follow up on my radiation/HT

shadowman

I am gleason score 9 (4+5) in six cores on left side prostate decided on HT and external beam radiation as treatment Had 2 shots of Firmagon and then a 6 month shot of trelstar Have had 30 radiation treatments 15 to go no real problems worst problem is the Hot Flashes from The HT They want to continue HT for 2 years Has anyone been on HT 2 years Also my PSA is now .47 and my testosterone is < 20

djs123

radiation & Ht
I can't actually answer your question regarding 2 years on HT, as we're not there yet....however, I did want to share that my husband is having basically the same treatment as we speak. (Gleason 9 5+4). He has had 2 Lupron shots, 1 (1 month) and 2nd one which was a 3 month shot. He will have his third in June. He has had 24 IMRT radiation treatments and it sounds like his side effects are very similar to yours.
All in all not too bad, with the exception of a few days of diarrhea (resolved with immodium) and the hot flashes (still not as bad as the ones I get). He will have his PSA tested on Thursday.
I wish you luck and good health.

Kongo

Duration of HT
Shadowman,

As I recall, the normal life cycle of a prostate cancer cell is over 400 days which makes a strong argument for maintaining a HT therapy duration that exceeds that limit.

K

mrspjd

Kongo said:

Duration of HT
Shadowman,

As I recall, the normal life cycle of a prostate cancer cell is over 400 days which makes a strong argument for maintaining a HT therapy duration that exceeds that limit.

K

duration of HT (aka ADT)
Question re: CADT vs IADT

Other than facts on the life cycle span of a PCa cell (±475 days), is there any solid evidence from medical/scientific literature that would support a “strong argument” that a Continuous ADT (CADT) treatment plan, such as ≈400-475 days or longer, is superior or better than an Intermittent ADT (IADT) treatment plan? How about when RT is given as part of an adjuvant ADT tx plan—would that make any difference or is there still a “strong argument” for CADT vs IADT? Why?

Kongo

mrspjd said:

duration of HT (aka ADT)
Question re: CADT vs IADT

Other than facts on the life cycle span of a PCa cell (±475 days), is there any solid evidence from medical/scientific literature that would support a “strong argument” that a Continuous ADT (CADT) treatment plan, such as ≈400-475 days or longer, is superior or better than an Intermittent ADT (IADT) treatment plan? How about when RT is given as part of an adjuvant ADT tx plan—would that make any difference or is there still a “strong argument” for CADT vs IADT? Why?

Continuous or Intermittent
I've read several studies that indicate intermittent application of HT improves quality of life without diminishing overall mortality. One recent study indicated that while on intermittent therapy the prostate cancer progressed faster than on continuous therapy but did not affect overall mortality.

I think this a doctor's call situation. Eventually the prostate cancer will become testosterone resistant regardless of whether or not it is given continuously or intermittently.

http://www.harvardprostateknowledge.org/continuous-vs-intermittent-hormone-therapy-iht-no-survival-difference

mrspjd

Kongo said:

Continuous or Intermittent
I've read several studies that indicate intermittent application of HT improves quality of life without diminishing overall mortality. One recent study indicated that while on intermittent therapy the prostate cancer progressed faster than on continuous therapy but did not affect overall mortality.

I think this a doctor's call situation. Eventually the prostate cancer will become testosterone resistant regardless of whether or not it is given continuously or intermittently.

http://www.harvardprostateknowledge.org/continuous-vs-intermittent-hormone-therapy-iht-no-survival-difference

IADT vs CADT
The info in the Harvard article cited above actually MAKES A STRONG ARGUMENT FOR IADT of ≤365 days (vs CADT). The study concludes: “…no difference in overall survival between the groups. Patients on IHT also experienced fewer side effects and had more sexual activity. Another plus: intermittent therapy could keep more money in patients’ pockets. Given the beneficial effects and the lack of a survival difference, the researchers conclude that patients and doctors should consider IHT.” The question remains: Where is the data to support a “strong argument” for CADT with or without adjuvant RT as indicated in your post?

Re your statement: “Eventually the prostate cancer will become testosterone resistant regardless of whether or not it is given continuously or intermittently.” That doesn’t sound very promising or hopeful for men on ADT txs. What evidence from medical/scientific literature and clinical studies concludes that ALL PCa becomes T resistant (HRPC/CRPC)?

Kongo

mrspjd said:

IADT vs CADT
The info in the Harvard article cited above actually MAKES A STRONG ARGUMENT FOR IADT of ≤365 days (vs CADT). The study concludes: “…no difference in overall survival between the groups. Patients on IHT also experienced fewer side effects and had more sexual activity. Another plus: intermittent therapy could keep more money in patients’ pockets. Given the beneficial effects and the lack of a survival difference, the researchers conclude that patients and doctors should consider IHT.” The question remains: Where is the data to support a “strong argument” for CADT with or without adjuvant RT as indicated in your post?

Re your statement: “Eventually the prostate cancer will become testosterone resistant regardless of whether or not it is given continuously or intermittently.” That doesn’t sound very promising or hopeful for men on ADT txs. What evidence from medical/scientific literature and clinical studies concludes that ALL PCa becomes T resistant (HRPC/CRPC)?

Context
Not sure what you're trying to say here, M. I didn't suggest that there isn't a strong case for intermittent HT (it's why I included the study as a reference) only that a two year regimen of HT makes sense in terms of the duration of HT and in fact is widely prescribed by many doctors. IHT is relatively new and one aspect of it that should be considered is that as the regimen progresses, the time off HT tends to grow shorter and shorter. Regardless, given the quality of life benefits that are possible I would encourage any patient to discuss the options of IHT with their doctor. Age, quality of life expectations, and other physical considerations obviously must be taken into account.

Advanced prostate cancer is well known to be a progressive disease. Eventually the cancer cells no longer need testosterone to grow and in fact can supply their own testosterone and HT is no longer effective. Other drugs, such as newly approved Zytigia are used.

You can do your own research, M. If you find anything that indicates that men with recurring or advanced cancer on HT don't progress to the castrate resistant stage I'm sure you'll let us know.

mrspjd

Kongo said:

Context
Not sure what you're trying to say here, M. I didn't suggest that there isn't a strong case for intermittent HT (it's why I included the study as a reference) only that a two year regimen of HT makes sense in terms of the duration of HT and in fact is widely prescribed by many doctors. IHT is relatively new and one aspect of it that should be considered is that as the regimen progresses, the time off HT tends to grow shorter and shorter. Regardless, given the quality of life benefits that are possible I would encourage any patient to discuss the options of IHT with their doctor. Age, quality of life expectations, and other physical considerations obviously must be taken into account.

Advanced prostate cancer is well known to be a progressive disease. Eventually the cancer cells no longer need testosterone to grow and in fact can supply their own testosterone and HT is no longer effective. Other drugs, such as newly approved Zytigia are used.

You can do your own research, M. If you find anything that indicates that men with recurring or advanced cancer on HT don't progress to the castrate resistant stage I'm sure you'll let us know.

more like semantics than context
K, here's what I'm saying:

Your statement “Eventually the prostate cancer will become testosterone resistant regardless of whether or not it is given continuously or intermittently” sounded so absolute & authoritative, that I thought maybe you’d come across something that many of us hadn’t, specifically that: ALL PCa becomes HRPC/CRPC. Thanks for clearing it up.

Actually, K, I think you did suggest there was a "stong argument" or "case" for CADT when you wrote: “I recall, the normal life cycle of a prostate cancer cell is over 400 days which makes a strong argument for maintaining a HT therapy duration that exceeds that limit.” I interpreted your statement, within the context of Shadowman's thread & question, as a confirmation of Shadowman’s doctor’s recommendation of a 2 yr ADT protocol, which many in the PCa medical community believe is Continuous ADT (CADT), since the "on" duration of IADT is most often a shorter duration cycle of less than the life span of a PCa cell. Certainly, each man's response will vary.

Guess it all really boils down to semantics & sorting out the facts from the opinions.

VascodaGama

mrspjd said:

more like semantics than context
K, here's what I'm saying:

Your statement “Eventually the prostate cancer will become testosterone resistant regardless of whether or not it is given continuously or intermittently” sounded so absolute & authoritative, that I thought maybe you’d come across something that many of us hadn’t, specifically that: ALL PCa becomes HRPC/CRPC. Thanks for clearing it up.

Actually, K, I think you did suggest there was a "stong argument" or "case" for CADT when you wrote: “I recall, the normal life cycle of a prostate cancer cell is over 400 days which makes a strong argument for maintaining a HT therapy duration that exceeds that limit.” I interpreted your statement, within the context of Shadowman's thread & question, as a confirmation of Shadowman’s doctor’s recommendation of a 2 yr ADT protocol, which many in the PCa medical community believe is Continuous ADT (CADT), since the "on" duration of IADT is most often a shorter duration cycle of less than the life span of a PCa cell. Certainly, each man's response will vary.

Guess it all really boils down to semantics & sorting out the facts from the opinions.

Intermittent VZ Continuous (Kondo and Mrs PJD)
Shadowman,

The protocol of your combi treatment (HT + RT) is common with two years adjuvant hormonal therapy. Gleason 9 guys are considered higher risk which may take doctors to consider extended periods on HT. In any case, there is no published study yet to prove that two years provides higher rates of survival than in shorter administrations.
You can discuss latter with your doctor/care team if the period could be shorten in case your condition improves and justifies it.

I wish you a good outcome and the lesser side effects from the treatment.
Sory to post the following but I believe that you will like to read it.

To: Kondo and Mrs PJD:

I am very glad to read about your heartful discussion on HT modalities.
I am a fan of the intermittent modality and I strong believe it to be better than the continuous.
I wrote my opinion in a past thread on the benefits of the intermittent which in fact got still more justifying reasons favouring its application since researchers from Canada and Europe have published their findings on the matter. The results were discussed at the 2011 ASCO meeting and the institution has included the modality in its practice guidelines. Nevertheless, this is the case for recurrence cancer after a radical failure. Here is an abstract of the study;
http://www.ascopost.com/articles/august-15-2011/intermittent-or-continuous-androgen-suppression-produces-comparable-survival-after-radical-therapy-in-prostate-cancer/

In my opinion the researchers have down played the benefits of intermittent against continuous resuming their findings on mortality rates, probably to not “offend” the many colleagues that do not support it and instead follow the urological recommendations of AUA for a continuous approach.
Here is the comment on the matter by a well known urologist;
http://www.medscape.com/viewarticle/738760

Against all odds, NCCN also have modified its Guidelines and now recommend the intermittent modality alongside continuous. And still to add fuel to the discussion, Johns Hopkins principles in PCa care (famous for being against HT) do now support its application, neoadjuvant or adjuvant to other treatments as a set or continuing intermittent modality.
Here is a video from an expert of NCCN;
http://www.youtube.com/watch?v=0XxH2uSha7k

My take on the matter is that I see the reason for the intermittent simply because HT is not curative but palliative, which is well known since the discovery in 1941 by Charles Huggins that androgen ablation slower cancer progression in breast and prostate cancer cases but it does not stop it.
Therefore, blocking testosterone in the intent of stopping the “feeding” of cancer does not imply that the cancer will die of starvation, which proves that the length of the ablation period does not regulate cancer response but that other causes are the reason to its resistance to die and continuing survival.

From bio researches on cells behaviour one may see that the cells are able to adapt to the newer environment (low levels of androgens) mutating to survive on very low levels of testosterone (becoming in a sort of indolence) and even do manage to start producing its own androgens from cholesterol (intratumoral activity).

In the past we would refer failure of HT as hormone resistant cancer or refractory cancer but that reference is erroneous if we mean it as a classification of the cancerous cell. The term that better qualifies the failure should be “Castrate Resistant” because the cell is resistant to the castrate level imposed by traditional drugs (LHRH agonists) typically at 0.2 ng/mL (20ng/dL). However, the cancer continues to respond to hormonal manipulations administered with perfected newer drugs such as; Abiraterone, MDV3100, Orteronel, ToK-001, etc.

These are the drugs that in future will take the front stage in the treatment, probably abolishing radical therapies.

Here is the link on my opinion of the benefits of the intermittent modality;
http://csn.cancer.org/node/213002#comment-1013947

Wishing the best to all my comrades in this boat.

VGama

shadowman

follow up

I  completed 2 years of HT  and my 45 treatments of  radiation     At 6 months my testosterone was 265 and psa was .31     at 1 testosterone is 369 and psa is .63   

I go back to doctor in a couple weeks  but I dont think the rise in psa is of concern right now      Has anyone have extended experience wit radition /HT treatments and what to expect in the longterm

ob66

shadowman said:

follow up

I  completed 2 years of HT  and my 45 treatments of  radiation     At 6 months my testosterone was 265 and psa was .31     at 1 testosterone is 369 and psa is .63   

I go back to doctor in a couple weeks  but I dont think the rise in psa is of concern right now      Has anyone have extended experience wit radition /HT treatments and what to expect in the longterm

OK, All Set

     It has been a while since I was on here. My CA Dx was May 6, 2009. I don't need to bore you with the details, but some are important: Initial Biopsy---Gleason 7, 25% cores positive............Surgery June 2009--daVinci--successful, but post path report shows Gleason 8 (4+4) and Stage 3tB----pretty serious junk.

     Go 10 months with incontinence battles using PT to do as much as possible....Have a very protective Urologist (thank God) who after an ultrasensitve PSA rise of 0.02 recommends RT, but I need and AUS before I have RT....So all that is done in  June/July/August of 2010....Start in May with HT (yes, Lupron), then AUS surgery, then 37 RT treatments. So I have run the gamat...No, wrong....I decide in Sept. 2010 to go Vegan after dietary study of physicians who have had CA and what they did for themselves and then iived to write about it....So I have been Vegan (no dairy, no red meat, reduced sugar) for almost 4 years. Now, I always exercised with vigor so that is not a variable (20 minutes cardio, 25 minutes resistence, 15 stretching at least 4-5 days per week).

    In Dec 2012 i was sweating bullets waiting for my ultrasensitive PSA results for I had been off Lupron for 6 months (after 2 years usage). It came back, normal testosterone, PSA less than 0.02. And it has remained that ever since. So this month I go in for my six months testing. Am I sweating bullets? You bet I am. But so far, great for a guy who was very close to "Dead Man Walking" in 2010....I am all zeroes, with normal testosterone. I cannot tell you why. 

    Was it the surgery, the HT, the RT, the diet, the exercise? I don't know. But while you argue treatment vs. excessive treatment, I will continue to take a slow breath in and let a slow breath out day by day.