Question to ask about hormone therapy

Robotic removal on 04/17/13, Gleeson 9, cancer had spread into the lymph nodes although scans prior to surgery showed it had not spread. CT and Bone scan. My surgeon has set me up an appointment with an oncologist to discuss hormone therapy. What questions should I plan on asking the doctor? My appointment is in Atlanta tomorrow, so I know this is short notice. The questions I have written down already are:
1. Why hormone therapy over other treatments?
2. Prognosis?
3. What are signs the hormone therapy is working or not working?
4. If hormone therapy does not work, what is next?
5. How do you (the doctor) decide what drug to try?

48 years of age
Prior to surgery I worked out 5-6 days per week at gym
Controlled diabetes
Law Enforcement

So Ga Patient,

Since you are in the Atlanta area, I wanted to tell you about a unique option there. Dr. David Schuster at Emory University has pioneered the use of a new tracer for PET scans called FACBC. In early trials, it seems to be able to detect even very small amounts of extra-prostatic cancer - cancer that has traveled outside of the prostate already. If you can detect the lymph nodes or other places to which the cancer has traveled, you may be able to pick them off with SBRT (short treatment, high-intensity, highly targeted radiation).

Bone scans are pretty much useless for detecting small amounts of cancer. Some of the other kinds of PET scans like NaF18, C11 Acetate, and C11 Choline are better, but the FACBC may be even more sensitive than those. It may be worth enquiring into as you decide about next steps.

- Allen

Tall Allen,
I am actually in Southwest Georgia, 15 miles north of the Florida line, so it is about a 5 hour trip to Emory for me. I will inquire tomorrow about Dr. Schuster and may make an appointment with him before deciding which route I will go. Thank you very much for the info.

Casper319,
I have added the question about side effects to my list. I also plan to ask about the Radiation treatments. Thank you for the info.

Wayne

So Ga,

Also sorry you have to be here to ask your questions, and I can only speak from my experience, that may not be applicable to your situation, and is DEFINITELY not a medical opinion.

I was given Casodex (Bicalutamide) as soon as I got my G9 biopsy result and was being scheduled for a bone/ct scan. The Uro said it (Casodex) would not affect any future treatment options for me and could be stopped whenever. At the time I didn’t understand that it was common to start Casodex a minimum of 10 days prior to getting a Lupron (leuprolide) shot, because it helps mitigate the “flare” effect of the Lupron.

During a subsequent visit with a second opinion Onco at Sloan, said she would have started my on Firmagon for the first few months, rather than Lupron, for two reasons: 1) it does not have the “flare” effect of Lupron and 2) tends to act faster at driving down your PSA. I think this was more critical for me because of my bone mets, and may not be such for you.

IF HT is where you end up going to, you might want to ask about the benefits of Firmagon (degarelix) vs. Lupron, given your situation. PSA and T (Testosterone) tests will give a good indication of the HT effectiveness for chemical castration. I have seen info where HT is used to temporarily to stop/shrink tumor growth, prior to other treatments such as radiation, maybe that is their game plan, and you need to know this. For long term HT, I think a lot of doc’s tend to go with Lupron because you can get this treatment once every 3 to 6mo vs. I think 1 mo. for Firmagon.

In my opinion you are doing the right thing by educating yourself and preparing your questions in advance. Best of Luck and get some sleep (if you can)!

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