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Radiation or Lupron?

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Prostate Cancer
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Posted 9/4/2019 10:19 PM (GMT 0)
Hello
I am 69 years old and in good health.. I eat healthy and get good exercise. In April of this year (2019) i was diagnosed with PC .My psa was 58 (fifty eight) and my Gleason was 9..Cancer has spread to the lymph nodes but scans of bone,chest and pelvis are clear. I started Lupron immediately and as of two weeks ago my psa was 2.7.
My oncologist asked me to consult with a RadOnc about treatment and possible (but very small chance) of cure
After discussions, because of my age, I am very worried about the long term effects of the radiation.
Alternatively, I am just as worried about the disease progression if I avoid radiation and stay on Lupron. I know cancer cells may become resistant to Lupron. I am afraid of the cancer spreading further.
I don't know which path to take.
Your thoughts are very much appreciated

Thanks
Posted 9/4/2019 11:24 PM (GMT 0)
Welcome to HW, sorry you need to be here.

It's a tough choice. ADT (Lupron) will keep the PC at bay for a long time, but it's not curative. At some point it will stop working. After that there are other drugs/chemo that can keep you going longer. There are side effects from the Lupron that some find bad.

If, big if, you PC is confined to the prostate bed, then RT would be curative - especially if you've been on ADT for awhile (this weakens the PC cells). RT is normally well tolerated by most guys. I'm 9 years from RT and the long term effects aren't much. Side effects aren't horrible, not nice, but mostly manageable. Bowel issues are most common. Other issues are possible, but rare. In general an older person is more likely to tolerate RT than surgery. It is worth at least talking to the RO and get an opinion.

Hang in there and keep us updated.
Andrew
Posted 9/4/2019 11:36 PM (GMT 0)
I am surprised you were not advised to get both radiation and ADT therapy immediately.

Am I missing something?????

You had a PET scan of the pelvis?

I am 4 months into ADT, and 4 weeks into radiation. I have no complaints but we are all different.
Posted 9/4/2019 11:49 PM (GMT 0)
AHeavyMind, welcome, and very sorry to hear that you are in this situation. It’s a tough choice. ADT as Andrew said could hold the cancer down for a long time, or maybe not. You could become hormone resistant in a year or two, or 10 years.
Radiation might cure you. Many variables and very little certainty with this disease.

I think only you can make this decision. Maybe ask yourself how badly do you want the chance of cure. If you decide on radiation, don’t wait too long. G9 is a tough mother.

FWIW, I am 10 months past the end of radiation and doing mostly fine. My side effects have been more from the Lupron. Also, mine was salvage radiation, when my PSA became detectable after surgery. And it is mostly believed that radiation if the prostate without having it taken out, produces less side effects than salvage radiation, after the prostate has been removed.

See the RO, ask a lot of questions relating to your concerns. Then make your educated decision.

In either case, all is not lost. Please know that you can and almost surely will, live many more years unless you get hit by a bus or something. And the clean scans are good news, very much in your favor.

Lots of success stories here, of G9 and 10 guys. Stick around , you’ll get lots of support.
Posted 9/5/2019 12:03 AM (GMT 0)
I can totally understand your 'heavy mind' status. It's something almost all on this Forum have dealt with. But with your (Gleason 9 and PSA= 58) diagnosis, there's no doubt that some form of radiation therapy is necessary. What exactly are you afraid of?
The usual recommendation for cases like yours is a 'triple' attack; two kinds of radiation and hormone therapy. That's what I had and many others on this Forum with similar diagnoses. Even though we all had side effects, the alternative would have been (a lot) worse...
Posted 9/5/2019 12:16 AM (GMT 0)
Well, you're already on ADT, so why not give the radiation a shot? In a sense it's really the only choice you have since the lymph nodes are involved. Even if radiation doesn't cure you, there is a theory - yet to be substantiated - that de-bulking the primary tumor may be life extending. Radiation would kill the cancer cells in the prostate (de-bulking), possibly slowing spread, even if some cancer cells have already escaped. This is a question to discuss with the radiation oncologist.

There may still be a chance for a cure, but if that doesn't happen, the radiation treatment could still be beneficial by reducing the tumor load.

Good luck!
Posted 9/5/2019 3:40 AM (GMT 0)
In many studies, Debulking the Prostrate (either by radiation or surgery) has been shown benefits even if it is not curative.
Posted 9/5/2019 9:37 AM (GMT 0)
Radiation is very tolerable. Just do it.
Posted 9/5/2019 11:56 AM (GMT 0)
aheavymind, Sorry to hear your diagnosis but glad you found us, Almost all of us here have experiened the feelings you are going thru right now. We try to eat right, do some exercising and then PCA shows up. I'm speaking from my experience but I always tell guys to get a good team in place and a good facility and then be sure to be your own advocate and it sounds like you have kinda done this and you are asking questions. With your diagnosis I would for sure want a team of including Urologist, RO, and MO,. We have several members here who have had psa's in the 100's and are still going strong. As far as a cure nobody knows but with all of the treatments available to you now and the future you probably will pass away from some other cause then PCA. Don't forget to keep living during your journey of PCA a lot of us have come to appreciate much more family, friends, and the simple things in life since our journey. Wishing you and your family the best!

Larry
Posted 9/6/2019 7:42 PM (GMT 0)
ADT will stop the tumor to progress for quite some time, but then the cancer will do so. The NCCN prostate cancer guidelines recommend radiating the prostate in your case and you may also get the affected lymph nodes radiated as well. This may cure you but if not, at least it will reduce the tumor volume so that the ADT will work for a very, very long time. You will not die from prostate cancer then, if it works as it should.
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