When to start Hormone Therapy?
|
From: Arthur Johnson on 22 Jul 2006 21:48 My question for all of you fine people here is at what psa point to start H.T.? Also can there be a bounce in psa after salvage IMRT to drive my 0.6 up from 0.1 after approx. 10 mos. ? RP 9-04 PSA 0.1 approx 9 mos. 0.6 I finished 8 wks.of salvage IMRT 72gy in 9-05 PSA 0.1, 0.1 & 7-20-06 back to 0.6 Bad news--will repeat psa again. T3a g-7 with microscopic extension at the bladder. PSA before RP 9.9 age 72+ Uro wants to start H.T. after repeat psa. I don't know but, I don't want too. He also wants a new C.Scan . I don't think that's right either. I will seek a Oncologest for H.T. THANKS, ART
From: Alan Meyer on 22 Jul 2006 23:11 "Arthur Johnson" <Arthur33(a)webtv.net> wrote in message news:2624-44C2D56F-607(a)storefull-3273.bay.webtv.net... > My question for all of you fine people here is at what psa point to > start H.T.? Also can there be a bounce in psa after salvage IMRT to > drive my 0.6 > up from 0.1 after approx. 10 mos. ? > > RP 9-04 PSA 0.1 approx 9 mos. 0.6 I finished > 8 wks.of salvage IMRT 72gy in 9-05 PSA 0.1, 0.1 > & 7-20-06 back to 0.6 Bad news--will repeat psa again. T3a g-7 with > microscopic extension at the > bladder. PSA before RP 9.9 age 72+ > > Uro wants to start H.T. after repeat psa. I don't know but, I don't > want too. He also wants a new C.Scan . I don't think that's right > either. I will > seek a Oncologest for H.T. THANKS, ART I don't know the answer to your question. I agree that you should consult a specialist oncologist who is experienced with hormone therapy for PCa. Some questions I would ask him are: How long is it likely to take before I experience symptoms if I do nothing? How long if I take HT? Ditto for dying of PCa. If he can't answer that because there isn't enough information, then ask him how long might it take to gather enough info? For example, he might need to see the PSA trend over a year or so before he can see how quickly it's rising. Or he might need to take a PSA test every 3 months and see how long it takes for you to reach a particular threshold. Ask if there is some PSA level above which you should definitely begin HT. I would also ask about non-prescription supplements. Does he think that lycopene (in tomato juice), pomegranate juice, vitamins C, D or E, selenium, EGCG (from green tea), or any of the other supplements proposed for PCa patients are worth taking in hopes of slowing down progression? A recent study much discussed on this newsgroup claimed that men drinking 8 ounces of pomegranate juice significantly slowed the rate of rise of PSA. In general, I agree with your cautious approach. HT has significant side effects. You don't want it if you don't need it. Experts seem to disagree about the best time to take HT. Some say to take it immediately and some say to wait. I would ask the doctor about his view of the pros and cons of each approach. I'm sure you can live for years before you will experience any symptoms. I hope the years are many and that your health is good. Alan
From: I.P. Freely on 22 Jul 2006 23:24 Arthur Johnson wrote: > My question for all of you fine people here is at what psa point to > start H.T. . . . after salvage IMRT Of the four basic options -- right after RT or RP, when PSA rises, when mets are detected by tests, or when met symptoms appear -- the only ADT (HT) starting points oncologists agree on is when symptoms appear. Any earlier starting point is debated among the experts. I don't know when or whether I'll start it (I had RP 20 months ago), and have no specific, medical reason to pursue further treatment yet. I.P.
From: Steve Jordan on 22 Jul 2006 23:36 On July 22, Arthur Johnson inquired about PSA "bump" post RT. Strum & Pogliano define the PSA "bump" as follows: "Approximately 35% of patients experience a temporary rise in PSA after first having a decline in PSA after completion of brachytherapy. This...has been defined as an increase of 0.1 ng/mL or greater above the preceding PSA level followed by a subsequent decrease below that level. The average time to the PSA "bump" is 18-20 months." _A Primer on Prostate Cancer_ 2nd ed., page 103. Note that the reference is to brachytherapy, not to IMRT. And a genuine "bump" is due to prostatitis Arthur also inquired about the point at which to resume or start ADT. Alan Meyer responded, in pertinent part: > Experts seem to disagree about the best time to take HT. > Some say to take it immediately and some say to wait. > I would ask the doctor about his view of the pros and cons > of each approach. > My favorite med onc, Strum, says: "There is NOWHERE in oncology where waiting for the tumor cell population to increase (and to mutate) is in the better interests of the patient. The use of early ADT3 as advocated by our group (Scholz, Lam & myself) & also by Leibowitz & Tucker & also per the experiences of Myers & Tisman, all attest to the rational, logical endocrinologic approach to PC management." (Emphasis in original) The exact PSA test result at which to start is a matter of debate. I have selected my cutpoint, but it is personal to me and likely would not be suitable to others. I'll only say that it isn't very high. Regards, Steve J
From: I.P. Freely on 23 Jul 2006 00:32
Steve Jordan wrote: > My favorite med onc, Strum, says: > > "There is NOWHERE in oncology where waiting for the tumor cell > population to increase (and to mutate) is in the better interests of the > patient. One solid exception is a pt who is reasonably likely to die of something else before his PC symptoms get severe. It's a crapshoot, with odds loosely defined by each pt's circumstances and choices strongly impacted by his priorities. I.P. |