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Posted 12/20/2012 12:35 PM (GMT -5)
I now have been on HT (Lupron & casodex) for over almost 15 months. My URO and RO want me to 
continue with the meds for 2 years. Last year they wanted me to go the full 3 years, but now they have 
looked at some current studies and think the 2 years will be enough and I always have the option to go
back on the meds if my PSA goes up after completion my 2 years.
My question is if you were in my shoes (see my stat's below) would you do the 2 years or complete the 
3 year process. I have the typical SE's so if I had to do the 3 years I could.
Thanks and happy holidays to all!!!!!
Posted 12/20/2012 12:58 PM (GMT -5)
I would get a second and perhaps a third opinion from medical oncologists. You will very likely get differing opinions, but at least you may have some different options to consider. When starting HT with SRT I got recommendations ranging from one 3 month shot of luron to 3 years of HT. The HT ranged from Lupron, to ADT2 and ADT3. Based upon the 12 months for HT that I had, I would very much want to avoid 3 years. Best of luck. BB
Posted 12/20/2012 4:01 PM (GMT -5)
Ah, that question, 2 vs 3 years .. I went back and forth on that for a long time. But, I had multiple oncologists recommending 3 years. Since I am doing fairly well on it, I have decided to stick it out for 3 years. My wife certainly thinks I should do the 3 years. I have 11 months left. I can make it .....

Dave, you can see my stats below .. worse than yours. It is a tough call. I would say 2 years minimum. Then, you have to decide how aggressive you want to be and consider how well you are handling the SEs. Good luck.

SC
Posted 12/20/2012 4:08 PM (GMT -5)
I was told 3 years as well....seems like we all have Gleason 9 and most Uros wont recommend intermittent HT for Gleason 9s...at least thats what Ive found so far.
Posted 12/20/2012 4:11 PM (GMT -5)
I'm not as far along as you guys with the ADT, and of course our situations are all a bit different, but my oncologist feels that two years will do it assuming my PSA continues to cooperate.

I am on what I call ADT4, by the way, if you look at its list of sexual side effects, Prozac fits right in with Casodex, Lupron and Avodart.
Posted 12/20/2012 5:19 PM (GMT -5)
Hi Dave,

As you know, our stats are somewhat similar, although I'm only on 12 months of HT. (And in my case, the question was 6 months vs 12 months.)

When I discussed the duration with Drs Scholz and Lam, I was told the data that exists on length of HT/radiation comb is mainly based on older radiation techniques instead of what is being used today at top-end facilities, so that makes it difficult to choose the optimal duration.

But for what it means, Drs Scholz and Lam have a reputation for being aggressive in their treatment and, at least in my case, I'm currently shorter in duration than longer.

Michael
Posted 12/20/2012 8:08 PM (GMT -5)
I am not a G9, but had PSA 59 and a boatload of cancer. From the start all my docs said three years. I have 10 months to go, so in the same boat as SC. Doing well, used to the side effects and they have greatly subsided....maybe I have become numb. I say hit it hard right up front and remember that these cells can take several years to die. Normal prostate cells live two years, one of the longest life span of any human cells. The PCa cells can live indefinately and have been known to lie dormant in bones for fifteen years before causing problems.
Posted 12/20/2012 10:50 PM (GMT -5)
Here's a question I have as I try to learn more about this...would the recommended duration of HT be different if it was part of your original treatment plan versus something that was implemented after surgery or radiation didn't work?
Posted 12/21/2012 2:44 AM (GMT -5)
Michael T,

I can only answer from my husband's standpoint. His primary treatment was HT and right a a year out, he had radiation, as they felt it was a small window for consolidation. We were told at least two years after radiation. So in his case, I guess the 3 year clock started running shortly after diagnosis.
Posted 12/21/2012 8:11 AM (GMT -5)
Hi Dave,
please have a look at the following presentation from Tom Pickles:

http://www.urologyrounds.com/files/PDF/apr-9-08.pdf

Page 23: So how much adjuvant ADT do men really need?
Posted 12/28/2012 11:24 AM (GMT -5)
Thanks LowRoad,

I am going to complete my 24 months (9 1/2 months left!!!! tongue ) and stop at that point. If I am reading the chart correctly I am getting 96% of the benefit at 24 months using ADT. Plus I am worried about other long term SE's after my treatment is over(i.e. heart issues).

Dave

 

Posted 12/29/2012 7:11 AM (GMT -5)
Dave- it is good to consider every darn thing including quality of life, long term effects and results. We in effect play trade off's in this wonderful game. One has to question everything, because results vary, some patients get refractive on LHRH or casodex within like 17-24 months (following ones psa especially monthly you would know if it creeps upward and right away, which is what I did from 2002 forward, watched it like a hawk). I had way worse stats and high risk scenario, ADT3 lasted 2 yrs. (max.) and I caught the minor increases happening 8 months in a row (they were small, but always upwards and progressing). So, one doesn't know for certain how long these drugs will even work, it varies alot. Kind of fantastic I got 8 yrs. more control with other drug method, really makes you question the whole game.

You already are aware of bone density losses and memory losses associated with these and some other drugs. So, probably monitoring your psa and blood markers vary closely after your 24 months might be wise and if you see a few minor increases, then consider either going back on those or switch to something else to control PCa. Even patients with G9's can have way different responses, mentioned in Paact Newsletters awhile back, Dr. Chinn I think it was had an article on such.
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