2 Oncologists disagree on Lupron use... Why ?

I had a prostatectmy.  A little cancer got out of the prostate, but there is nothing in the bones or lymph nodes.  So I need IMRT to the pelvic bed.

I had a consultation with oncologist #1, regarding IMRT at his treatment center.

Not being sure who I wanted to do the IMRT, I had a consultation with oncologist # 2 shortly after having my consultation with oncologist #1.

Oncologist #1 said I should do the IMRT and continue with Lupron for 2 years.  Oncologist # 2 said I should not get any more Lupron shots...just do IMRT.

My urologist said he thought I should not get any more Lupron shots.  I have had 3 Lupron shots so far.

Question:  Why are there two schools of thought on how long I should take Lupron ?

For you all who have had a prostatectmy, how long have you been on Lupron?   Any on it for 2 years after a prostatectmy?

Thanks,

Bob

It is even controversial that you 'need' IMRT to pelvic bed, might be a decent idea or worth gambling, but some docs even disagree on that, although usually endorsed and Lupron usually endorsed above all and any other HT therapies which can also work well and myself have proven that point very well in my own case after failing on ADT3 and doing better on something else for many more years. Just like some docs will argue open surgery is better than LRRP, or Proton radiation is better than Photon (some will say, not me saying these things). Just like some docs will say Joe the local pathologist is just as good as Bostwick, Oppenheimer, Epstein or some docs will say they have just as much experience as Strum, Scholz, Vogelzang, Sartor and other onco-docs whom actually have more years of experiences and patient types already treated.

There is evidence that ADT prior and/or after radiations (especially primary therapy), give patients longer survival times, via abstract studies.

This is PCa, the twilight zone , no definitive rules, no definitive perfection in tests and lots of protocols and ways to try and fight it, comes with no guarantees, the lower the risk patient the bigger the chance for actual cures. You don't have to take my words for it, just look at patient case histories.

Bob,

The most famous study regarding use of HT (3 years compared to 6 months) with external radiation as a primary treatment, for high risk cases, is the Bolla study. It is easy to search and find the report. Without knowing your stats I can't say if that should apply to you, especially since you had a RP. For guys with a RP, you have to decide whether to exptrapolate the Bolla study (and any other similar stuides as well) to your situation based on your risk, surgical pathology report, nomograms, etc. It is not that straightforward and you will get doctors diagreeing on it. For me, it is was more straigthforward decision based on my risk .. use the study results and apply them directly, even though I had the RP. Just my opinion only: if adjuvant radiation is worth doing based on your risk profile, I would add some some duration of Lupron. I think the data is convincing, even when extrapolated to adjuvant radiation.

Bob:  Here is a study that shows 6 months of HT plus RT cuts in half the chances of death by PCa.

http://doctor.ndtv.com/storypage/ndtv/id/5093/type/news/Hormone_therapy_boosts_prostate_cancer_survival.html

The study was based on RT as the main therapy but common sense tells me it would do the same for SRT also.  It's a very recent study

Also if you put your stats into the namograms and add HT to SRT you'll find a higher chance of cure. 

Disclaimer:  Common sense to me may not be the same to someone else.

Good luck

David

MY PSA from Dattoli visit 4.8..... Why would Mayo Surgeon tell me today I did not
need to be on Hormones ......Crazy the differing opinions for guys trying to Kill
PC.....

>I had a prostatectmy. A little cancer got out of the prostate, but there is nothing in the bones or lymph nodes. So I need IMRT to the pelvic bed. For you all who have had a prostatectmy, how long have you been on Lupron? Any on it for 2 years after a prostatectmy?<

I had a prostatectomy Feb of 2007 and have been on Eligard/Lupron ever since. After RRP, doc said that there were micro-cancer cells afield (metastasis), and that RT in the pelvic bed would risk damage for no really good effects. Last year about this time (3 years from RRP) my PSA started rising dramatically. Scans showed nothing. Last August I had some pc invasion of bladder. Got Provenged. More, severe, bladder intrusion---got IMRT to zap pelvic bed resurgent tumor. No adverse side effects from the radiation ('cept fatigue--big deal). No bone mets. THEN....recently I have had MASSIVE bone mets and am now on chemo (Taxotere). Were I to do it all over again (shudder the thought) I would have opted for IMRT shortly after RRP to "kill" the bed tumor from rising and spare me some grief. Hindsight!

142:

Why do you believe the HT would land you on long term disability or unpaid leave.  I haven't heard of any of us who have done HT that couldn't work.  Obviously I'm missing something here.

David

Mel -- are there any SEs from the avodart?

ed

Mel,

You'll just have to trust me on this one. I can't go into detail.

Jerry,

Sarcastic question, of course. It sucks.

David,

It has nothing to do with being able to work. See note to Mel.

Jim,

Tonight I finished the last of a bottle of Duas Quintas, a Portugese Red (from Ramos Pintos, the Port folks). Not as smooth as what we tried, but nice table wine.