Intermittent HT for advanced high risk PCa

I was told today by my Uro today that intermittent HT was not an option in my case. Thoughts?

Cheers, Doug

It's complicated. Maha Hussain did an important study on this issue on men with mets (M1). Directionally, she found that men with mets did about 10% better with continuous than with intermittent ADT. However, because of the sample size/statistics, she couldn't rule out "non-inferiority" - the difference was not statistically significant.

In sub-group analysis, she found that among men with minimal disease, men on continuous therapy lived 30% longer; men with more extensive disease lived 11 % longer on intermittent therapy - however, none of those differences were statistically significant. She defined minimal disease as confined to the spine, pelvic bones, or lymph nodes, and extensive disease was disease present in the ribs, long bones, or visceral organs. I'm not sure which sub-category you fall into. So most oncologists just scratch their heads and say, like yours does, that for men with mets, continuous might be better.

Here's her study, if you want to scratch your head too:
Intermittent versus Continuous Androgen Deprivation in Prostate Cancer

Her study did not include the effects of docetaxel, or of the new generation of hormone therapies.

- Allen

Dr. Myers and Dr. Strum seem to recommend IHT, if the PSA can be brought to undetectable levels for at least 12 months for any PC patient. My father's oncologist also mentioned that in his view, IHT for patients who can maintain <0.1 for a year while on HT, can potentially prolong the time to hormone-resistant disease. He did say that formal studies have to be done to prove this explicitly, but he was making a case based on his understanding of cell biology and the fact that continuous HT would force surviving cancer cells to adjust sooner and find alternative ways to feed themselves.

Not a black-and-white answer, but I guess nothing is when it comes to most medical questions.

Arthur

G9, failed surgery, 90 day PSADT, distant mets...........you need to knock the dog snot out of it. ADT3 and docetaxel as a start....then Provenge, Zytiga, etc.

Get the best medical oncologist that has great success with ultra high risk PCa. This is now past the urologist in my opinion.

We have similar issues as Canadians. I inquired to my Uro about Chemo/HT combo - I get my first Eligard shot Dec.17. He said that he does not want to use Chemo at this time. During my consult with a Radiation Oncologist, he stated it is not in Canadian protocol to use HT/Chemo, so that is why its not being promoted for me. He did however now refer me to a Chemo Oncologist to try and get me all options possible - possibly go to a trail in Canada that is doing Chemo/HT therapy - if there is one - go to the U.S and get Chemo (cost issue maybe). But at least he tried to get me some way to consider the chemo option. My Uro offered no suggestions, and he was educated and trained in the U.S. Thought he might speak of options, although with due respect to him, perhaps he does not think the Chemo/HT is the right way to treat me. I am G9, PSA125, bone mets pelvis,2 spine, 2 rib,one small spot on right lung. My Uro is considered the BEST in my area of Canada and I do have great respect for him - but I seem to continue to find positive reports about the Chemo/HT that I am stuck worrying that I should go that way or not. I have read other members comments stating its the way to go.
What I am wondering - is HT/Chemo standard protocol for advanced prostate cancer in the U.S.A or must you push hard and find someone who will give it to you? I know the cost here for Eligard - $1500 for 3 month shot, but have no idea the cost of the Chemo if you get the Chemo/HT option.
Best of luck Shaba.Doug and to all members!

Doug, just want to say whatever you decide over the weekend, my thoughts are with you, and it's good that you are thinking this through in a methodical way.
Obviously this stuff is way beyond my scope of knowledge at this point, so I'll refrain from giving any opinions (not that I have any)

But know that my thoughts are with yoy

Hello !

I was diagnosed over a year ago with metastatic prostate cancer.  My initial PSA was over 100, with metastatic nodules in both of my lungs from the prostate cancer.

I was started on Lupron hormone shots immediately.  Those Lupron shots completely cleared up the lung nodules within a few months, for which I was grateful.   The Lupron shots also brought down my PSA score to a low decimal level. 

I have been told that the Lupron shots will continue for me indefinitely, for my case, since I had metastatic prostate cancer at diagnosis. 

Meanwhile, I  recently qualified for the new protocol of adding chemotherapy  (Taxotere) treatments to the Lupron hormone shots.  I just recently completed the six rounds of chemotherapy treatments.  These were given every three weeks, over the course of a total of eighteen weeks.  It's important for me to say that the chemotherapy treatments added to the hormone shot treatments lowered my PSA number down even further, to less than 0.10, for which I was thankful.   I was fortunate that my side effects from the chemotherapy were relatively mild, and I was able to go to work each day.   It's important to state that side effects from chemotherapy can vary widely from patient to patient, however.

Originally, I was under the care of my urologist for the Lupron hormone shots.  I had to directly ASK him for a referral to an oncologist, in order to begin the chemotherapy  (Taxotere) infusions.  I am in the first wave of patients that have been treated with the new hormone therapy/chemotherapy combination treatment given soon after diagnosis.   There are still doctors out there that do not know about this new recommendation, so you might have to become your own advocate and request a referral with an oncologist.  It's my personal opinion that if you are diagnosed with advanced prostate cancer, you need to get an oncologist on your team EARLY in the game.   Ask for that referral from your urologist !   You need the expertise of an ONCOLOGIST for advanced prostate cancer cases, in my opinion.

Today, my urologist AND oncologist work together on my case.  Any tests or lab work that is done get sent directly to both of them.  My urologist continues to oversee the administration of the Lupron hormone shots and my oncologist oversaw my chemotherapy treatments.   I appreciate the expertise of both my urologist and my new oncologist overseeing my treatment and medical care.

Hope this is helpful to other readers, who might be in a situation similar to mine.

Stay strong in the battle !

CYCLONE

Jim, what I was thinking is, that when the surgery is completed the Uro's usefulness will have come to an end. I'll go to my GP have him refer me to an MO. I don't think we can self refer.

Cheers, Doug