps 3 years with radiation should I choose that route.

Redwing

Thanks for the advice. I thought I was going to be finished with Lupron after 10 months. But, My RO advised last week that 18 - 24 months of ADT was the norm in cases like mine. I have my next Uro appointment in Mid August. I expect that he'll continue the ADT for the 24 months.

I'm a 4+3 with one positive node but zero PSA six weeks after surgery (and still zero); MD Anderson's protocol for moderate (or am I considered high?) risk was six months of Lupron *and* radiation. As long as my PSA is zero (or undetectable) no more Lupron.