Decision Time RP or ADT/HDR/EBRT

CMO2021, Your decision is made, and I wish you the best of outcomes on this leg of your PCa journey.

Great news for reaching a decision. I hope it works well and gives you peace of mind for the years to come. 18 months on ADT is just the typical in this sort of combination treatment, starting the radiation process two to three months into the hormonal. I just wonder if Abiraterone is the best to those ADT naive guys. Surely there have been more interest in the use of abiraterone since its generic become available (at 1/10th of the original price) but one shouldn't forget that this is a drug belonging to the second line ADT protocols recommended when refractory of the more common antiandrogens occur (if ever). Abiraterone requires the use of Prednisone which could interfere in the appropriate function of the immune system. It requires closer vigilance.

I am eager to read your update along the journey.

Best wishes for full success and luck in the spectrum of the side effects.

VGama

Best of luck on your journey with the beast.

CMO2021 said:

 Just a quick update the plan

 Just a quick update the plan is to have my HDR Brachy on 7/26/2021.  I will update as I  move forward with ADT.

Chris

Great choice to have HDR brachytherapy. Two treatments in a week or so is excellent.

Also, you are avoiding to have life changing SE that change man aAntony and functionally for ever.

once again, congratulations on excellent choice for your treatment.

MK

CMO2021 said:

I want to thank everyone for

I want to thank everyone for your support and insight.  After additional thought and additional consultation with the MO, RO and Surgeon I think my best course forward is ADT/HDR/IMRT I am starting with Firmagon and abiraterone (18 months)after three months of ADT I will have the  HDR Brachy followed by IMRT four weeks after the HDR Brachy.  I  will continue to  provide updates on my journey.  I am thankful for this group, and my supportive wife and family and friends.

Chris

Chris, your decision involved a rare combination of complexity, new-ish modalities, and world-class experts at SKCC advising you.   While it is a situation that is somewhat of an outlier for first-line response, all of the guys here who have successfully battled metastatic disease see it as wise, so so do I.  It was clear before you started that HT of some variety would be the heart of your recovery.  The Brach and IMRT are nice additions, and retain some hope of curative outcome.  Good luck and continue writing.  We always learn more here than we teach,

max

CMO2021 said:

Dear All,

Dear All,

Thank you for all of your support its hard to express how much it helps.  

Georges,  I should have posted that I had my  Firmagon injections on May 18th.  Yes those little buggers stung and definitely  more sore for a day and then started to get better.   Now  I have these two bumps like large welts or Hives on my stomach.  Doing ok so far just started to have some hot flashes.  Bought a stationary bike and resistance bands.  Haven't quite figured the best workout for the bands but I get on the bike every morning and evening and  break a sweat.  Also get out walking with my wife and our dogs. So hoping that it will help reduce some of the potential effects of ADT if nothing else I think it helps me mentally.

I am fortunate to have a very supportive wife who is somewhat amused (in good way) with my hot flashes its been  a bonding moment.  Additionally I am fortunate to have a friend who was diagnosed at 50 and went 13 years then recurred with mets to the bone which responded well to ADT.  Its nice to talk with someone face to face who is on this journey. So I am building my support group between, this board, my wife and my friend.  Sorry rambling a bit but so appreciative for you all.  

Chris

Great strategy, CMO.  You will find that your 'drive' to work out regularly will diminish greatly as the ADT takes affect, but 'force' yourself to remain active and consistent with your workout plan.  It really does help to minimize the effects of ADT.  I am on my second round of ADT, and I can personally verify that what you are planning is workable and will be greatly beneficial to you. For me, it is a treadmill and a set of adjustable dumbbells.

Hopefully, your medical team recommended that you take daily doses of calcium and vitamin D, to help reduce the effects of bone loss, associated with ADT.

And yes, your wife being supportive is huge.  Ask her to 'push' you, whenever she observes that you might not be sticking with your workout plan.  She can be your task master, as well as being your cheerleader.

Like you, when I complained to my wife about the hot flashes, she replied (good naturedly), "All woman go through this in their lives, so man up!".

CMO,

I have never used Firmagon, or at least, not yet.

My first round of ADT was a cocktail of Lupron and Casodex.  I took Casodex for a month, and then I received my first injection of Lupron.  For me, the effects of Lupron took place slowly after the first injection, and it took about 2 weeks for the typical symptoms to take full effect.

My current round of ADT is a cocktail of Eligard, Zytiga, and Prednisone.  I took Zytiga and Prednisone for 2 weeks, and then I received my first injection of Eligard.  For me, the effects of Eligard took place slowly after the first injection, and it took about 3 weeks for the typical symptoms to take full effect.

As you can see, the symptom occurrence trajectory is similar for both rounds of ADT, as I believe that Lupron and Eligard are essentially the same hormone, with the main difference being how they are injected into your body.  Lupron is injected into muscle tissue (rear end), and Eligard is injected into fat tissue (stomach).

The symptoms for both rounds of ADT for me are similar, with the only significant difference is that with my current ADT cocktail, I get alternating hot flashes and deep chills.  So, I am continuously adding or throwing off clothing, depending on which part of the hot flash and deep chill cycle that I am on at the moment.  I do not recall having the deep chills, when I was on my original ADT cocktail.