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Landbaby's first post- anyone familiar with Eldorado trial?

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Posted 9/4/2009 2:01 AM (GMT 0)
My husband was just diagnosed with prostate cancer he is 68 years old his PSA is 12.10 his Gleason score is 9 and he has 40 % tissue involvement in the right side of his prostate I understand this is a very aggressive cancer and they are treating it as such
He is scheduled for a trial study called the Eldorado trial it is a combination of (Eligard) Leuprolid a Hormone treatment ,Radiation treatment and Docetaxle chemo therapy
I am wondering why if it's not outside of the prostate why they don't just remove the prostate gland does anyone know anything about this?

Post Edited By Moderator (James C.) : 9/3/2009 8:19:33 PM (GMT-6)

Posted 9/4/2009 2:19 AM (GMT 0)
Hello and welcome to HW, landbaby. Sorry you have a need to come here, but glad you found us. Yes your husbands statistics are on the serious side, but as any of the advanced case guys will tell you, it's not hopeless by any means. I have to assume that he has had a recent biopsy, do you remember what his staging was? If you could post his full biopsy stats, it would help us understand a little better.

I am sure some of the advanced guys will be coming along soon to answer your questions a little better. This is a great place for comfort, for advice, to vent even.

I will keep your husband and you in my thoughts, and please stay with us, and keep us posted of developments.

David in SC
Posted 9/4/2009 2:23 AM (GMT 0)
Welcome to HW, sorry you have to be here. There's some guys who probably will be along shortly to answer your question. I'm not familiar with your questions, so will leave it to them. I am guessing you have this info. from the biopsy? Any other tests been done? Is your husband in bad health otherwise, anything that would preclude surgery.

Oh, I edited your post to give it a subject... smilewinkgrin
Posted 9/4/2009 2:49 AM (GMT 0)
Welcome to the club that hates to get new members. We are sorry that you are here but we are here with you.
Your situation illustrates how hard it is to hear and understand everything a doctor says and to ask all the questions that you need to. A good doctor will understand this and will want you to phone his office if you need more information.

First, know that radiation and chemo may be exactly the right treatment for your husband. There are members here for whom it has worked. From the information that you give, it is hard to see why prostectomy is not an option. If your doctor is not clear on this, you may want to seek another opinion. Getting a second opinion is very common for PC and a doctor will not feel that you are wrong in doing so.

All this said a Gleason of 9 shows an aggressive cancer that needs prompt treatment. If you haven’t looked at the links at the very top of the topics list you might want to do so. There are a number of very good books and websites that can help you to become better informed.
Posted 9/4/2009 3:16 AM (GMT 0)
I looked up the Eldorado trial and found it at:
www.clinicaltrial.gov/ct2/show/NCT00452556

Here is an excerpt of the criteria for being accepted
Life expectancy greater than 5 years.
Any one, or more, of the following criteria:

* TNM stage T2c, T3a or T3b
* Gleason score 8 to 10, as determined by central institutional review.
* PSA > 20 µg/L, but < 50 µg/L. OR Have a > 50% chance of recurrence after radical prostatectomy, as predicted by the Kattan Nomogram and
* Post – op PSA < 1.0 µg/L.
* Must be able to start protocol treatment within 6 months from date of surgery.

No evidence of metastasis, as determined by bone scan and Chest x–ray/CT abdomen/pelvis.

I think that some of these, especially the no evidence of metastasis, are good news for your husband.

As I understand it, the purpose of the trial is to see if using radiation can make it possible to give higher doses of Docetaxel than could otherwise be tolerated. This has already been shown to work in treating other cancers.

I hope this helps.
Posted 9/4/2009 4:46 AM (GMT 0)
It also says "within 6 month of surgery" which he is not having
Posted 9/4/2009 11:23 AM (GMT 0)
landbaby,

How long is it expected that your husband will be on Eligard and Taxotere? That's a potent combination and if you add radiation at the same time....ugh. I would do something like that only if I didn't have to worry about going to work every day.

I will say that with a cancer that there is no question that it is aggressive, there is no such thing as over-treatment. I would just hope that the quality of life concerns would be relatively short-term like 6-9 months.

Posted 9/4/2009 12:10 PM (GMT 0)
Welcome, landbaby.  You are among friends - lots of guys who are dealing with prostate cancer and also many family members who want to support their husbands/fathers who are dealing with this disease.  Thank you for taking a proactive interest in your husbands treatment.  It means a lot - I know it does for me.  My wife has been very involved from day one and we have actually grown closer as we have dealt with all the issues you face with this disease.  The advanced guys will weigh in and can give you more specific input but it sounds as if even though your husbands case is agressive there are lots of  options and lots of reasons to be optimistic.  Look forward to hearing from you again as time goes by.  David

Posted 9/4/2009 2:07 PM (GMT 0)
Colin
Note that the mention of surgery is part of a list connected by OR. Apparently this trial is open both as a primary treatment and as a follow-up to surgery.
JoeyG
I re-read the protocol. A part of the experimental procedure is a change in the way that the radiation (IMRT) is done. The standard is to begin with a wide area radiation and then go to more focused radiation. The problem is that this can effect other organs such as the bowel. In the proposed study they will begin with focused radiation and Docetaxel. The idea is that the radiation will make the Docetaxel more effective and that the lack of bowel irritation will allow higher dose rates of Docetaxel. At the same time, hormone therapy will help to immobilize the cancer cells to prevent their spread.
Landbaby
I hope you understand that we are not giving medical advice or trying to second guess your doctors. We are trying to raise issues that you and your husband should consider and perhaps discuss with your doctor. The problem with PC is that there are many reasonable treatment alternatives each having both good points and drawbacks especially in terms of side effects. Unlike other medical conditions where there are very few treatment options this puts a much greater burden on the patient to learn and to come to their own informed decision.
Posted 9/4/2009 3:26 PM (GMT 0)
Hi landbaby,
As you can see by my signature I was an advanced case. After surgery I was offerred a clinical trial with Eligard and Taxotere (docetaxel) and I declined it because it did not include radiation. In fact that study excluded it. I decided to keep control on my side and had Lupron in combination with Casodex, and adjuvant radiation.

I would get a second opinion in your husbands case. I would talk to a surgeon and a radiation oncologist as well. If a surgeon does not want to proceed then the RO will very likely with seeds and external beam supplimentation. I do think starting HT could have benefits prior to radiation.

I know many guys with your husbands numbers that are doing well. A positive attitude is very important. Stay positive.

Tony
Posted 9/4/2009 6:28 PM (GMT 0)
Thank you for all the information regarding my post my husband had his biopsy 2 weeks ago the Urologist called our home to tell him he had cancer and would be starting radiation treatments to shrink the tumor before they would consider operating I was expecting him to set up an appointment to talk to us we were not prepared with questions to ask .He made an appointment with his family doctor and he told him the Gleason score a few days later and that he was being referred to the cancer center for the Eldorado trial. I had the Urologist call here because I found some questions online to ask we then found out how much tissue was involved.He has since had the bone scan on Monday gone and was called 2 days later to book an appointment with the Doctor doing the study.
Everything has been such a rush and my husbands bother just passed away last night from prostate cancer we didn't even know he had it until a few months ago he does not live near us .
If anyone has a list of the right questions to ask the Specialist I would appreciate it , this information is somewhat overwhelming , Oh yes does anyone know where to post the subject ? Thanks to you all.
Posted 9/4/2009 9:44 PM (GMT 0)
"radiation treatment to shrink the prostate before operating" Perhaps you did not hear correctly -- it is generally hormone treatments that are used to shrink the prostate. As a general rule, radiation treatments mess up the prostate to the extent that no surgeon will operate on it because the results tend to be so bad. So, you can have surgery followed (if needed) by radiation but NOT radiation followed by surgery.

My heart goes out to you and your husband to have found yourselves in such a complicated situation. I think you need another independent opinion. A doctor with no connection to the ones you are seeing now. Best would be a prostate oncologist because they are not committed to either radiation or surgery. Second, in my opinion, would be a urologist (surgeon.)

Let me also express my sympathy for the loss of your brother-in-law. Such a loss is hard enough and your husband's situation compounds it. I will keep you and your husband in my prayers.

As far as questions are concerned -- trust your self. You started with the question -- "why not just cut it out?" And that remains a good question. Always ask about side effects and possible follow up treatments. DO NOT be intimidated -- if you don't understand something, ask for a better explanation. It is your doctor's duty to be clear -- especially when pressing for an experimental procedure.
Posted 9/11/2009 1:44 AM (GMT 0)
landbaby

I am a non surgery, proton radiaition advocate. 

First stay positive and as others have suggested do some research. Once you have decided, do it and don't look back.

 My story and journey is on www.gleasonscore10.com

I wish you and your husband the best.

Richard

aka smilingoldcoot

Posted 9/11/2009 2:28 AM (GMT 0)
I was diagnosed with Gleason 8 and coupled with high PSA and family history I was considered "high risk". I belive your husband is high risk as well. I was offered two clinical trials, both designed to reduce the probability of recurrence. The hypothesis is that the reason high risk cancers recurr even when confined to prostate is the micro mets. The systemic treatment to kill cancer is thought to kill those and to make the surgery easier by reducing the tumor size. First trial was a stage 3 trial of HT plus Taxotere, the second was stage 2trial of Taxotere plus Avastin, a drug to prevent formation of capilars that feed tumors. The HT plus Taxotere stage 2 trial that was finished by then had two people whose cancer was completely gone from the prostate. While what you are describing is different, I think the motivation is similar. I join others in sugesting you seek multiple opinions, but do go and listen what the Eldorado people have to say. If nothing else, they will give you more questions to ask other docs. Best of luck in your search for the treatment. Stay cool. This is not the end of the world.
Posted 9/11/2009 10:45 AM (GMT 0)
Thanks for the comments we have been busy with appointments etc
T_ Stage T3a
N_ NX
M_ Stage MO _No _distant _metastasis
Gleason_ score 9
number of biopsy taken 8
number of cores of showing prostate cancer 4
percentage of prostate cancer that was in the surface area of the biopsy 40
PSA level 12.1
Brother deceased last week from Prostate Cancer
CAT scan to determine if it's in the lymph nodes - waiting for available machine -We will then determine what course of treatment to take all treatment depends on it still being confined to the Prostate

We did discuss Eldorado Trial with the specialist he explained the procedure which is purely volunteer it is hormone therapy for a period of months which is to shrink the tumor followed with radiation IMRT daily ( a more localized beam ) and a chemo treatment once a week with minimal sickness & hair loss ( they use a weaker mix of chemo) this is my understanding anyway the trial has been ongoing for 5 years and has been very successful the choice is up to my husband
The second choice offered was hormone therapy followed by radiation therapy
There are no plans to remove the prostate
Posted 9/11/2009 1:22 PM (GMT 0)
landbaby, welcome to you and your husband. no denying, he has a serious case, and with his brother passing recently (may he rest in peace) from PC, it must seem even more scary. please try to keep all these incidents seperate from one another. you have been giving a lot of good advice above.

"there are no plans to removed the prostate"

that statement would only mean one of two things to me. either your husband has other major health issues, and they don't feel like the risk of surgery is worth it. though if you husband is a healthy 68, that should be an issue otherwise. or, it means they feel like his cancer has spread elsewhere outside his prostate, or is likely to. in that case, surgery wouldn't usually be offered.

i would like to re-empathize a point made above, if there is even a ghost of a chance that they may want to do surgery later on your husband, or if you two change your mind and want surgery regardless, do not let them do any type or method of radiation prior to the surgery. salvage surgery is brutal at best, almost always fails, and almost always leaves the patient with perm. ED and incontinence.
A good surgeon would not even offer to do that.

hopefully, your husband will have other legitiamte options. the trial type stuff is over my head, so i have no opinion on that. some of our advanced case brothers have given opinions on that.

i close by saying, sincerely, we are here for both you and your husband. please keep us posted, and we will help in any possible way if needed.

david in sc
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