Lupron + SBRT vs. EBRT + Brachy boost

Hi everyone—

Husband saw King at UCLA (thank you Allen) and is now seriously considering ADT 6 months, followed by SBRT. I guess Dr. King feels strongly that ADT be used, with SBRT, but that this treatment should be effective.

Husband is currently thinking he’d rather have ADT than go through hassle of 5 weeks of radiation, plus the invasive brachy procedure. But prior to meeting King he was feeling good about brachy combo option. Both doctors are great.

I’m now getting really scared. Nothing has quite rattled me yet like the idea of him on ADT. Husband has history of negative childhood and alcoholism (2 years recovery). He’s been doing really well, so much better. But the hormone treatment effects make me super nervous. We have two teenagers that went through the wringer when he got sober. I’m very protective of our stable home environment now.

This is all a personal and private matter that I’ve hardly discussed with anyone, but it seems important to get feedback from anyone with experience or info re: ADT and mood stability changes/problems. I have a bad feeling about it.

I believe King said he would only treat with SBRT if ADT was used adjunctively.

Thank you for any input. You are all wonderful and appreciated.

Allen, I will talk to my husband about this. It was the first appt I was unable to attend due to work, which was a bummer. My husband recorded the appt. but our nights are crazy busy with kid stuff so I haven’t listened.

I know that HT is at least strongly recommended and definitely got the impression that it is not optional, that King feels strongly that the 5% increase in outcome is worth it in my husband’s case. I also know my husband is now feeling less confident about San Diego RO who didn’t recommend HT, given how much King convinced him he needs it. What he told me King said was one shot, 6 months. But I will confirm.

I guess I need more info from husband. I’m relieved to hear that it is maybe “optional”, though I believe I heard otherwise. It’s not so much that that I worry about falling off the wagon, though that would be a big problem. We have just been through a lot of emotional stress as a couple and his recovery was not an easy process. We are still getting back on our feet as a couple, so it’s unsettling. Maybe I’ve read too many horror stories about ADT.

I also know King’s read on MRI report was that extension is a possibility but not a definite. The DRE felt the lesion along side of prostate and he said it was very hard. That’s all I know.

I will definitely tell my husband about support groups. He works in Santa Monica and may be able to join one up there.

You are very kind for spending this time to respond. You’ve been really helpful to us. Thank you!

Thanks John. Glad to hear about your successful treatment.

I feel silly for stating my fears. Hopefully everything will be fine! Ive read a couple stories about depression and people being hospitalized for mental health reasons, people who had pre-existing issues. I think there’s still some residual trauma that I’m dealing with, always waiting for something bad to happen. But that’s my issue.

I’m glad to hear positive stories about this kind of treatment, as I have a feeling he’s going to choose that modality.

Thank you for the input. Stay well!

I don't know where this rates on your decision tree, but I'd certainly guess that SBRT is more affordable than the brachy/IMRT combo if you're paying out of pocket. I know you're more concerned about getting a cure (as you should be), but unless you have unlimited resources I'd have to think that it would be difficult to completely ignore the cost factor.

ADT is no picnic, so I'd certainly want to know more about what risk classification King sees your husband and how much he thinks ADT would help. Does he consider your husband high risk? (Sure must be difficult to go from considering AS to the other end of the spectrum so quickly.)

That said, six months of ADT is manageable for most--it's just a matter of slogging your way through the process. As to your husband's history, I don't really know if that would be a factor. I never stressed on ADT (I did stress over my treatment decision). FWIW, I did 18 one-month shots of Lupron since I wanted to give myself the option of bailing early if I wanted to.

I had the same protocol as Sr. Sailor - a 1 month shot to see how I handled the side effects, then three month shots. I echo John_TX with the Lupron side effects - in addition to his, I have neuropathy in my hands and feet. It is manageable, but not much fun.

I believe that any episode of cancer can lead to depression - it is something I've been asked about several times in this journey over the past year. Right now, I'm struggling a bit with the last few IMRT salvage radiation treatments - it reminds me every day that "You have cancer!". Lupron does seem to have an emotional effect, but I don't believe it causes depression by itself.

Keep us informed - there are lots of smart people who have been where you find yourself today.

Rob

As a wife, I can tell you that ADT has sucked and been pretty hard on our relationship (not devastating, we're fine, but it's been a stress).

That said, if it's only for 6 months, and Dr. King feels it's worth it, I trust Dr. King implicitly (he's hands down my favorite doctor we've seen, and we've seen many...the guy has always spoken to us with zero ego involved and I've always believed that his recommendations were sincerely in the best interest of a cure rather than hailing him a hero). I am confident you could knuckle through 6 months if you believe it's a necessary lifesaving piece.

My husband really didn't have a choice on the ADT - with his diagnosis it was an important piece of saving his life, so we went for it.

We are a younger family too (3 kids still at home). If you'd like to email me, my address is in my profile, I can talk to you about the ADT effects and what we've done to manage it along the way if you think that would be helpful.

PS I just looked at your earlier post...we are the same age and both in Orange County. I hope you reach out. I haven't found many wives my age dealing with this disease, and it can be a lonely fight.

Next meeting is May 14 - 2nd Monday of the month.

The assessment as unfavorable intermediate risk due to high tumor volume is reasonable. I wasn't there, of course. All I can tell you is that I have never heard King recommend ADT for an intermediate risk patient, and it is not his style to take that decision away from the patient. It may be that what he meant was that the addition of Lupron would only raise the probability of success by about 5%, and your husband took that as a recommendation. It is hard for me to understand why he would label 5% as "important" when the probability of success is over 80%. But if your husband wants to eek out every last bit of probability of success, and he doesn't mind putting up with its side effects for 6 months, that is certainly his option.