How long on adjuvant ADT?

VascodaGama said:

Adjuvant period of HT in combo treatments

 

David

 

Thanks for sharing your story with us. I can see that you know well about your options and that you are aware of what to expect. Old Salt has given you the link from ASCO with the information you were looking for. I also believe that long term adjuvant ADT does not add any particular benefit to the combo treatment (HT plus RT) you are planning to follow. In any case, researchers comment that for patients with high-risk prostate cancer, using hormone therapy for just a short while is not effective.

 

As far as I come across in my researches, the neoadjuvant hormonal treatment portion will sensitize cell’s ARs helping the purposes of the radiation treatment, in damaging cell’s DNA. The high energy waves damage the DNA which causes the destruction of the cells that may “try” to divide prior to repairing the DNA. Since cancerous cells divide quicker than healthy ones, these (damaged cells) cannot divide and will die. The significance of the adjuvant HT in the combo is reduced and seen as effective during the mitosis period when a cell divides. It keeps them on the “canvas” not allowing a perfect duplication to occur. (PCa cell to another PCa cell). Proteins help to regulate the cycle of mitosis so that taking antioxidants (pills, etc) should be avoided during the treatment to keep the “environment” as much toxic as possible to the PCa cells.

 

You can read about the purposes, cells’ grow and division, and the whole concept in these links;
http://mct.aacrjournals.org/content/6/7/1920.long

 

http://www.cancer.org/acs/groups/cid/documents/webcontent/003019-pdf.pdf

 

http://www.sciencemuseum.org.uk/whoami/findoutmore/yourbody/whatdoyourcellsdo/howoftenareyourcellsreplaced/howdocellsgrowanddivide.aspx

 

http://science.education.nih.gov/supplements/nih1/cancer/videos/act2/transcript-act2-anim.htm#video5

 

The pathological stage sets you at the high risk group. Your description of your status is pretty bad with seminal invasion and positive lymph nodes. The Gleason grade 4 is for an aggressive type of cancer that is producing fewer PSA. With this in mind maybe it would be better that you plan an aggressive attack on the bandit.

 

It seems that the radiation oncologist laboratory has no ultra sensitive assays. The PSA <0.2 and Testosterone <50 is the LLD of their assays, not practical for a case of cancer producing low levels of the serum. The 0.2 ng/ml could mean 0.03 or lower. The castration level is best at <20 ng/dL.

 

Surely the side effects are of concern and they will superimpose. The hypogonadism (kind of menopause symptoms) you are experiencing from the hormonal manipulations can be treated with tactics and a change in the life style (naps and earlier dinners, etc). Physical exercises help me a lot to counter the effects and gain back lost muscle mass. Some guys use over the counter drugs too.

 

There is a good book with advice on supplements and nutrition for HT patients;
“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers.

 

UCSF got a publication on Nutrition & Prostate Cancer, which copy I highly recommend you to get.
http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

 

I would recommend you to consult a medical oncologist for a second opinion in the treatment protocol and advice in treating the symptoms.

 

Best wishes for successful outcomes.

 

VGama

 

V Gama

Thank you for your reply, yes my status is poor. I went ahead with the Trelstar injection on August 28 which will bring me to 9 months of HT of which almost 3 were prior to the start of RT. I am trying to balance the benefit of adjuvant ADT with my quality of life. I was actually feeling quite good prior to the cancer diagnosis. All of my troubles now are the result of treatment.

September 3 I met with my urologist who was kind enough to be blunt. He is knowledgeable and not reluctant to refer my case to others. He did his fellowship with Dr Paul Lange. He feels my pathology was the worse he has seen without bone metastasis but sees no reason to give up hope. He asked that I continue HT as long as I can, but admits that there are no definitive studies to rely on. My cancer is aggressive with low PSA so we will use ultra sensitive tests to track it. There is a small chance that the treatments have killed the Bandit, but if not he feels that it has been knocked back at least 5 years. He would like more PSA and testosterone tests before going to the medical oncologist. He doesn't believe this is a fast cancer, more likely slow with low PSA and we were fortunate to find it before it had spread to more lymph nodes.

Having said all of that, I am in danger because of my age. At 52 I have many more years left for this cancer to grow, not that it isn't a tragedy at any age. My urologist's prognosis is 2-3 years before it returns and another 2-3 years before I become symptomatic.. His advice is to live life now and we will attack it when it shows up. He seems very optimistic for future prostate cancer treatments.

Any thoughts?

David