Androgens and rad therapy post daVinci

ob66

Back again with another question. Prior to my daVinci surgery in June 2009, I was lead to believe that the "gold standard" was surgery plus radiation (the rationale being best chance for total removal in mind and body of CA). I was unable to follow with the radiation immediately after surgery due to incontince. Did everything to remove the incontinence over the 11 months post op. It went way down, but not all the way. Then in April 2010 (with the "ultrasensitive" PSA testing) my PSA level went from 0.05 to 0.07. Not a large rise, but a rise nevertheless. Decision was radiation ASAP, but AUS surgery first. So in April I had Casodex/Lupron(the 4 month shot) and on May 10 had the AUS surgery. I started radiation IMRT therapy in June and am 20 days in with no side effects.
Now getting to my question. It seems as if the choice is to continue me on Lupron for a year. I am not sure I understand. It seems to me the Lupron was to stop the "feed" for the CA cells (which are apparently there due to the small PSA rise) until I got the radiation therapy completed. That I will have complete on Aug. 5th. So technically I should have another Lupron shot on August 12th (four months after the first one), but I wonder if it is necessary since the radiation will be done just before the Lupron is "done". Does anyone know with the course of treatment I have been through if the continuation of Lupron has benefits, or if it raises questions with you as it does with me???? Thanks in advance.

mrspjd

RT w/ ADT questions
Hi ob66,
I see no one has addressed your questions yet. Wondering if you have asked your doctor those questions and what answers, if any, he gave you? Also, I'm sure you've previously posted your pre and post surgery stats elsewhere, but if you could post them again, it might be helpful, i.e. pre surgery biopsy results (# cores and % of postive cores); and post surgery pathology results, as well as pre surgery gleason as in x+x=x. Do you know what your PCa stage was at initial dx and whether it changed as a result of post surgery pathology--such as T1-T3? What did the post surgery path report indicate as far as positive/negative margins? What is your current IM/IGRT scheduling plan, i.e., GY doseage total and how many txs total?

Although PJD has not had surgery, his tx plan includes triple ADT (Lupron, Casodex, Finasteride) and one or two forms of IM/IGRT (tbd), which he has not started yet. Once you post the add'l info, I will check with him (as he is the expert on the specific details) to see if he might have some answers for you.
Best,
mrs pjd

ob66

mrspjd said:

RT w/ ADT questions
Hi ob66,
I see no one has addressed your questions yet. Wondering if you have asked your doctor those questions and what answers, if any, he gave you? Also, I'm sure you've previously posted your pre and post surgery stats elsewhere, but if you could post them again, it might be helpful, i.e. pre surgery biopsy results (# cores and % of postive cores); and post surgery pathology results, as well as pre surgery gleason as in x+x=x. Do you know what your PCa stage was at initial dx and whether it changed as a result of post surgery pathology--such as T1-T3? What did the post surgery path report indicate as far as positive/negative margins? What is your current IM/IGRT scheduling plan, i.e., GY doseage total and how many txs total?

Although PJD has not had surgery, his tx plan includes triple ADT (Lupron, Casodex, Finasteride) and one or two forms of IM/IGRT (tbd), which he has not started yet. Once you post the add'l info, I will check with him (as he is the expert on the specific details) to see if he might have some answers for you.
Best,
mrs pjd

Thanks mrspjd
Yes, I have discussed it with my doctors and have their judgment. I was mostly concerned about the generalities of opinion relating to radiation following radical or daVinci prostatectomy. I am less worried about my particulars as being involved in that equation. Before I had my June 2009 daVinci I had a friend from the West Coast who had gone to UVA for his daVinci and followed that with radiation for no other reason than it affords the least amount of metastitis, the longest longevity, etc. Kill, kill, kill if you get my drift. It sounded very reasonable to me. My course was slightly different but still wound up with daVinci followed by radiation within a year. I have heard it is a good way to go, especially if done within the first two years. I can imagine there would be a lot of resistance to this as overtreatment, especially in my friends case, but was wondering what opinions were in regards. Thanks for any help.

BRONX52

OB66
I HAD THE DAVINCI SURGERY IN FEB-2010 AND ADJUVANT RADIATION--IMRT--IN APRIL. FINISHED UP IN JUNE WITH THE RADIATION. I WASN'T A FAN OF HORMONE THERAPY AND I TALKED AT LENGTH ABOUT IT WITH BOTH THE UROLOGIST AND ONCOLOGIST. MY POST OP STATS SHOWED A GLEASON 7 (3+4),EXTRAPROSTATIC EXTENSION, AND POSITIVE MARGIN. THERE WAS NO SPREAD TO LYMPH NODES OR SEMINAL VESICLES. NOW, BACK TO THE HORMONES--MY DOCTORS FELT THAT SINCE MY GLEASON WAS 7 AND MY PSA WAS ZERO 6 WEEKS AFTER SURGERY THAT I DIDN'T NEED TO HAVE HORMONE THERAPY IN CONJUNCTION WITH THE TMRT. HE ASO EXPLAINED THAT RADIATION KILLS CANCER AND HORMONES DO NOT. THIS IS NOT TO SAY THERE ISN'T A NEED FOR HORMONE THERAPY. THEY DO SHRINK TUMORS AND HAVE A POSITIVE EFFECT ON PSA. DR. WALSH'S BOOK ON SURVIVING PROSTATE CANCER HAS A VERY INFORMATIVE SECTION ON HORMONE THERAPY. HE STATES THAT EVENTUALLY HORMONE THERAPY STOPS WORKING BECAUSE CERTAIN CANCER CELLS ARE IMMUNE TO HORMONES. THIS CAN TAKE SEVERAL YEARS THOUGH.IT DOES HOWEVER BENEFIT THOSE WHOSE CANCER HAS SPREAD TO OTHER PARTS OF THE BODY. AGAIN, THE CANCER PATIENT HAS TO MAKE A CHOICE-- DO I HAVE HORMONE TREATMENT NOW OR DO I WAIT AND SEE IF/WHEN THERE IS PROGRESSION OF THE CANCER. ITS A PERSONAL CALL, AND UNFORTUNATELY NOT AN EASY ONE TO MAKE. I CHOSE NOT TO HAVE THE HORMONE THERAPY ALONG WITH THE RADIATION THERAPY. TALK TO MORE THAN ONE DOCTOR AND VOICE YOUR CONCERNS ABOUT YOUR COURSE OF ACTION. YOU MIGHT BE SURPRISED AT WHAT KIND OF ANSWERS YOU GET BECAUSE EVEN THE MEDICAL COMMUNITY DOESN'T AGREE ON WHEN/IF TO USE HORMONE THERAPY---GOOD LUCK!!