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External beam RT and HDR RT + HT for 12 months

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Posted 10/6/2011 12:24 PM (GMT 0)

Hi All,

 I'm trying to target those guys who are on similar treatments as I am, to compare experiences and expectations. 

 My history will be below in my profile and here is my current status.

Diagnosed April 1, 2011

External beam RT - 2 phase method, first phase including pelvic regional nodes, 4 field technique, dose 4500 cGy in 25 fractions, 18 MV photons. Second phase was by high dose rate HDR, dose 950 cGy per fraction. radiation source Ir-192 with treatment prescription based on CT planning technique.

Started June 22, 2011

Ended   July  29, 2011

HDR implants

June 16, 2011

July 21, 2011

My URO recommended 2-3 years of HT.

I convinced my OCO to take me off the HT.

My HDR OCO recomended that I stay on my HT as it's being used as a cure.

I'm into my 5th month of my HT.

Posted 10/6/2011 1:19 PM (GMT 0)
We are in a similar situation. My IMRT protocol was in line with yours and I had two HDR procedures. I started on ADT one month before IMRT started. I am today getting my third Eligard shot and tomorrow is my one year anniversary of treatment starting.

My uro said 2-3 years on Eligard and indefinately on Jalyn. My med-onc says 18-24 months Eligard and indefinately on Jalyn. My rad-onc stays out of the ADT discussion, but says..."you are high risk and you need to hit this hard, do the ADT".

I can stay on the HT for awhile as the se have been tolerable and studies show significant results with this approach. As I see it, the only argument is how long to stay on the ADT. A few doctors, Meyers included, are now only going one year. He used to be three years, then came to 18 months, and now is saying one year in general. My uro uses a SWOG study of a couple of years ago that says 2-3 years is best for advanced cases. My med onc is in the middle. Thus I will do this shot today and next spring we will decide if I go longer.


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Posted 10/6/2011 1:35 PM (GMT 0)

JNF said...
We are in a similar situation. My IMRT protocol was in line with yours and I had two HDR procedures. I started on ADT one month before IMRT started. I am today getting my third Eligard shot and tomorrow is my one year anniversary of treatment starting.

My uro said 2-3 years on Eligard and indefinately on Jalyn. My med-onc says 18-24 months Eligard and indefinately on Jalyn. My rad-onc stays out of the ADT discussion, but says..."you are high risk and you need to hit this hard, do the ADT".

I can stay on the HT for awhile as the se have been tolerable and studies show significant results with this approach. As I see it, the only argument is how long to stay on the ADT. A few doctors, Meyers included, are now only going one year. He used to be three years, then came to 18 months, and now is saying one year in general. My uro uses a SWOG study of a couple of years ago that says 2-3 years is best for advanced cases. My med onc is in the middle. Thus I will do this shot today and next spring we will decide if I go longer.


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Hey JNF,

 We are in a pretty similar situation and thanks for your reply. I think a lot of us are having some difficulty with who to listen to and who to go to for advice on some aspects of our journey. This forum has played a huge role in most of my acquired knowledge.

 As I siad in my opening statement, my URO recommended 2-3 year of HT and my main OCO allowed me to opt out of it, while my secondary OCO(whom I trust the most) recommended, although he did not want to override other professional opinions, at least 12 months inorder for my treatment to be successful.

 As for SE, I'm beginning to tolerate the hot flashes and I am sleeping better, BUT I also want my sex life back and that's my biggest concern right now, next to beating this crap! I also don't like the other SE for long term HT and feel as though it maybe overkill, but then again?

Posted 10/6/2011 5:16 PM (GMT 0)
Glenn,
I had 4500 gy of IMRT and 8500gy of low dose Brachy and was on HT(Casodex) for 9 months. So far the resuts have been exellent in all areas. There is a lot of disagreement as to how long a patients should be on HT, with 2 years being the standard. Lately as JNF as mentioned there are many doctors that think that 1 year is sufficient. I think the agressiveness of the cancer would dictate the time on HT with the higher risk cases going longer and the intermediate risks going for a shorter period.
Posted 10/6/2011 5:24 PM (GMT 0)

John T said...
Glenn,
I had 4500 gy of IMRT and 8500gy of low dose Brachy and was on HT(Casodex) for 9 months. So far the resuts have been exellent in all areas. There is a lot of disagreement as to how long a patients should be on HT, with 2 years being the standard. Lately as JNF as mentioned there are many doctors that think that 1 year is sufficient. I think the agressiveness of the cancer would dictate the time on HT with the higher risk cases going longer and the intermediate risks going for a shorter period.

 

Hey John T,

  I'm curious, you're only doing the Casodex and not the Lupron? And in all fairness to the right length of time to be on HT, why be on it for any amount of time beyond the radiation in your system. The HT itself will not destroy the cancerous cells, only starve them for a period of time!

 

GlennK

Posted 10/6/2011 8:27 PM (GMT 0)
Glenn,
The HT will destroy cancer cells; it is excellent at destroying cells that are androgen dependent and have not yet mutated to an androgen independent stage. HT will shrink the prostate making radiation more effective; more dose to a smaller area means more killing power without more side effects. HT will also kill cancer cells in the blood stream that have not yet set up in permanent place so they can grow. The main reason I went on Casodex was to shrink the prostate and because it kills some cells and changes the dna of other cells to make the radiation more effective. I had a low probability of systemic spread so I was not worried about killing cells in other parts of my body. If I were a higher Gleason grade or indication of systemic disease then I would have done Lupron along with Casodex for at least a year.
There is a common misconception that HT will not kill cancer cells. Liebowitsz has proven that a 13 month protocol of HT for low risk patients will effect a cure in 93% of patients. Scholz has indicated that 30% of his intermediate and high risk cases show no signs of cancer after one year on HT. There are certaintly some strains of PC that resist HT, but not all. There are some strains that over time will mutate to form resistance to HT and an early application of HT will kill these before they have a chance to mutate. It is well accepted that HT will kill cancer cells and some other cells will resist HT. The only disagreement is how long the protocol should last. There is a recent trend to reduce the time period to around 1 year, but this is still a contraversial issue that no one really knows the answer to.
JT
Posted 10/6/2011 8:48 PM (GMT 0)
Glenn -- i did HT (9 months), BT and IGRT.  i'm sure you've heard the expression:  "dead men don't have sex"?  you're at the point in your hormonal therapy where everyone wants it to be over.  hit it hard, dude.

ed

 

Posted 10/6/2011 9:49 PM (GMT 0)

John T said...
Glenn,
The HT will destroy cancer cells; it is excellent at destroying cells that are androgen dependent and have not yet mutated to an androgen independent stage. HT will shrink the prostate making radiation more effective; more dose to a smaller area means more killing power without more side effects. HT will also kill cancer cells in the blood stream that have not yet set up in permanent place so they can grow. The main reason I went on Casodex was to shrink the prostate and because it kills some cells and changes the dna of other cells to make the radiation more effective. I had a low probability of systemic spread so I was not worried about killing cells in other parts of my body. If I were a higher Gleason grade or indication of systemic disease then I would have done Lupron along with Casodex for at least a year.
There is a common misconception that HT will not kill cancer cells. Liebowitsz has proven that a 13 month protocol of HT for low risk patients will effect a cure in 93% of patients. Scholz has indicated that 30% of his intermediate and high risk cases show no signs of cancer after one year on HT. There are certaintly some strains of PC that resist HT, but not all. There are some strains that over time will mutate to form resistance to HT and an early application of HT will kill these before they have a chance to mutate. It is well accepted that HT will kill cancer cells and some other cells will resist HT. The only disagreement is how long the protocol should last. There is a recent trend to reduce the time period to around 1 year, but this is still a contraversial issue that no one really knows the answer to.
JT

 

Hey JT,

 I'm not sure I totally agree with your HT theory......if HT alone can kill cancer cells then why bother with any ratiation. There are other theories out there as well, like the on/off HT. Like I said earlier, it's a tough decision on who to believe most days.

 

GlennK

Posted 10/6/2011 9:51 PM (GMT 0)

F8 said...
Glenn -- i did HT (9 months), BT and IGRT.  i'm sure you've heard the expression:  "dead men don't have sex"?  you're at the point in your hormonal therapy where everyone wants it to be over.  hit it hard, dude.

ed

Hey Ed,

  How why were those 9 months, and why 9 and what were you on? and what is BT?

GlennK

Posted 10/6/2011 10:28 PM (GMT 0)
Glenn -- i gained 30 lbs while on HT, had no interest in sex, had hot flashes and night sweats, lost most of the nether hair on my body, slept 10 hours a day, was depressed and teary .... but other than that it wasn't too bad cool .  six to nine months is what my doctors recommend for gleason 7.

better than death for sure.  we're on a heroe's journey, my friend.  time to buck up and hit 'er hard

BT is brachytherapy, which unlike the treatment you will be receiving is permanent radioactive seeds implanted in my prostate.

ed

 

Posted 10/6/2011 10:40 PM (GMT 0)

F8 said...
Glenn -- i gained 30 lbs while on HT, had no interest in sex, had hot flashes and night sweats, lost most of the nether hair on my body, slept 10 hours a day, was depressed and teary .... but other than that it wasn't too bad [img]/community/emoticons/cool.gif[/img] . six to nine months is what my doctors recommend for gleason 7.
better than death for sure. we're on a heroe's journey, my friend. time to buck up and hit 'er hard

BT is brachytherapy, which unlike the treatment you will be receiving is permanent radioactive seeds implanted in my prostate.

ed

wow you did suffer......what's the difference in BT and HDR implants?......did your sex drive return? I don't mind bucking up and hit'er hard as long as it's necessary....LOL
Posted 10/6/2011 11:44 PM (GMT 0)
Needless to say, Fairwind is reading all this with great interest....
Posted 10/7/2011 1:18 AM (GMT 0)
Glenn -- when your testosterone comes back you feel like the incredible hulk with and erection cool .  seriously my sex drive is back.  the flesh however needs a little more coaxing but 10mg of cialis does a pretty good job usually.

ed

Posted 10/7/2011 1:20 PM (GMT 0)

F8 said...
Glenn -- when your testosterone comes back you feel like the incredible hulk with and erection cool .  seriously my sex drive is back.  the flesh however needs a little more coaxing but 10mg of cialis does a pretty good job usually.

ed

Thanks Ed......that's the stuff I want to hear.....can't wait

Posted 10/7/2011 1:21 PM (GMT 0)

John T said...
Glenn,
The HT will destroy cancer cells; it is excellent at destroying cells that are androgen dependent and have not yet mutated to an androgen independent stage. HT will shrink the prostate making radiation more effective; more dose to a smaller area means more killing power without more side effects. HT will also kill cancer cells in the blood stream that have not yet set up in permanent place so they can grow. The main reason I went on Casodex was to shrink the prostate and because it kills some cells and changes the dna of other cells to make the radiation more effective. I had a low probability of systemic spread so I was not worried about killing cells in other parts of my body. If I were a higher Gleason grade or indication of systemic disease then I would have done Lupron along with Casodex for at least a year.
There is a common misconception that HT will not kill cancer cells. Liebowitsz has proven that a 13 month protocol of HT for low risk patients will effect a cure in 93% of patients. Scholz has indicated that 30% of his intermediate and high risk cases show no signs of cancer after one year on HT. There are certaintly some strains of PC that resist HT, but not all. There are some strains that over time will mutate to form resistance to HT and an early application of HT will kill these before they have a chance to mutate. It is well accepted that HT will kill cancer cells and some other cells will resist HT. The only disagreement is how long the protocol should last. There is a recent trend to reduce the time period to around 1 year, but this is still a contraversial issue that no one really knows the answer to.
JT

 

 

https://www.healingwell.com/community/default.aspx?f=35&m=2229492

Posted 11/8/2011 3:28 PM (GMT 0)

Had my third Lupron 3 month injection today and one more to go. DRE exam was good and my PSA level is <0.03 and T level 1.66 L. I did request another perscription of Imovane, as it works wonders for getting a good night sleep(which is the only complaint I have from teh SE hot flashes)

Posted 11/8/2011 3:42 PM (GMT 0)
One year so far on Lupron. I just "signed up" for another 6 months of Lupron (injection on 11/1) which will take me to 18 months. My rad onc recommends 3 years. I cannot get my head around 3 years. I am sort of at peace with making through 2012 on HT for 2 years total. My argument to him will be surgery + adjuvant external radiation (including whole pelvic/lymph nodes) + 2 years of adjuvant HT = very aggressive. I want to test the waters after that.

I am aggressively managing the HT SEs and seem to be successful so far on that point.

Posted 11/8/2011 4:16 PM (GMT 0)

GlennKavanagh said...

Hey JT,

I'm not sure I totally agree with your HT theory......if HT alone can kill cancer cells then why bother with any ratiation. There are other theories out there as well, like the on/off HT. Like I said earlier, it's a tough decision on who to believe most days.

GlennK

Glenn,
It kills androgen dependent cancer cells, but not the portion that are androgen independent that might be present. That is why HT is not considered "curative" and RT is needed. BTW, JohnT mentioned that in his post.

RalphV
Posted 11/8/2011 5:02 PM (GMT 0)
Glen,
As doctor Strum explained it radiation is very volume dependent. You can fry an ant with a very small dose, but it takes a much higher dose to kill a cockaroach. HT is used to shrink the tumor volume so radiation will be more effective. If systemic disease is suspected a longer time period on HT is used to kill the cancer cells in the blood stream and lymphatic system that have not yet turned into tumors. The success of HT is also tumor volume related; this is why a lot of doctors suggest early HT while the tumor burden is still low as it is more effective and will kill dependent cells that have not yet had a chance to mutate into independant cells.
JT
Posted 11/8/2011 8:11 PM (GMT 0)

John T said...
Glen,
As doctor Strum explained it radiation is very volume dependent. You can fry an ant with a very small dose, but it takes a much higher dose to kill a cockaroach. HT is used to shrink the tumor volume so radiation will be more effective. If systemic disease is suspected a longer time period on HT is used to kill the cancer cells in the blood stream and lymphatic system that have not yet turned into tumors. The success of HT is also tumor volume related; this is why a lot of doctors suggest early HT while the tumor burden is still low as it is more effective and will kill dependent cells that have not yet had a chance to mutate into independant cells.
JT

Thanks JT & RalphV.....that's more knowledge then I'd ever get locally and something to remember.

GlennK
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