need imput on hormone therapy

Ohorvie,

I can give you some insight on my expererience with hormone therapy. Some info first;

I was diagnosed with prostate cancer at 64.  Had biopsy of prostate done 10/15, 12 cores samples taken six of which showed cancer. Four w/Gleason 4+3=7 and two w/Gleason 4+5=9, 60 to 70% of prostrate involved with tumor. Classified as high risk. Had PET and CT scans done cancer is belived to be non-metastatic. Was given choices for types of treatment. But was advised by doctors to do surgery followed by seven weeks of radiation and ADT (hormone therapy.) Which I ended up doing.

Hormone that I'am on is commonly referred to as Lupron and I have been on it for about two years now and I contribute it to keeping my cancer at bay. My PSA levels at last testing was 0.014 classified as undetectable, they have been at that level for a while now. Having said all that Lupron can come with some not so fun side effects. Many of which I currently deal with. First it was hot flashes, which went away after a short while. Right now I'am dealing with memory loss, weakness, muscle loss, tiredness (all the time,) rashes, and just recently a new fun one, bone loss in my left femur (Osteopenic.) There are many ADT drugs that the doctor may choose from, some may not have the same side effects. But ADT is given to reduce male hormones so most may have alot of these side effects. But again I only know of the ones I have on Lupron. I get one shot every three moths.

Good luck to you and your husband, mtop.

Ohorvie,

I welcome you to the Board, as well.

You will find that the folks here are fantastic in providing personal information and experiences, solid layman suggestions, as well as a phenominal amount of freely-provided information that each has personally researched on PCa.  I've had both surgery and the combined hormone/radiation salvage therapy.  You can find a discussion of my personal experiences on the combined hormone/radiation salvage therapy at the link below, titled 'Salvage Treatment' and dated 10/30/2013:

https://csn.cancer.org/comment/1414101#comment-1414101

I wish you the best of outcomes on your journey.

Max Former Hodgkins Stage 3 said:

Plan

Ohorvie,

Welcome to you.  You need to get a paper copy of your husband's biopsy results.  It will be of value to you both later.  It will be free, and no doctor can reasonably refuse your request.  Even if his results are available online (very common today), get a paper copy.

His condition is probably worse than the doctor is letting on at present. A (convention) PSA of 25 is astronomical.  It is good that his CT and bone scan were negative, but they absolutely do NOT prove the lack of metastasis.  MOST doctors assume that PCa (prostate cancer) has spread with a PSA that high.   CTs are poor at detecting metastatic disease, and false negative results are quite common.

Treating metastatic PCa is tricky, and requires a lot more still than attacking early-stage disease.  But know that it is virtually always very controllable, and many men here have lived way more than a decade with cases that initially sounded worse than what you report regarding your husband.

HT and radiation are to be expected in his situation.  Surgery is counterindicated in new cases presenting with a PSA that high, so it is fitting that the doctor did not mention surgery.

Again, know that this is very likely extremely managable, and he probably will move forward with good quality of life from this development. Other here are much more conversant with hormal therapy than I am (I have never needed it myself, but have followed several friends through it).  These HT experts will hopefully write soon,

max

 

 

Max,

I do not agree with you. A PSA of 25 is not astronomical, it just indicates a high risk PCa. I would guess a Gleason 7 or 8. I know of a patient that came to the doctor with a PSA value of 6,000. Bone mets all over, no pain. After starting hormone therapy the PSA value got down below 1.0 for a while.

If bone scan and ct are clear, surgery is still an option. I agree that there may be undetected mets but many patients get surgery if bone scan and ct are clear.

G53

Are we assuming there is no other cause for the high PSA score, and therefore must reflect excessive antigen release from activated cancerous prostate cells... or are we assuming that there may be other causes of antigen release such as BPH or infection or sexual activity or any such combination, along with activated cancer cells?.. and the somewhat excessive PSA score is not as threatening.

I think this should be clarified for Ohorvie.

I'm late to the party here, as I just checked in this morning... but I am two years into my treatment and my case is very similar to your husband's. But in my case it could have gone either way. At 65 I was right on the edge of the surgery or no surgery dividing line. Five years older and my surgeon said he wouldn't do it. My (2nd) biopsy was just over two years ago, and at G8 also I was right on the line. If there had been any grade 5 component he would have recommended radiation over surgery.

My last PSA pre-op was done early 2016 by my GP and it was 25. That was the impetus to get the second biopsy. I'm afraid that I must disagree with Max and side with G53 on this one. Although a PSA over 20 is one of the factors that classified my case as "high risk" (at that time, very high risk) everything appears to have worked out. I have been on hormone ADT for eighteen months and my PSA has been zero. I was told immediately after surgery that I would require adjuvant radition, which started one year ago and was completed with many of the more common side effects.

Do not despair, Ohorvie. Your husband stands every chance of getting thru this successfully. While the bone scan and CT are indeed poor diagnostic tools, they are intended to detect bone mets, not to rule them out. Such a finding would indeed alter the treatment plan. But it is not metastatic until it is proven to be metastatic.

I chose surgery as the first salvo to take out the motherlode of the cancer. I do not regret it in the least. It allowed the surgeon to actually get in there and see what is going on. And the post-op pathology report provided greater certainty regarding what treatment path to follow thereafter... which was far better than relying solely on external scans.

Sorry, you guys have to go through this. I would recommend that you have a second opinion on your pathology report and some genetic testing done. I received a second opinion from John Hopkins which was covered by my insurance and the genetic tests; Prolaris and a PTEN test.  I am in my 4th month on Lupron 2 months to go while receiving 44 radiation treatments. Here is what the Lupron has accomplished PSA.12 from 12.7 T. Total <7 from 869. T3 MRI 9.5.18 "The prostate gland measures 3.0 x 2.6 x 3.4 cm in CC, AP, and transverse dimensions, for a total prostatic volume of 14 mL. Post-surgical changes of prior transurethral resection of the prostate gland again noted. The prostate gland now demonstrates mildly diffusely decreased T2 signal throughout, consistent with interval hormone therapy. The focal 1.8 cm PI-RADS 5 lesion seen within the right mid gland extending into the base and apex on the prior MRI is no longer visualized as a focal lesion. No other focal prostate lesions are seen."  There are side effects as everyone has pointed out. Exercise and diet will help deal with those and many use couples counseling too. But as you can see if your husband need HT it is very useful in treating PC.  Best wishes to you both.

Sorry that you found us but we’re glad that you are here.

i agree that biopsy results are needed for a more complete picture. A PSA history is also usually used to **** the situation by understanding things like the doubling rate.

do I understand correctly that the only treatment that your husband has had is hormone therapy? Did you discuss any other treatment options at diagnosis such as radiation, surgery,  seeds, etc?

George

has anybody taken testostorone booster to get testoterone back to normal after radiation and HT?