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Can HT be discontinued after 5 years of Undetectable PSAs following EBRT for node positive GS7?

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Posted 10/19/2015 4:08 PM (GMT 0)
Hi, I have been on HT with casodex for 5 years after my RT. PSA undetectable. I was considered high risk with gleason of 7 and nearby lymph node involvement. I have been considering discontinuing injections but have received conflicting advice. Anyone with similar experience?

Gave your thread a title. -- PeterDisAbelard

Post Edited By Moderator (PeterDisAbelard.) : 10/22/2015 11:09:44 AM (GMT-6)

Posted 10/19/2015 4:46 PM (GMT 0)

LES31 said...
Hi, I have been on HT with casodex for 5 years after my RT. PSA undetectable. I was considered high risk with gleason of 7 and nearby lymph node involvement. I have been considering discontinuing injections but have received conflicting advice. Anyone with similar experience?

Hey LES31,
My URO recommended 2-3 years but I only did 12 months, my Brachy ONC convinced me to do, at the very least, 1 year in conjunction with the seed therapy.

Are you still doing the casodex?
Posted 10/19/2015 4:53 PM (GMT 0)
Hi LES -

Can you share a little more? It might help in understanding your treatment:

• What was your diagnosis before treatment? PSA, Stage and was your Gleason score - 4+3 or 3+4?
• How was your LN involvement discovered? CT scan?
• What kind of RT did you have? 40-44 treatments that included your pelvic LNs? What was the dose to the pelvic nodes?
• Were you told originally that you would have 5 years of an HT injection plus casodex? If so, why? (It's very unusual to exceed 2 years when they are trying for a cure).

- Allen
Posted 10/19/2015 5:35 PM (GMT 0)
Welcome to HW, sorry you need to be here.

If anyone could answer your question Allen can.

Hang in there,
Andrew
Posted 10/21/2015 1:05 AM (GMT 0)
GS was 4+3. CT scan. I think there were about 36 RT's. First UR took samples twice that were negative. PSA kept rising, but at that point I didn't care ( recently widowed ). Waited too long-then I went to another UR who repeated samples ( pos. & lymph node ) can find out dose if necessary.
Posted 10/21/2015 1:22 AM (GMT 0)
I think I got the general picture, thanks. It wasn't clear from your post that you were talking about salvage radiation after prostatectomy. I'm assuming you started hormone therapy before radiation began and continued to this day without a break - is that right? I would assume that the salvage radiation you had already treated your pelvic LNs, and the GS4+3 explains why they added hormone therapy. But I really don't understand why they continued the hormone therapy for so long. I've never heard of anyone having adjuvant hormone therapy after salvage radiation for 5 years. By this point, either you were cured or you weren't, and there's no evidence that continuing the hormone therapy any longer will be a benefit. I think you should discuss this with your RO - ask him why he has been keeping you on it this long.

(If you can, add a signature with the details of your diagnosis and treatment - it really helps us respond to you better)
Posted 10/21/2015 2:00 AM (GMT 0)
Started HT after EBRT. Discussed continued Lupron/Casodex treatment with UR. He said as long as I can tolerate the side effects it's just precautionary, like paying for an insurance policy against it starting up again. But with an undetectable PSA for 4.5 years I am questioning continuing. I will have PSA checked again this year & make a decision in Jan. ( next scheduled injection)
Posted 10/21/2015 4:39 AM (GMT 0)

LES31 said...
Started HT after EBRT

I'm trying to understand your situation, so please bear with me. There are many different situations in which HT is used, and it's used differently in each.

So after your EBRT, did you have a PSA test before your HT started? What I'm asking is whether you learned that the radiation failed to control your cancer before you were started on HT. If so, I can understand why you'd be on HT for so long. Many doctors now question starting HT that early nowadays, unless there is some indication (like metastases). Many would also give you breaks, called intermittent hormone therapy.

- Allen
Posted 10/21/2015 6:44 AM (GMT 0)
Hi Les and welcome to HW. I hope you are able to get a break from HT with success. Won't add any more, because TA is the guy with the best advice for if and when you should talk to your doc about discontinuing. Best Wishes.
Beth n Gary
Posted 10/22/2015 4:49 PM (GMT 0)
HT was started as a precaution. My UR said I was "high risk" and that PC "feeds" on the testosterone the body produces. I believe the PSA went to undetectable shortly after the RT and has remained so. There was metastases to one lymph node. Five years ago he gave me 8 to 10 years to live, now with current PSA he says I'll probably die of something else before the PC grows to be a problem, but dealing with the side effects is diffulcult .
Posted 10/22/2015 5:32 PM (GMT 0)
I gave this thread a title. Seems like it might be useful for others in similar situations and I wanted to make it a bit easier to find.

I have no particular input. I usually clam up when Tall Allen arrives. But it does occur to me, LES31, to ask: how old are you? Success in managing prostate cancer is often defined in terms of the patient living long enough to die of something else without ever suffering any dire symptoms from his cancer. That is a bar that gets a bit lower every year for most of us. In general, the younger and healthier the patient the more aggressive it makes sense to be in his treatment.
Posted 10/22/2015 5:47 PM (GMT 0)
PDA, I was wondering where you've been - I've missed you! Please don't clam up on my account - your intelligence, experience and good humor are invaluable.

LES, the PSA went to undetectable shortly after the RT was finished but before the hormone therapy was started? Are you sure? That doesn't make any sense to me. Perhaps you should get a second opinion.

- Allen
Posted 10/22/2015 7:58 PM (GMT 0)
Info from RT, IMRT-38 treatments-7420 cGy to prostate, 4500 cGy to pelvic area lymph node. Will have data from UR Monday.
Posted 10/22/2015 9:14 PM (GMT 0)
Tall,

I wonder if Batman suspects that Inspector Gordon doesn't like him. Gordon never turns on the old Bat-signal because he wants to sit down together with a couple of beers and watch a game on TV. It's always "There you are -- thank God! The Joker has escaped from Arkham again!"

I always hesitate to comment on threads where you have already answered the question because the time members spend reading anything I post would usually be better spent reading your answer again.

Actually, I've been around but the forum seems to be running itself pretty well just lately and I've been lurking a bit, waiting to spring out, when least expected, like the priests in the Monty Python "Spanish Inquisition" skit.
Posted 10/22/2015 10:59 PM (GMT 0)
Inspector Gordon is kickass in the new TV series, and he doesn't have to wear a silly cape.
Posted 10/22/2015 11:42 PM (GMT 0)
PDA and TA.....this is one of the reasons I keep coming back.

Now, back to Les........as one who spent three years on HT and am thankfully PSA undetectable, I would like to see you take a vacation. While HT does suppress cancer, one should not stay on any longer than is absolutely necessary. It really can cause some other problems that can be as bad or worse then the cancer.

I hope you get good direction from your urologist, but don't hesitate to seek another opinion...preferably from a medical oncologist that treats a lot of high risk advanced stage prostate cancer.
Posted 10/23/2015 11:18 AM (GMT 0)
Yes, what they ^ said. yeah
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