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HT FOR THE REST OF MY LIFE??? YES OR NO!

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Posted 11/3/2013 12:04 AM (GMT 0)
Hello everyone,

Yesterday (Nov. 1st), I went for my monthly HT injection.  I ask the nurse if and when I could take a rest from my HT, she looked at me in such a pitiful face and said "NO" shakehead ......

Well, it could be a lot worst and I'm still very thankful for the HT injections because it's still doing its job. 

On my FB page, everyone's telling something that their very thankful for during the month of November.  I have a long list.  I've very thankful for my family and my faith in God!

Dave in Bartlett, TN

Posted 11/3/2013 12:51 AM (GMT 0)
Actually, Grandpa, maybe it is worth getting a second opinion?

Are you seeing a top medical oncologist specializing in PC?

You are doing so well with HT. Maybe you can get a vacation?

I know if my February tests are good, it will be vacation time for me. I wonder what the protocol is?

Maybe G9 gets no vacation? Or due to mets? It wouldn't hurt to ask

Mel

Posted 11/3/2013 1:33 AM (GMT 0)
That is much to be thankful for! It looks like the HT is controlling well, and that's great. Rock on!
Posted 11/3/2013 2:15 AM (GMT 0)
compiler: Right now, I'm still with my urologist. Last November, I did see a top medical oncologist specializing in PC. He told me that my urologist was doing a great job and agreed with his treatment starting out. He told me when my current HT went refractory, he'd take over.

Yesterday, I mention to my nurse about the refractory issue, she also said the urologist would turn me over to my medical oncologist. Monday, I'll be seeing my urologist again and will ask him.

Redwing57: Yes, the HT is doing its job and a very good job.

Dave in Bartlett, TN
Posted 11/3/2013 2:57 AM (GMT 0)
Dave,

You said:
I've very thankful for my family and my faith in God!

I agree with you fully. Those are the two things I am always thankful for, and what keeps me going in my life and PC journey. Without those, I would be nothing, and have nothing.

David in SC
Posted 11/3/2013 3:21 AM (GMT 0)
Dave,
If you reach a consensus on your hormone therapy there is a way to avoid the shots. I know quite a few men that have had the orchiectomy. There were glad they did. Most of them were older than you however.

Dave I am an ecclesial lay minister and teach adult education courses on Tuesday nights at our Parish. I am on my fifth year of it. I was commissioned just this last June by the Bishop of Las Vegas. This year I am teaching 5 Jesuit courses. I have completed two years of formal training from a Loyola professor. And I am enrolled in the University of Notre Dame STEP program. I had to postpone my first course because of the conflicts with the other work I do in my off hours. If I choose, I can complete my deaconate training in three years but I don't know that I will. It would take me away from my work in the cancer front and I don't want to do that. At least not anytime soon.

May peace always find you and keep you, sir!

Tony
Posted 11/3/2013 3:41 AM (GMT 0)
G 9, bone met guys can have a vacation....I've been on one for close to a year...but I would definitely discuss options with your medical oncologist.
Posted 11/3/2013 3:49 AM (GMT 0)
It is possible at any time to take a vacation. The idea of a 100+ PSA guys with mets from head to toes is reasonable. But I do know a few guys that have done it after having terrific results on HT.

Shall I mention Todd? PSA 3200+.

Tony
Posted 11/3/2013 5:35 AM (GMT 0)
Dave,
With all due respect to Tony's comments on consideration of having an orchiectomy, the SE's would be the same and a vacation would no longer be possible. Many men to include myself consider the concept abhorrent and not necessary. If the shots bother you possibly the frequency could be extended.
You are responding very well and I wish you the best; I agree with Mel's comments..Thanks for the support you have continually shown all members! Bill or "Older Gramps"
Posted 11/3/2013 6:27 AM (GMT 0)
Bill,
I started a new thread on the topic of Orchiectomy. I certainly am not recommending the procedure, but the new thread will help folks understand it's use in prostate cancer therapy.

Tony
Posted 11/3/2013 9:58 PM (GMT 0)
The Hussain study proved that there is a significant survival advantage to continuous hormone therapy over intermittent hormone therapy when there are known bone mets. She also showed that there was no perceived quality of life advantage after a while.

But that's the average case. Each man has to decide for himself what's best for him, and whether an ADT vacation will improve his quality of life.

- Allen
Posted 11/3/2013 10:54 PM (GMT 0)
I have consulted with Hussain. She emphasized that my situation (no mets on imaging) means that study is irrelevent for me and she did recommend intermittant.

You are right that in Grandpa's case, the study suggests continuous HT. But it only gives a slight advantage.

Did she really say the quality of life is the same? That can't be!

Mel

Posted 11/4/2013 12:04 AM (GMT 0)
Mel,

Myers told me pretty much the same thing...

Jerry
Posted 11/4/2013 12:06 AM (GMT 0)

Mel,

Take a look at the QOL results in Figure 2 in the Bolla study (link below) comparing 6 months of ADT to that of 36 months. It is a non-intuitive result but supports Dr. Hussain's comments on QOL not being different after a while. In the study the overall score was not different between the two groups while some of the components QOL items were different.

SC

http://www.nejm.org/doi/full/10.1056/NEJMoa0810095#t=articleResults

Posted 11/4/2013 12:14 AM (GMT 0)
A lot of this discussion is more relevant to my newest thread on Orchiectomy than it is to Grandpa whom is responsive to HT. Either way, the Hussain study is disputed by traditionalists that say chemical HT is better.

I'm not not really sure based on those that had bone mets and achieved remission. Certainly is a zero PSA is unattainable then surgical removal makes a lot of sense. Unless the patient wants children.

Tony
Posted 11/4/2013 12:40 AM (GMT 0)
Thanks guys for all your help and input to my question. Unless something else comes down the pike, guess I'll just stay on 100% HT.

You guys are awesome.

Dave
Posted 11/4/2013 12:41 AM (GMT 0)
Mel, you're right that her study only showed a 10% survival improvement overall for continuous HT, which did not meet the 20% threshold that the study was designed for. I looked at her subgroup analysis. The survival difference was about 1 1/2 years for those who had minimal disease, but was only 6 months favoring intermittent (not statistically significant) in those who had extensive disease. Based on that subgroup, grandpaof4 will probably have about the same survival either way.

Hussain said...
Intermittent therapy was associated with improved erectile function and mental health at 3 months but not thereafter...At 9 months after randomization, the scores for four of the five quality-of-life outcomes favored intermittent therapy over continuous therapy, but at 15 months, only physical functioning scored higher in the intermittent-therapy group; none of these differences were significant at the prespecified level.

She does mention that there were wide variances in these measures, so individuals may react differently from the average.

I think that for this group T recovery after the "on cycle" gets progressively slower, especially as castration resistance sets in. Perhaps it's also partly due to acclimatization to the new normal.
Posted 11/4/2013 12:49 AM (GMT 0)
Tall

But again, the cohort consistent of folks with Mets.

Mel
Posted 11/4/2013 12:53 AM (GMT 0)
There is another issue. Folks on long term HT, over one year, do have a greater risk of heart disease and diabetes. This may be discounted in the study. I can have a good QOL and drop dead with a heart attack.

Incidentally, according to Dr. Lam, it is really the weight gain due to HT that causes the other problems.

Mel
Posted 11/4/2013 12:55 AM (GMT 0)
Thanks guys for all your help and input to my question. Unless something else comes down the pike, guess I'll just stay on 100% HT.

You guys are awesome.

Dave
Posted 11/4/2013 3:09 AM (GMT 0)
Mel- Yes- only men with mets - that's what I said and why I mentioned it here where it is relevant.

As for cardiovascular events, all the research I've seen has been on men with non-metastatic disease. In the 8 randomized clinical trials, none have shown any association between ADT and death from cardiovascular events:
Association of Androgen Deprivation Therapy With Cardiovascular Death in Patients With Prostate Cancer:A Meta-analysis of Randomized Trials

However, several database analyses among non-metastatic men have shown an association. Why there should be an association but not a causal link, I can only conjecture.

Because of the increased risk of Type 2 Diabetes, I think it is a good idea for men on ADT to take Metformin. Metformin has been associated with a PC survival benefit in men with Type 2 diabetes. There is a clinical trial in the works to confirm this.

While ADT in non-metastatic men may be controversial, the survival benefit for metastatic men is not.

- Allen
Posted 11/4/2013 3:11 AM (GMT 0)
I am G9 (4+5) with bone mets. Initially I was given a 24-month sentence on Lupron that would take me to March 28,2015.

I am assuming at that point that IHT may be an option rather than that my medical oncologist was only spoon feeding me the bad news 24 months at a time.

Theoretically the 5 bone mets I have and the prostate itself is shrinking as a result of the Lupron so that at 24 months, we can also look into surgery or various flavors of radiation.

Of course the big IF is whether I remain testosterone resistant for those 24 months. If not, several other options would come to the forefront.

LupronJim
Posted 11/4/2013 3:15 AM (GMT 0)
Jim:

When do you get your next PSA test?

My doctor has me do it about every 3 months.

Tall-- Dr. Lam has indeed added metformin to my regimen. Just started on it yesterday

Mel

Posted 11/4/2013 3:20 AM (GMT 0)
I have been taking Metformin for the past year+.

Jim- Here's hoping that you'll have that option (iht) down the road...
Posted 11/4/2013 3:41 AM (GMT 0)
My next appt with UF & Shands is Nov 12th.

When I was on vacation in San Jose CA for a couple months I had PSA readings at Quest and at Labcorp that showed lower values ( think one was 0.40 and another 0.20) but UF & Shands only goes by their tests to keep the assays constant. On 8-8-13 it had declined from 3.68 to 0.68 on the Shands PSA testing. So I should probably change my signature to those metrics.

I am hopeful my PSA continues to decline before it nadirs out, even though PSA other than doubling time has not been a very reliable indicator for me.

If not, I intend to ask my medical oncologist about Avodart or Casodex to attack the testosterone from the other direction, in addition to what the Lupron does.

LupronJim
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