Preparing for hormone therapy

I will be starting hormone therapy in the next few days prior to beginning radiation (with the specific protocol TBD). First, Casodex with a Lupron shot about one week later. Dr. Lam here in the LA area is my oncologist.

What can I be doing to prepare myself and to help cope once I begin? I'm 5' 10" and about 185 pounds (down from 200 about a year ago), so still somewhat heavier than I should be and, overall, I'd say I'm in decent but not great shape. I walk regularly, but that's the limit of my exercise. I eat better than most, with lots of fish and vegetables, but I know there's tons of room for improvement. I have borderline high blood pressure.

I've never been a workout kinda guy, but is now perhaps the time to start? Perhaps check in with a nutritionist? I did start taking supplements after my diagnosis: Vitamin D and C, calcium and fish oil. Not sure if there's any help to be had with hot flashes and some of the other symptoms, but I'm all ears if there is.

I'm sure this info is out there on this forum, but I didn't have any luck searching.

Michael

Michael_T,

A few tips from my perspective (I have been on ADT for 2 years now):

• Get into a regular exercise routine that includes both cardio and resistance exercises. Resistance training helps avoid muscle mass loss that can occur with ADT. If you can afford it, I recommend you get a personal trainer. Make it your goal to increase muscle mass despite ADT.
• Pay attention to your bone health. If I had it to do over, I would get a bone density scan at the beginning of my ADT. At least make sure you are getting plenty of dietary calcium. If a bone density scan shows any issues, take more appropriate action. Dr. Lam is big on this. I am sure he will cover it with you.
• Of course, eat healthy.
• For hot flashes, get a fan or two for the bedroom. Start wearing lighter clothing.
• ADT will negatively affect your libido and likely cause ED issues. Resolve now to deal positively and proactively with these issues. For me: I still like sex just fine despite low/no testosterone. However, the desire for sex starts in my head .. my brain. It is mind over matter on this point. Start thinking about your ED strategy .. pills, trimix, pump.

This is all that I can think of at the moment.

SC

Michael,

I went on HT a little over a month ago (no Casodex). I had gotten myself down from 212 to 167 in August with heavy walking (NO LESS than 4 miles a day, except for GFMPH weekend), and some exercise (pushups, situps, etc) for a half hour a day. Since then, I have upped the walking to at least 5 miles a day, tried to limit portions, and dropped some food items altogether. BUT, I am back up to 186. I can literally see my waistline expanding. I think I can gain weight without eating anything now.

Get busy.

I am taking Vit. C & D3/calcium at doctor's orders (to help combat the Lupron bone loss). Also Fish oil, but be sure it is the omega3 only, as the omega6 is supposed to be bad for us PCa guys. The fish oil is not Dr. ordered.

I thought I was starting the hot flashes a couple of weeks ago, but that was only a warning shot. They are in full bloom now. I'm changing sheets on the bed almost daily now, and a sports shirt is good for half a day if I'm lucky. I'm considering what to do about those.

My IGRT daily "journey" is linked in my sig. Fatigue was a big issue for me.

Seems D3 is absorbed much better than just D, the blood test is OH25 for specific results on what level you are actually at. Talk to Dr. Lam about what to use to diminish the fun side effects of fatigue, weight gain, bone loss, memory loss....ask about using megace, effexor, soy, etc's, or estradiol patches and other things than can assist the negatives of ADT2 combo. I did ADT3 for 2 yrs. without any counteracting drugs, after 2 yrs. was fed up with the hot flashes/sweats and more (plus was losing psa war on it 2004)....fixed that fast using DES another type of estrogenic drug. You will not be the same guy using ADT as you were prior, but that is PCa in general. You can endure this stuff, just won't be fun.

MichaelT,

So sorry you have to start HT but if you consider the alternative you can deal with it.
One thing we hadn't done prior to starting HT was some baseline tests such as Testosterone, vitamin D, measure DHT, bone density and doing ultra- sensitive PSA, but am certain Dr. Lam will discuss these things with you.
My husband is fairing O.K. on HT and he will complete 1 year on it in Dec. which at that time he will try being off until or unless his PSA starts to rise.
I echo all of the above mentions and will add you may be perplexed at times, but that should pass when you are off if you are doing intermitten HT!

Good luck!
BOOGEE

I started HT about 5 weeks ago... So far so good. No sides. I've stepped up the workout. 40 minutes cardio on an elliptical machine and 20 min on a bow flex. I try to every day... But usually average 6 days a week. As for diet... I started tracking what I eat and track steps with a pedometer. Site is fitbit.com. Im working on the principal of calories in have to be less than calories burned each day. I know it might be hard to keep it up but it does make me feel better. I don't have much control over anything else. As for supplements... Calcium... 1500 mg, vit D 1000 u, vit E 400 u. I have a bone density test this week as a base line... Some recomendations may come out after I get that. The vit E is an early strike for the hot flashes BTW.
So far so good... As for my relationship with my wife... Everything is chugging along fine. Need I say more.
I don't know if this helps but I'm only a bit ahead of you and doing fine so far.
Let's hope it stays that way.

Michael, when you check the gym, see if there are any trainers who will work with you to develop a personalized program for you. It will probably cost a few dollars to pay them, but will be well worth it to anyone who isn't a gym rat and feel out of place there. (I was that way, spent $50 with one, who showed me the ropes and developed a plan for me, plus helped me thru the first couple visits. Not a bad deal at all..)
They can help you develop a routine that will be effective and workable for you. Good luck.

Michael_T,

I went through the same regime. My formula is exercise, exercise.  I like to walk, so most days I was walking or hiking 1-2 hours a day.  Many days a lot more hours. Some weights for tone, cut back on the carbs, swimming no good (not weight bearing), a drink now and then (if you drink) for morale, vitamins of dubious value -- no evidence. Keep moving.  Loss of libido and hot flashes inevitable.  Sex and sexual interest become a remembered country.  Kind of oddly funny actually.  What was all the fuss about?  "This is another fine mess you've gotten us into," said Ollie to Stan.  Hot flashes vary -- lots of expereince on this Board.  My wife and some friends have been through chemo --  from seeing that, I would say that is much worse.  You will get through.  Best wishes!

Newspaper Lover

Age 68

DaVinci surgery 11/09. Clean margins, clean seminal vessels.

Rising PSA noted 06/11

Gleason 8

Time to recurrrence 18 months

Three month doubling time (summer 2011).

PSA rose from .07 on 06/11 to .17 on 11/11.

MRIs and bone scans negative so far.

Started hormone therapy (Lupron/Casodex) 12/11

Began radiation (SRT) 02/20/12.

Finished SRT 04/16/12

Last Lupron shot 03/12

PSA and testostorone "undetectable"  07/12

Next PSA and testostorone test early January

Michael T--I've been reading your posts and journey with interest. Although your stats are somewhat similar to mine, I've been quiet since I didn't want to influence your decision since I'm hardly an expert and there are so many options..Yes, I went with radiation also since hospitals scare me and during the initial consult--10 minutes--the urologist was "pushing" surgery and "open" at that with the nerves gone...I had to ask about radiation and was informed that the facility I was at didn't do that!! Well, anyway I got all my records and went elsewhere..I didn't rely or talk to experts but did my research myself utilizing the library reserved for Doctors and medical personnel and made my decision. You are young and have chosen the least invasive form of treatment..
Some of the members here continue to work while going through treatments and even with lupron. You have had excellent advice from this forum's members but it's for you to decide what your path will be..example: instead of joining a gym why not walk more since you enjoy it so much? Instead of burdening your wife too much with details just have a 1 time discussion about what you can both expect--try to keep it light since you are well educated and I assume she is also..In my case my wife has MS and I didn't want to burden her too much..Her comment was that I wouldn't have to shave as often and my beloved sister said I would grow "boobs"...How could I top that!!
My major problem with lupron is the emotional highs and lows that I am experiencing--I've been on it for 2 years now..In some ways it's a benefit--my wife and I are very close since I am experiencing emotions that I never knew existed..My doctor took my viagra away and said I wouldn't be needing that--he's right and at my age sex is a fond memory...It may be different at your young age!!!!!!!! Yeah, fatigue is a problem but a good, brisk walk always helps..Good luck to you.
Bill
DX's sept 2010--psa 4.89 w/5 g8's and 4 g7's out of 10 cores with high volume and ece..imrt (79.2 g's) completed in feb 2011--after rads psa .06 and now <.03..1 year left on lupron--a "seasoned" age 70 now.