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Posted 8/17/2018 1:53 AM (GMT 0)
I started thinking, I know not good....
How soon after HT can you start RT....
Posted 8/17/2018 2:06 AM (GMT 0)
I started RT 2 months after I began HT
Posted 8/17/2018 2:08 AM (GMT 0)
To add to what Mark said, My RO said it’s 2 months after first HT shot. But I’m going to ask him if we can do it at 6 weeks.
I’m scheduled to start on the same day as you, MG
Posted 8/17/2018 2:12 AM (GMT 0)
2 months seems to be usual, but my RO said it wasn't necessary. Began RT three weeks after I started Casodex, 10 days after my first Eligard injection. He's seems more focused on getting me to stay on Eligard at least 9 months, instead of just 6 months as other ROs I consulted recommended.
Posted 8/17/2018 2:13 AM (GMT 0)
I think they want your T at castrate level which is below 50.
Posted 8/17/2018 2:38 AM (GMT 0)
I agree with Mark. It's however long it takes to get down to castration level before the RT begins. Hopefully, PSA will become undetectable by then. They need the radiosensitizing effect to start. They used to wait 6 months, but now they only wait 2.

More in my response here:

/www.healingwell.com/community/default.aspx?f=35&p=1&m=3694395#m3697605
Posted 8/17/2018 2:54 AM (GMT 0)
Your first line brought this old one to mind:

"Did you ever stop to think and then forget to start again?"

and the answer is whatever TA said.

Andrew
Posted 8/17/2018 3:26 AM (GMT 0)
Mayo had me start RT three weeks after my Lupron shot.
Posted 8/17/2018 3:51 AM (GMT 0)
TA--
Is there any difference in standard practice on HT lead time depending on whether it's in conjunction with primary RT or salvage RT?
Posted 8/17/2018 6:03 AM (GMT 0)
SP- No- 2 months is pretty standard on both if ADT is used at all.
Posted 8/17/2018 10:12 AM (GMT 0)
From what I have read, there is no one treatment fits all. Its up to the doctors, your scores, size prostate, and a lot of other variable. Ex. I'm having triple treatments. I started Casodex to decrease T, shrink my prostate, etc to get it ready for Brachy. Next up I start ebrt, followed by brachy. I was under the assumption that I would take casodex for a full 30 days, then ebrt treatments would start-nope. It just so happens that my first treatment will be the exact day I finish Casodex, but based on my numbers, both my oncologist(s) said they could start ebrt during Casodex.
Posted 8/17/2018 11:02 AM (GMT 0)
If you want to start early with the radiation you want to make sure your PSA reaches its lowest point (nadir), and that nadir is maintained for a month. It usually takes two to four months to reach nadir. My PSA reached 1.4 in 30 days with a T Tot of 17, but I didn't want to start radiation treatment until after a wedding trip for my niece who recently lost her dad to colon cancer. So I will start after 4 months on Lupron and 30 days of Casodex. This delay was fine with MD Anderson and UNM. When you end HT depends on your risk profile. You will want to be on HT during the radiation treatment. I hope to be on it for 6 months total, while others may be treated for 9 months, a year, or 18 months or more. I get my final 3 months injection on Monday. I expect with 6 months on Lupron I will have at least 3 extra months of T suppression and side effects. Exercise helps.

68 yrs. 3+4=7 involving 15% of the right apex and 15% of the right mid with additional Gleason 3+3=6 prostate cancer involving 5% of the left base confirmed by John Hopkins and UNM 4+3=7 MD Anderson Proton Center w/o percentages. PSA 2.1, 2.2012, 13.7, 2.18 12.7 5.21.18 1.4 6.18.18. 0.12, 8.15.18 Prostate about 24 grams. T3 MRI 1.8 lesion left apex. A Prolaris test 3.5, PTEN test negative, Bone Scan negative.

Post Edited (SantaZia) : 8/17/2018 2:52:01 PM (GMT-6)

Posted 8/17/2018 2:50 PM (GMT 0)
My first 6-month Lupron shot was 2 months before my IGRT was to start. Seven weeks later my PSA was still 2.0, well above the <0.5 we were looking for. At that point we added Casodex.

We'll never know if the Casodex was really necessary, especially after the radiation was done. It's usually given only for the first 30 days or so while Lupron's testosterone surge cycle happens, and then stopped. My docs didn't think Casodex was needed at the start, because as neoadjuvant treatment before radiation there's no real risk to the initial testosterone surge. In my case, it just seemed to take longer than expected for my PSA to drop.

Because the first post-radiation PSA check was undetectable, my docs decided to just continue both as "ADT2". I was on both for 3 long years (sigh...). The whole 6/12 positive core biopsy, all G9 some 5+4, cT3a, PNI, and all that led to abundant caution and a fairly aggressive IGRT/ADT treatment plan, at least in 2013 terms.
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