Posted 12/30/2016 6:42 PM (GMT 0)
Dear Sallyyy,
Your husband has had what my doctors called a "tremendous response" to initial treatments. Like your husband, I also started immediately on ADT hormone shots. I saw immediate and dramatic decreases in PSA after the first shot was given. I have remained on ADT shots continuously, ever since.
Soon after my initial diagnosis, I was in the first wave of fellows here in the United States who pursued the "early chemo" plan for advanced cases. That was over two years ago.
Adding chemo treatments to the ADT hormone shots gave me the unique advantage of seeing what adding chemo treatments to the hormone shots could do --- my PSA had leveled out on the hormone shots and did not seem to be decreasing any lower, after a certain point --- doctors call this the NADIR level.
From there, I jumped on the "early chemo plan" just at the time it became recommended --- it was then that my oncologist and I saw my PSA begin to creep down LOWER than it had on just the ADT hormone shots alone. My treatment experience is a testament to the potential power of pursuing both forms of treatment for advanced cases, upon diagnosis --- which is exactly what you are doing at this moment in time.
In my case, I literally WITNESSED what the additive power of adding chemo treatments did to enhance what the ADT hormone shots were doing ... watching my PSA creep down even lower, with each successive chemo treatment.
After chemo was over, then my oncologist recommended we add the newer breakthrough medication known as ZYTIGA, which miraculously brought my PSA level down even lower. In my case, ADT hormone shots, the "early chemo" strategy, and ZYTIGA have all helped me, in my particular case.
Something that I HAVE learned, over the course of time, that directly addresses one of your questions. My oncologist and I started to notice a few "spikes and flares" in my PSA levels over time. Because of that, he decided to start tracking my TESTOSTERONE level each time we did a PSA test --- it was easy to do. What we discovered in my particular case --- I was on the longer-lasting ADT hormone shots --- we began to see "spikes and flares" in my TESTOSTERONE level from month-to-month and this seemed to correlate with little flares in my PSA level, as a result.
I was on LUPRON shots for quite a few months, upon diagnosis. My oncologist felt that he could perhaps work the testosterone level down by trying the other forms of ADT shots --- we tried FIRMAGON shots for a couple of months, but it didn't seem to impact the testosterone level, as we had hoped. From there, we tried ZOLADEX injections --- and then went to MONTHLY shots, instead of the longer-lasting shots.
My original urologist was unwilling to try anything but the LUPRON shots. Fortunately, my ONCOLOGIST believed there was some merit in trying FIRMAGON and ultimately ZOLADEX, in my case. Better PSA control each month was the end result !
In my particular case, switching to ZOLADEX worked the testosterone level down BELOW 10, for the first time EVER, and it has now stayed there consistently, with the monthly dose shots of ZOLADEX.
In your case, it would be wise to simply ASK your husband's doctor to order an occasional testosterone test, along with your usual PSA tests --- you want to ENSURE that your husband's testosterone level is being adequately suppressed with the ADT shot he is on currently. It's simple and easy to ask for that test --- in my case, it has helped to control the PSA more evenly.
I have read research articles that state that oftentimes, doctors do not check the testosterone levels, along with PSA. It can be a helpful and informative component, in ensuring that the ADT shot is working to its best advantage. In my case, we found a way to suppress the testosterone to an even greater degree, by switching to a different form of ADT shots and going back to the once-a-month dosage, which seemed to be needed, at least in my case.
Each of us have a different situation, and each of us have a unique chemistry. I've been on the once-a-month shots now for quite a few months and now my testosterone stays below 10 each month.
I hope something in my treatment story will give you some helpful insight. My best advice? Ask your doctor for an occasional testosterone test, to make sure your ADT hormone shot is keeping the testosterone suppressed at a very LOW level.
Sent with my best, from across the miles, from the United States to the United Kingdom ~
"Cyclone Team Fan" ~ Iowa State University