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  • 75 years old started treatment for prostate cancer

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    Old 10-11-2020, 04:22 PM   #1
    BC1967
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    75 years old started treatment for prostate cancer

    I'm 75 years old and was diagnosed with prostate cancer a year ago. At the time I had 1 tumor with a Gleeson score of 3,3. I had a biopsy done 2 months ago and there is a second tumor with a Gleeson score of 4,3. The first tumor hasn't changed. I met with the cancer team at Dana Farber in Boston and the plan is hormone therapy (stop production of testosterone), brachy therapy and targeted radiation. The hormone therapy I started 4 days ago and I'm feeling fatigued. Had one injection and taking Bicalutamide 50 mg x1. The brachy therapy will happen in about a month and targeted radiation a week or 2 after that. The brachy therapy will be one time high dose. I'm looking for any experiences or advice that anyone in this group can provide. Thanks in advance and best of luck in your journey.

     
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    Old 10-11-2020, 08:12 PM   #2
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    Re: 75 years old started treatment for prostate cancer

    The good news is you are in the early stages of the disease and your age has you toward the upper value of your life expectancy. The treatment sounds rather aggressive considering your age. 6 months should be the maximum duration of the ADT and your testosterone should recover within 6 months of the end of treatment.

     
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    Old 10-11-2020, 08:32 PM   #3
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    Re: 75 years old started treatment for prostate cancer

    i have not had that treatment, but have read many, many comments from men who had. That is probably the most prescribed treatment plan for men of your age and pathology, and it has very good non-recurrence results.

    But, listen to Insanus about the duration of the ADT, as you do not want that impacting your quality of life for longer than necessary.
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    Seven biopsies from 2009 to 2021. Three were were positive with 5% Gleason(3+3) found.

     
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    Old 10-12-2020, 05:28 AM   #4
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    Re: 75 years old started treatment for prostate cancer

    I am 76 and my history is almost identical. This past spring my Uro wanted to send me for 44 radiation treatments. I knew I would go crazy doing that so went to Sloan Kettering. They recommended 5 radiations (M, W, F, M, W) using their version of CyberKnife, "Precise". After a couple of prep sessions, did the treatments. No significant after effects, except for some minor burning when urinating for a couple of weeks. The radiation Oncologist who managed me said that nothing else needs doing except every 3-6 months a PSA.

    Your situation may be different, just offering mine as something to think about.
    Good luck.

     
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    Old 10-12-2020, 11:37 AM   #5
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    Re: 75 years old started treatment for prostate cancer

    Hi BC1967 and welcome to the Board!

    The Boston area has some of the top expertise in treating prostate cancer in the world, especially in radiation, with Dana Farber being a well-known center for prostate cancer research and treatment. While you have not identified the radiation oncologist, it seems highly likely that you would be getting top-notch treatment.

    I am a veteran of high-risk prostate cancer, holding the fort with a long course of intermittent ADT until radiation and related technology improved, then going for an apparently successful cure in 2013, and that helps me understand your case and recommeded course of treatment. Based on the limited case data you presented, your case is at least "intermediate" in risk level. As such, 4 to 6 months of ADT in support of radiation would be the well-accepted norm, based on an abundance of medical research. If you have a high-risk case, then 18 to 24 months would be the norm. In either case, it would be very wise for you to use some countermeasures for side effects of ADT, but especially if you will be on a long course of ADT. I just recommended two books that cover dealing with side effects on today's other recent thread involving radiation.

    In particular, exercise, if you can do it, is VERY important in countering fatigue from ADT. Both strength (weights, resistance) and aerobic exercise are helpful, and neither needs to be extreme. My main aerobic exercise was/is walking. There are also some anti-fatigue medications that may help. I'm off ADT now, but I use some of those small containers of energy liquids from time to time to get a 5 hour boost and find they do the job, and I'm still able to sleep well, at least most of the time.

    Has your team mentioned the old diabetes drug metformin in support of both radiation and ADT? It is not yet standard of care as studies are ongoing, but it is looking good, and for almost all patients it is well tolerated with proper dosing. Ask them about it.

    Good luck!

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 10-12-2020, 03:14 PM   #6
    GuyBMeredith
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    Re: 75 years old started treatment for prostate cancer

    I'm curious as to why the brachy therapy. At 74 I had ADT and IMRT. Not a big deal if you can deal with menopause symptoms during the ADT course. Hot flashes, sometimes strong emotions, shrunken testicles, etc.

    One of my big issues is maintaining sexual function, which, at age 74, got a roll of the eyes from the urologist. I like to tease her about that now. Anyway, you will most likely have little interest while on ADT, but with physical stimulation and erotica you can probably produce the erections needed to help keep erectile tissue healthy and functional once off treatment.
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8 Aug 2019 PSA 3.1 Urologist suggests biopsy in Oct Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020. Sexual functions okay except ejaculate has changed. Without libido it is an academic process that requires much focus. July 27 first measure of PSA and total testosterone. PSA: .13 ng/dl Total testosterone is less than 12 ng/dl.

     
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    Old 10-12-2020, 04:17 PM   #7
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    Re: 75 years old started treatment for prostate cancer

    Quote:
    Originally Posted by GuyBMeredith View Post
    I'm curious as to why the brachy therapy. At 74 I had ADT and IMRT. Not a big deal if you can deal with menopause symptoms during the ADT course. Hot flashes, sometimes strong emotions, shrunken testicles, etc.

    One of my big issues is maintaining sexual function, which, at age 74, got a roll of the eyes from the urologist. I like to tease her about that now. Anyway, you will most likely have little interest while on ADT, but with physical stimulation and erotica you can probably produce the erections needed to help keep erectile tissue healthy and functional once off treatment.
    He is having a brachytherapy boost to his IMRT treatment. It has a very impressive non-recurrence record.

    https://www.medpagetoday.com/hematologyoncology/prostatecancer/71560

     
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    Old 10-12-2020, 07:27 PM   #8
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    Re: 75 years old started treatment for prostate cancer

    Side effects?
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8 Aug 2019 PSA 3.1 Urologist suggests biopsy in Oct Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020. Sexual functions okay except ejaculate has changed. Without libido it is an academic process that requires much focus. July 27 first measure of PSA and total testosterone. PSA: .13 ng/dl Total testosterone is less than 12 ng/dl.

     
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    Old 10-13-2020, 05:32 AM   #9
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    Re: 75 years old started treatment for prostate cancer

    Prostate cancer is multifocal, meaning it does not grow as a tumor, but in numerous cells/ locations.

    The biopsy samples a very small single digit percentage of the organ. It is more accurate to say you have prostate cancer than to say you have two prostate cancer tumors in your prostate.

     
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    Old 10-23-2020, 08:36 PM   #10
    BC1967
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    Re: 75 years old started treatment for prostate cancer

    Thanks. I'm still getting used to the terminology as well as treatment options. All I know is that I had cancer in a portion of the prostate which was Gleeson 3+3. Active surveillance for a year and second biopsy was performed. Found cancer in another part of the prostate Gleeson 4+3. The first one is still Gleeson 3+3. When they did the biopsy they snipped (best way I can describe it) 12-13 samples from different areas of my prostate. Not on my bucket list to have that done again soon

     
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    Old 10-24-2020, 01:50 PM   #11
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    Re: 75 years old started treatment for prostate cancer

    Only 4 Months of Supportive ADT Needed for Radiation for Intermediate Risk Cases

    Hi again BC1967. I am writing to modify something I previously posted:

    Quote:
    Originally Posted by IADT3since2000 View Post
    ... Based on the limited case data you presented, your case is at least "intermediate" in risk level. As such, 4 to 6 months of ADT in support of radiation would be the well-accepted norm, based on an abundance of medical research.....
    I recently learned from one of the world's leading prostate cancer radiation oncologists that only 4 months, as contrasted with 4 to 6, is needed for men with intermediate risk prostate cancer. The source is Dr. Mack Roach, who practices at UCSF, a renowned center for prostate cancer research and treatment. He stated that the biggest mistake he saw intermediate risk patients making was to get 6 months instead of just 4 months of ADT in support of their radiation. He based that on a study that compared 4 months of ADT to 7 or 9 months for such patients; the study found that 4 months was equally effective, and therefore anything from 5 to 8 months would be no more effective while extending ADT side effects with no value gained for the unnecessary two months.

    This research is reflected in recent guidance from a prominent, widely accepted guideline group, the National Comprehensive Cancer Network, NCCN, in its guideline 2.2020 for prostate cancer (physician's version). (You need to register, for free, but do not have to be a physician to access the guideline at https://www.nccn.org/professionals/physician_gls/pdf/prostate_blocks.pdf. ) The key study is " Pisansky TM, Hunt D, Gomella LG, et al. Duration of androgen suppression before radiotherapy for localized prostate cancer: radiation therapy oncology group randomized clinical trial 9910. J Clin Oncol 2015;33:332-339. Available at: http://www.ncbi.nlm.nih.gov/pubmed/25534388 " Both Dr. Roach of UCSF and Dr. Anthony D'Amico of Dana Farber are on the NCCN guideline panel, along with six other radiation oncologists.

    The guidelines are in two sections, Principles and Discussions, and the length of supportive ADT is addressed in both. The section on Principles is equivocal on the length of ADT, allowing the possibility of more than 4 months. It is clear from the Discussion Section, Neoadjuvant, Concurrent, and/or Adjuvant ADT with EBRT for Intermediate-Risk Disease (MS-29), that a duration of only 4 months is needed.

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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    Old 10-25-2020, 03:01 AM   #12
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    Re: 75 years old started treatment for prostate cancer

    Quote:
    Originally Posted by BC1967 View Post
    Thanks. I'm still getting used to the terminology as well as treatment options. All I know is that I had cancer in a portion of the prostate which was Gleeson 3+3. Active surveillance for a year and second biopsy was performed. Found cancer in another part of the prostate Gleeson 4+3. The first one is still Gleeson 3+3. When they did the biopsy they snipped (best way I can describe it) 12-13 samples from different areas of my prostate. Not on my bucket list to have that done again soon
    They punch a hollow needle into your prostate and remove a core of prostate tissue. They do this typically 12 times in a pattern designed to sample all areas of the prostate. The samples are about the diameter of a wet kite string less than a half inch looking.

    However some areas are very difficult to reach from the angle they approach. It can miss significant cancer. 80% of all men will have prostate cancer by the time they are 80 years old.

     
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    Old 10-25-2020, 11:46 AM   #13
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    Re: 75 years old started treatment for prostate cancer

    I decided that if I were to have additional biopsies on the AS option they would be under sedation. My urologist just said that I had tolerated the biopsy well, suggesting that sedation is not needed. I hope she was kidding.

    Thanks, Jim, for the remarks on duration of ADT with IMRT. I was in a position to call quits after 5 months and when I asked was THEN told the guidelines call for 4 to 6 months. I was doing pretty well on lupron so decided to go the 6th month.
    __________________
    Diagnosed at age 73 Feb 2019 DRE indicates nodule PSA 2.8 Aug 2019 PSA 3.1 Urologist suggests biopsy in Oct Results of biopsy: 2 of 12 cores positive. Low volume T2b, intermediate risk, GS 3+4, PSA 3.10, prostate cancer, perineural invasion. Followed up with MRI to help decide between surgery and IMRT. MRI shows suspicious PIRADS 5 lesion measuring 2.cm in diameter, with associated left neurovascular bundle involvement. Started 6 month lupron series Feb 2020, 28 sessions of high dose IMRT Apr 15, 2020. Sexual functions okay except ejaculate has changed. Without libido it is an academic process that requires much focus. July 27 first measure of PSA and total testosterone. PSA: .13 ng/dl Total testosterone is less than 12 ng/dl.

     
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    Old 10-25-2020, 12:56 PM   #14
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    Re: 75 years old started treatment for prostate cancer

    Quote:
    Originally Posted by GuyBMeredith View Post
    Thanks, Jim, for the remarks on duration of ADT with IMRT. I was in a position to call quits after 5 months and when I asked was THEN told the guidelines call for 4 to 6 months. I was doing pretty well on lupron so decided to go the 6th month.
    That makes sense to me, as I too tolerated Lupron well. I had side effects, but by the fourth month I was cruising along, used to the routine (and knowing that I had many more months ahead of me thanks to my high-risk case).

    It's going to take some time for the research on four months to percolate through our medical community. At least empowered patients can now let their doctors know that they want the shorter duration and give the docs research to support their point.

    .Jim

    - - - - - - - - - - - - - - - - - - - - - - - -
    Diagnosis Dec 1999 PSA 113.6 (first ever), age 56
    Gleason 4+3=7 (J. Epstein, JHU), all cores +, most 100%; "rock hard" prostate with ECE - stage 3, PNI, PSADT determined later 3-4 months; technetium bone scan and CT scan negative; prognosis 5 years.
    Later ProstaScint scan negative except for one suspicious small area in an unlikely location. ADT Lupron as first therapy, in Dec 1999, then + Casodex in March 2000, then + Proscar and Fosamax in Sep 2000. Rejected for surgery January 2000; offered radiation but told success odds were low; switched to ADT only vice radiation in May 2000, betting on holding the fort for improved technology; PSA gradual decline to <0.01 May 2002. Commenced intermittent ADT3 (IADT3) with first vacation from Lupron & Casodex. Negative advanced scans in 2011 (NaF18 PET/CT for bone) and 2012 (Feraheme USPIO for nodes and soft tissue). With improved technology, tried TomoTherapy RT, 39 sessions, in early 2013, plus ADT 3 in support for 18 months (fourth round of IADT3), ended April 2014. Continuing with Avodart as anti-recurrence shield. Current PSA remarkably low and stable at <0.01; apparently cured (Current PSA as of 9/4/2020). (Current T 128 9/4/20.) Supportive diet/nutrition, exercise, supportive medications during this journey, as well as switches in antiandrogen, 5-ARI, and bone drugs. Barely noticeable side effects from radiation; continuing low T, likely do to long use of ADT, but good energy and adequate strength. I have a lot of School of Hard Knocks knowledge, and have followed research, which has made me an empowered and savvy patient, but I have had no enrolled medical education.

     
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