Jen said...
Since there was no RISE in PSA after surgery I wonder if a year of Lupron sentence is a good idea.
I don't understand why you've refused adjuvant radiation. Is it because you think it's so far gone already that radiation won't make a difference? In that case, it is not a year of Lupron you're looking at, it's a lifetime (whether intermittent or continuous).
If you are at all hopeful of a cure, your
only bet is to have adjuvant radiation immediately. The longer you wait, the lower his chances for a cure get. He had a very adverse pathology report with the pT3b and the tertiary 5's (which are highly invasive). There isn't a lot of agreement among radiation oncologists about
some borderline indicators for adjuvant/salvage radiation, but I'm sure they would all agree and recommend it in his case. The PSA that never goes down to undetectable is a sure warning sign.
The adjuvant radiation should be about
70 Gy, and with his very high initial PSA and his tertiary 5s, the radiation oncologist will probably include the pelvic lymph nodes too (unless they've already all been removed), even though the lymph nodes they sampled were clear. Lupron usually begins 2 months before the radiation and continue for at least 18 months afterwards.
Very few guys (only about
13%) get any erectile function back if the nerves were not spared. Viagra or cialis most likely will not work either, although he can and should try it. He will probably be able to get erections with injections of trimix, however. The other thing he could do is use a pump every day. That may also help reduce the loss of penile size, and will help keep those tissues oxygenated. He can also use it with the constriction ring to maintain an erection. Lupron will destroy his desire for sex while he is taking it. Eventually, he may want to get a penile prosthesis.
- Allen