When to start ADT [Prostate Cancer Support]

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From: Sue Mullen on 30 Sep 2008 17:23

Alan Meyer wrote:
> There's very little that I can add to I.P.'s excellent post.
> He's pretty much said it all. However I will add a refinement to
> what I.P. said:
>
>> ... ADT's most certain SE is probably fatigue; that's a minor
>> nuisance for an inactive person, a showstopper for a diehard
>> jock ...
>
> I agree with the general point but will add that an inactive
> person may suffer most from ADT fatigue. Steve K. has pointed
> out that he had done well when he exercised every day but when he
> stopped he became overly tired. Another poster, I forget who it
> was, said that he was working out every day like a demon and now,
> in spite of the ADT, is in the best shape of his life. So to
> _some_ extent, fatigue is under the patient's control.

One thing I haven't seen posted is that there is more then one brand of
ADT. Kevin has found that Trelstar makes him more fatigued and his
migranes get to be very bad. When he gets Lupron shots his headaches
easee up and he has a lot more energy.

sue

From: fred on 29 Sep 2008 22:37

What is the conventional wisdom about when to start ADT when faced
with rising PSA after surgery and SRT?

I assume that, like everything to do with PCa, there are different
schools of thought. I see Steve K and others started ADT when their
PSA was well under 1.0, yet Bill/Memphis says all the drs he has
consulted advise him to do nothing until he goes over 5.0. I know
everyone's case is different, but that seems to be quite a spread...

Fred

From: Heather on 30 Sep 2008 01:01

From: Steve Kramer on 30 Sep 2008 04:45

"fred" <ndaviesruckrnd(a)aol.com> wrote in message
news:1a139e8e-d8a0-4ca3-a1ad-8618b2364821(a)m44g2000hsc.googlegroups.com...
> What is the conventional wisdom about when to start ADT when faced
> with rising PSA after surgery and SRT?
>
> I assume that, like everything to do with PCa, there are different
> schools of thought. I see Steve K and others started ADT when their
> PSA was well under 1.0, yet Bill/Memphis says all the drs he has
> consulted advise him to do nothing until he goes over 5.0. I know
> everyone's case is different, but that seems to be quite a spread...
>

And that's exactly how it is. Different doctors select different mileposts
in which to start. I would imagine most would say they are eliminating all
other possibilities other than recurrence of cancer. My SRT was decided at
0.37. By then, I had had two consecutive raises and a .19-year doubling
rate. There was no doubt my cancer was back.

--
PSA 16 10/17/2000 @ 46
Biopsy 11/01/2000 G7 (3+4), T2c
RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
EBRT 05-07/2002 @ 47
PSA .34 .22 .15 .21 .32 PSAD .056 years
Lupron 07/03 (1 mo) 8/03 and every 4 months there after
PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
Casodex added daily 07/06
PSA <0.04, <0.05, <0.04, <0.04, <0.1 2/12/08
Illegitimati non carborundum

From: I.P. Freely on 30 Sep 2008 12:09

The world's leading experts disagree. Some oncologists advocate ADT as
soon as we recover from our first surgery or radiation, PSA or no PSA,
just in case there may be some stray cancer cells lurking. Others say
wait until PSA rises to some level or another or some scan or another
shows positive results. Others say wait until symptoms appear, still
others ask "why not wait until symptoms reach the point that ADT
*improves* the patient's QOL?" Some (wisely?) say any of the above may
be appropriate, depending on each pt's priorities.

Picking a college, a career, and a wife -- collectively -- was easy for
me compared to evaluating ADT ... until I backed up and assessed my
criteria and THEN returned to my study of how ADT would mesh with them.
Only choosing what new car to buy takes me longer than any of those, but
then my only ADT decision so far has been in the vacuum of unmeasurable
PSA; my tune may change when I reach your stage.

One pt might value interim QOL above the timing of his demise and refuse
ADT. Another may value max life span above all and welcome ADT. The next
guy may try ADT to determine how significantly it impacts his QOL before
deciding when to start in earnest. Still others have decided their ADT
SEs were worse than their advanced cancer and quit cold turkey with full
medical knowledge of the outcome. Many, maybe most, doctors don't care
about our priorities, so it could be argued that their recommendations
are sort of irrelevant unless they fully evaluate and understand our
priorities and show clear signs of tailoring their advice accordingly.
There's no way I'd let a doctor or car salesman choose my next car; why
should I let him dictate my near and/or far term health and/or QOL? You
apparently agree to some extent, because you're asking for our input.

Thus I suggest you very clearly identify and prioritize your short and
long term criteria regarding QOL, ultimate longevity, and objectives.
Only then, I believe, can we assess how each ADT fact, statistic, and
professional opinion (I've deliberately omitted anecdotal stories) may
affect us. For example, ADT's most certain SE is probably fatigue;
that's a minor nuisance for an inactive person, a showstopper for a
diehard jock. You might ask yourself, for example, where you fit on that
scale. Do you have any arthritis? Diabetes? Sleep problems? (ADT often
exacerbates those.) Would you rather ultimately live a few months
longer, or win the state seniors' tennis tournament a few more times?
Only you can ask and answer those and many similar questions ... and at
some point symptoms may render them moot unless SEs are even worse.

You'll notice I keep waffling. That's deliberate, because although we
can all list ADT's pros and cons and the published but highly debatable
statistics thereof, no one but ourselves can list our priorities and
individual cases vary so much. I think this is a classic case of the
insignificance of conventional (i.e., average or median) wisdom.

I.P.

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