To HT or not to HT

Hello all-

Been a while since I've posted. I've been working lots of hours and have managed to investigate and narrow treatment options down to two: HDR Brachy mono therapy or HDR combo with IMRT/ADT. I've got dates lined up and am ready to pull the trigger.

The experts I've met with believe that HDR Brachy mono therapy would give me around a 75-85% cure rate (depending on the doc). I've been told by the same set that HDR brachy combined with IMRT including the lymph nodes + 2 months neoadjuvent/2 months concurrent ADT would improve those numbers an additional 5 -10%. I have been told that without ADT the combo therapy to the LN's has been shown to add relatively little benefit and is pretty controversial.

The SE's of HT from the studies I've read and seem daunting even though this has been downplayed by most for the docs for a treatment duration of 4 months.

My single biggest concern is the potential impact on my emotional and cognitive state. I have suffered with severe anxiety and depression for most of my life. It has crushed me time and again stolen long stretches of my life and diminished most of the rest. I'm not speaking about worry here - instead a near paralysis, including one brief hospitalization.

I'm in a comparatively good place now in spite of the added anxiety of the prostate cancer, but still have to fight my way through symptoms daily. The literature seems pretty clear that this is a real concern, especially when there is a predisposition. One doc told me that he never thought much of the risk until one of his patients had to be hospitalized. If ADT causes my condition to deteriorate I'm concerned of the impact on my wife and young child and my performance in a pretty demanding workplace.

I'm challenged with the prospect of being stuck if things go bad because of the minimum one month dose (lupron or degarelex). Though using testosterone as an "antidote" might help counteract this (with lupron anyhow), regaining any sort of equilibrium would probably still take time and be difficult.

I apologize in advance if it is hard to be empathetic with someone who has a choice - especially one that includes only 4 months of treatment. I have read here that many of you have endured so much more. I'm looking for your first hand knowledge on how ADT impacted you and what you have learned from others being treated.

My question is to all but especially to those have taken HT - what are your thoughts on adding combo with the HT especially in my situation?

I know that if the first round of treatment is not successful I won't have a choice the next time. I'm trying to to take the best shot with this one and have to decide if that means leaving the extra 5 - 10% on the table.

Thanks,

Walton

I am no doctor, but given your concerns I'd think going the HDR Mono might just be the ticket for you.

85% is good odds and I'd suspect that might be all you need.

It's a tough choice, but HDR brachy followed by a year of monitoring might be all you need. The odds, what ifs and maybes can drive you crazy. Take your shot and hope for the best.

Andrew

In my experience, four months of ADT is very minor for side effects. The studies show that you also recover very quickly from a short period, particularly at your age. I would not think that TRT would be necessary. I was on ADT3 for more than three years and compared to side effects of advanced metastatic cancer, they have been mild.

My brother's brother-in-law has very aggressive PCa and has been on ADT twice following surgery and radiation. Each time for three years. The first time he did start to suffer from depression. Knowing this, his doctors better prepared him for the second round with improved physical activity, diet, and meditation and he had a much better experience.

Walton,

I take Klonopin for my anxiety. I am not sure if you are on Meds for your anxiety; however, if you are I would give some consideration to drug interactions.

I would check with my psychiatrist, or whoever is prescribing my Meds, before I would start HT.

Post Edited (RCS) : 12/9/2014 8:01:23 AM (GMT-7)

Walton:
I feel your pain! I suffered anxiety all my life and depression/panic attacks starting at age 43, which I treated with every imaginable medication and years of psychiatry sessions. Finally, after retiring early at age 54, due in part to the pain experienced with stress, and going on Cymbalta, the pain of depression started to stop. A couple years ago, I added deplin which helps cymbalta work and, anxiety and depression is a thing of the past.

If it weren't for these meds, and going to the gym 3-4 times a week, and playing golf, I don't know how I could have withstood, the following over the last three years: Knee surgery, rotator cuff surgery, Radical Prostatectomy after dx with gleason 9 Pca , total shoulder replacement of same shoulder, and IMRT and ADT after recurrent Pca! I took all of these insults to the body and mind in stride.

ADT is tough. If you look at my signature, you'll see that it was the worst of my three pCa treatments in terms of side effects. I would not go through it if I didn't have my depression and anxiety under control. Being a stage pt3b gleason 9 patient, I really had no choice but to go through ADT, which studies have shown benefit the most from ADT. Some would argue that six months was not enough, but it's enough for me.
If you only need ADT for four months, that's great and not as bad as a longer period. Just be sure you have an outstanding urologist and do everything you can to reduce your anxiety and depression!!

God Bless!
Bob

Walton,

You are getting some very valuable information. Hopefully it will put you in a great position for your next doctor visit. I suggest you print this thread and share with your doctor. After all I bet he has never had brachytherapy, hormone therapy and probably doesn't suffer from anxiety or depression. These real life experiences could be useful for your doctors to determine the best approach.

I certainly second Michael_T's suggestion that you get one month shots. You are likely to recover faster versus a four month shot. Depending on whether you are on Lupron or Eligard, the more frequent injections are not fun, but may be worth it for a faster T recovery. My uro says that Lupron and Eligard have a half life of six months. Thus it will linger in your system for awhile following the last injection.