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Old 06-22-2008, 12:23 PM   #1
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hormone shots prior to radiation

what kind of side effects can i expect with the shot or is it better to skip the shots?
the doctor wants me to have the shots wait awhile then implant gold seeds prior to seven weeks of radiation.
i have a gleason score of of four sixes and one seven.
psa 4.1

 
Old 06-22-2008, 12:28 PM   #2
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Question Re: hormone shots prior to radiation

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Originally Posted by spk958 View Post
what kind of side effects can i expect with the shot or is it better to skip the shots?
the doctor wants me to have the shots wait awhile then implant gold seeds prior to seven weeks of radiation.
i have a gleason score of of four sixes and one seven.
psa 4.1

 
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Old 06-22-2008, 03:07 PM   #3
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Re: hormone shots prior to radiation

Hello spk958,

I'm a fan of hormonal therapy, so I'll give you my view and hope you get others.

Shots for hormonal blockade prior to seeds and external beam radiation are used routinely where the prostate is large. The blockade will shrink the prostate by up to about 30%, often bringing it within the bounds of conventional seeding technique, small enough that the pubic arch does not preclude placement of seeds in some areas. (At least one expert doctor, Dr. Dattoli in Florida, has developed a technique that enables him to insert seeds even when the pubic arch would interfere with a conventional approach.)

Hormonal blockade also serves other purposes. For one thing, it knocks the cancer back on its heels, kind of sterilizing the area through which the seeds will be inserted, it's thought by some, thereby decreasing the likelihood that cancer might escape along the path of insertion. My impression is that that risk is quite small, but apparently it does exist.

Blockade can also in effect stun or even kill some of the prostate cancer cells, especially if it is maintained for a number of months, with maximum cell kill achieved around the nine to twelve months point, according to current opinion. However, it appears that it rarely can knock out the cancer completely, and therefore it is rarely curative.

A lot of research has been done on radiation plus hormonal blockade, and the evidence is strong that many patients will do much better with the combination instead of just with radiation. On the other hand, patients with very low risk cases will probably gain a minimal benefit that makes the value of blockade of questionable worth. I'm a layman with no enrolled medical education, and I have not had radiation, so I haven't kept up with this combination approach as much as I have with blockade itself. I hope you get other responses from those of us who have had to make this choice.

There is a set of side effects with blockade, with most patients experiencing at least some of them. One of the best sources for information is the section on blockade ("androgen deprivation therapy") in the book "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen B. Strum and Donna Pogliano. There are also important countermeasures that will help make the time on blockade as tolerable as possible. Often doctors are not very good at passing that knowledge on, unfortunately. A key point is that the side effects are reversible when blockade is stopped, though they gradually tail off - not a sudden recovery. Another key point is that the length of time on blockade makes a difference for most of us, with a short time usually being associated with an easier time with side effects.

Take care,

Jim

 
Old 06-22-2008, 04:45 PM   #4
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Re: hormone shots prior to radiation

PS - My last post did not give details regarding side effects, and I realize that that is what you probably wanted.

While the Primer has much better detail, here are some of the main ones, with statistics from the medical co-author's practice as stated in the Primer:

- hot flashes (about 48% get them to some degree, with 25% getting them to a really annoying degree). They can be counteracted with medication very effectively for most men, but more of us will have milder flashes that don't require medication A book by Dr. Mark Moyad considers the incidence to be 50 to 66%, not far from the 48% used in the Primer. (The Primer's author is an expert; Dr. Moyad is generally knowledgeable about prostate cancer but is not expert in blockade; I assume he is basing his numbers on a research study.) A book with particularly strong coverage on countering flashes is "100 Questions and Answers About Prostate Cancer," Ellsworth, Heaney, and Gill; the 2003 edition describes them around pages 133-135. It goes into the specifics of several different medications and the possible role of soy.

- decrease or loss of libido (quite common, with about 90% having at least some decrease). Sets in gradually over several months. Partial to substantial ED also for most of us. Both are reversible when blockade is stopped, but radiation may affect ED.

- bone and joint pain (30% of us, with 4% having it to a really bothersome degree)

- decrease of bone density (quite common, though probably quite mild with short term blockade. Can be very effectively counteracted with a bisphosphonate drug (like Fosamax, Boniva, Actonel, etc.) plus calcium and vitamin D3 supplementation (wise to have a Bone Mineral Density scan - Primer discusses DEXA scan vs. qCT scan).

- Anemia (45% with 13% having substantial anemia that might require medication such as Procrit) This means that about 87% of us will not have a significant problem with anemia. It's important with all these side effects to think of the glass as half full, not half empty.

- Weakness (56%, with 5% experiencing substantial weakness). Aerobic and weight bearing exercise are particularly important and effective here, though they generally help counteract many of these potential side effects.

- Hypercholesterolemia (57%, with 34% having it to a substantial degree). Statin drugs help with this side effect as well as with overall survival of prostate cancer. Nutrition, diet, supplements and exercise will also help.

- Gynecomastia (breast growth and tenderness - 38%, with 19% experiencing it to a bothersome degree) Possible but not common from just the shot alone or in combination with an antiandrogen drug. Very common with an antiandrogen (like Casodex or flutamide) used alone.

- Mental/Emotional changes (17% with 14% reporting these changes to a quite bothersome degree)

The Primer has a table covering most of these on page 153. It covers impotency on page 151 and bone density issues on pages 142-143.

I've just mentioned some of the main countermeasures. There are others, and it's helpful for us to use them.

As a general rule, younger men, say in their 50s or younger, have stronger side effects on blockade than do older men.

I've been on intermittent hormonal blockade as my sole therapy for a challenging case for over 8 1/2 years. Like most men who are treated with hormonal blockade, I have found the side effects to be a nuisance and somewhat bothersome but basically quite tolerable. Some of us have a very hard time. One approach is to start blockade with a one month shot and see how you do. At the end of that time, you should have a pretty good idea. If the side effects are too strong (usually hot flashes and sweats) and uncontrollable, then you can knock off the blockade or switch to just an antiandrogen or antiandrogen with finasteride or Avodart. The main issue there is gynecomastia, and there is an optional approach to counteracting that - a short course of radiation to the breasts. Liver function is affected in a few of us, and this can be serious if not addressed, so Liver Function Tests are routinely performed until it's clear how the patient handles the antiandrogen drug.

Again, I'm not a doctor or medically trained, so please just take these as suggestive leads and not as authoritative information.

Jim

 
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Old 06-23-2008, 08:29 AM   #5
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Re: hormone shots prior to radiation

This is a message to Jim:

I read your response regarding hormone shots...do you I read you correctly that you have been taking shots as your only treatment for cancer ?

Thanks,

Mike

 
Old 06-23-2008, 08:46 AM   #6
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Re: hormone shots prior to radiation

Quote:
Originally Posted by mike999 View Post
This is a message to Jim:

I read your response regarding hormone shots...do you I read you correctly that you have been taking shots as your only treatment for cancer ?

Thanks,

Mike
In case Jim doesn't sign on for a while-- the answer is "yes" (and some diet changes etc). There's quite a bit one can learn from his posts-- I'd suggest you look through his previous ones on this board and check these out.

 
Old 06-23-2008, 12:19 PM   #7
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Re: hormone shots prior to radiation

Quote:
Originally Posted by mike999 View Post
This is a message to Jim:

I read your response regarding hormone shots...do you I read you correctly that you have been taking shots as your only treatment for cancer ?

Thanks,

Mike
Hi Mike,

My only treatment has been intermittent hormonal blockade, for which shots have been the foundation, as daff mentioned, plus pills that deliver an "anti-androgen" drug (Casodex, 50 mg for me) and a "5-alpha reductase inhibitor" drug (finasteride, which used to be called Proscar, for me). That's known as intermittent triple blockade with Proscar maintenance, or triple androgen deprivation therapy with maintenance, or similar names. Most of us on that therapy are also taking a bisphosphonate drug to preserve bone density and, if the drug is Zometa, to help avoid, control or reverse bone metastases. As daff noted, nutrition, diet, supplement, and lifestyle tactics including exercise and stress reduction are also part of my therapy. I'm also taking a statin drug primarily because those drugs appear to help us avoid lethal prostate cancer; of course, it also helps control cholesterol.

I wrote about my eighth year anniversary as a survivor and gave my story in two threads last winter. Those threads included details, if you are interested.

I chose this therapy in 2000 because it then looked likely that no local or combination therapy would be curative and I would have the side effect burden without the curative benefit (still looks that way). It now appears that knocking down the volume of cancer, even without getting it all, may provide a substantial benefit, but patients like me are faced with the question whether to stick with our current course or add a non-curative approach, with its additional side effects, that may or may not provide a substantial benefit.

Some low risk patients are choosing this therapy, and it appears that many only need one round of full blockade of about a year before knocking off the heavy duty drugs and continuing with just finasteride or Avodart for maintenance.

Intermittent triple blockade with maintenance is probably rarely curative, but it appears to offer long-term control for many patients, perhaps indefinite control. It's a judgment call, and hopefully more papers describing results will be published in formal medical literature about this approach. At the moment, there has been only one paper in a major journal, plus a few other publications. There have been a number of presentations at medical conferences and informal publications.

Take care,

Jim

 
Old 06-24-2008, 09:21 AM   #8
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Re: hormone shots prior to radiation

Hello Jim:

You are very knowing & you have been incredibly helpful to many of us out here.

Thank you for the information regarding hormone treatments. Here is the latest with my situation....I had both psa & free psa tests repeated recently, the results came back as follows...total psa 6.8 & 8.0 ! the lab had reported 2 values....is there that much reading to reading variability ?, and a free psa of 13 % these values have been the same since last nov. Do you think that a second biopsy is warranted ? {my 1st was negative for 16 cores}

Thanks,

Mike

Last edited by mod_007; 06-24-2008 at 05:15 PM. Reason: Do not put anyone in the position of having to breach posting rules. It is not permitted to post claims to medical training

 
Old 06-24-2008, 10:09 AM   #9
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Re: hormone shots prior to radiation

You addressed this to Jim but I thought I'd throw my two cents worth in. Good news that your PSA readings haven't changed much. IMO it's a little too much to expect to get specific advice on whether or not to get a biopsy from people on this board who obviously aren't familiar with your complete medical history, don't know your age etc. If I recall, there was a past post that mentioned a nodule on your prostate- so obviously the DRE factors into this too. Maybe now's the time for you to get an opinion from a different doctor before deciding on if/when to get the next biopsy- and if so, whether or not to have even more cores sampled.

Last edited by mod_007; 06-24-2008 at 05:16 PM. Reason: removed unnecessary quote

 
Old 06-24-2008, 01:42 PM   #10
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Re: hormone shots prior to radiation

thanks for your input..I am 57 I have an enlarged prostate & a nodule...this is the reason my doc wanted me to get a biposy in the first place

Mike

 
Old 06-26-2008, 04:59 PM   #11
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Re: hormone shots prior to radiation

Quote:
Originally Posted by mike999 View Post
...I had both psa & free psa tests repeated recently, the results came back as follows...total psa 6.8 & 8.0 ! the lab had reported 2 values....is there that much reading to reading variability ?, and a free psa of 13 % these values have been the same since last nov. ...Thanks,

Mike
Hi again Mike,

daff makes excellent points!

and thank you for your kind words!

Regarding variability between tests, I recall 15% variability as common even for the same test run by the same lab but on a sample from a day later. I wish I could confirm that; help someone? Comparison of two different tests on the same sample, or even the same test on the same sample but by two different labs would also lead to some variability, something I've seen in my own results in those rare circumstances where I've had back-to-back tests. The amount of variability you saw strikes me as within what you could expect, but I would sure ask the doctor what he thought the cause was.

About nodules, today I was reading something written in 1999 by Dr. David Bostick, a leading prostate cancer pathologist. He wrote that fewer than half of nodules turn out to be prostate cancer, and that false positives are due to BPH, stones (such as calcium stones), prostate infections, and the results of previous surgeries.

Jim

 
Old 06-27-2008, 10:13 AM   #12
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Re: hormone shots prior to radiation

Thanks Jim:

This waiting & not knowing my conditon for sure is making me nuts ! what do you make of my numbers?

Mike

 
Old 06-27-2008, 03:02 PM   #13
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Re: hormone shots prior to radiation

Quote:
Originally Posted by mike999 View Post
Thanks Jim:

This waiting & not knowing my conditon for sure is making me nuts ! what do you make of my numbers?

Mike
Going back to what you posted in the past, your PSA has been as high as 11.4 before dropping. To me that's a sign that something other than cancer is involved, but I'm not medically trained, and a doctor could give you an authoritative view. Why couldn't whatever caused that rise to 11.4 still be affecting your PSA somewhat? That could account for some elevation and variation, it seems to me. Also, an enlarged prostate would generate some extra PSA. You can use the rule-of-thumb of cc of prostate X .066 to estimate the amount of PSA due to healthy cells. But the big thing is the possible infection or other cause leading to that 11.4 in my layman's opinion.

Waiting is tough! Hang in there!

Jim

 
Old 06-30-2008, 09:26 AM   #14
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Smile Re: hormone shots prior to radiation

Jim:

As always, thanks for your insights......From what I have learned if I did have prostate cancer, I would expect to see a consistent increase in psa level over time. Over a 7 month period {11/07- 6/08} my psa level has "flattened out at ~ 6.7, with the one spike @ 11.4.
The concern is the free psa level, which has ranged from ~ 11 to 15 %, what other "assignable cause(s)" other than cancer would yield a free psa level in this range ? The current thinking is that > 10 % to < 25 % is a "grey zone"

Mike

 
Old 07-01-2008, 02:06 PM   #15
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Re: hormone shots prior to radiation

Quote:
Originally Posted by mike999 View Post
...The concern is the free psa level, which has ranged from ~ 11 to 15 %, what other "assignable cause(s)" other than cancer would yield a free psa level in this range ? The current thinking is that > 10 % to < 25 % is a "grey zone"

Mike
Hi Mike,

That free PSA will probably remain a concern; I know I would feel concerned.

However, there is an explanation that could likely apply in your case, based on what you have posted previously: prostatitis. Here's what the Primer says about it: "... However, prostatitis can result in low free PSA percentages that make laboratory distinction from PC treacherous...." ("A Primer on Prostate Cancer - The Empowered Patient's Guide," p. 38)

Take care,

Jim

 
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