Discussions that mention zoladex

Cancer: Prostate board

[COLOR="DarkGreen"]Hi again Richard,

I'm going to intersperse some comments in green. About your wondering if you did the right thing. My feeling is that we all pay our money and place our bets, hopefully after sound thought and prayer. Sometimes it works out well, but sometimes it leaves us with further work or a challenge. It doesn't seem that much good comes from looking backward.

[QUOTE=richarda123;3632541]... 1st PSA was unfortunately .11 with .1 sensitivity. Removed prostate had a good pathology report but did have the 1 out of 22 lymph node involvement. ... Had my 1st oncology visit that said my long term chances would have been better if I had gone with combo radiation/hormone, rather than RP, which was surprising. We're waiting for a 2nd PSA and then a probable 7 week radiation treatment. Kind of puzzling but he didn't know if he would add hormone or not. He hinted at 7 weeks radiation and 2yrs hormonal (Luperin 1,2,3,or 4 mnth treatments) but wasn't sure; I should get some insight from urology about hormonal. Oncology added if he immediately added hormonal to the radiation he would never know if the radiation did the trick, but he did express the benefits of the hormonal/radiation combined together.

[COLOR="darkgreen"]I don't know the answer to that - whether it makes sense to wait to see if the radiation worked. But I'm thinking you won't have lost much ground if the hormonal treatment is started within a few months of ending the radiation. But see below on how the hormonal therapy can set up cancer stem cells for radiation killing.

He closed by saying there are no guarantees but patients in my situation should be doing well at the 10 year mark. Does that seem overly optomistic:

[COLOR="darkgreen"]No, not at all.

I think I've seen charts that mortality is about 50% at 5 years?

[COLOR="darkgreen"]No way, except for exceptionally dire cases that probably are not like yours, even with that Gleason 8 and short recurrence! The vast majority of prostate patients these days who have a recurrence after surgery do much better.

You may be thinking of the tables in the "Freedland" study from Johns Hopkins, which found that Gleason of 8 or greater, recurrence (reaching .2) within three years of surgery, and short PSA doubling times (PSADT) after surgery all predicted shorter survival. For patients with a Gleason of 8 or greater, short recurrence, and a PSA that doubled in less than three months, without any near-term follow-up treatment, survival was 51% at five years, with a statistical range of 19% to 82% for the true value if more patients had been in that group. Just increasing the doubling time to the 3 to 8.9 month range increased survival a lot at five years, with 81% surviving that long (and a true range of 46% to 95%). Those with the same Gleason of 8 or greater, and the same short recurrence but doubling times of 9 to 14.9 months had a 94% five year survival (range 63% to 99%), and those with a PSADT longer than 15 months had a survival of 98% (range 90% to 100%).

Are you getting another PSA so you will have a handle on your PSADT? Even so, you should do better than these numbers indicate, because these men generally had no follow-up treatment until they got much worse, unlike you, and they faced their disease between 1982 and 2000. That's a long time ago, considering developments in the prostate cancer field. Also, it's doubtful that many of them used nutritional and physical activity tactics to help hold back the disease.

But then that may include other health factors and more PC advancement through the body. I asked about the bones and was told I should add some OTC calcium and vitamin D.

[COLOR="darkgreen"]To me as a layman who has become somewhat educated in this disease, that is a fairly standard answer but not good enough. The book "A Primer on Prostate Cancer - The Empowered Patient's Guide" tells how to assess bone mineral density, preferably with a qCT (quantitative CT) scan. The vitamin D should be D3, and it needs to be from a company that has tracked the effect of its product with blood tests showing that it actually increases 25 hydroxy vitamin D in the blood. Hoffman LaRoche makes one such product and probably markets it through various companies. One is the Life Extension Foundation. I've read of patients having success with other products. If you like a certain vitamin company, try its vitamin D3, but be sure to get the blood test to see how you are doing. The doctors I follow want to see 25 hydroxy vitamin D levels in the 25 to 80, or even up to 100 range.

So then, are there just the 2 treatments available: radiation and testosterone reducing drugs?

[COLOR="darkgreen"]That's really three options: radiation alone, radiation plus testosterone reducing drugs (hormonal blockade therapy - single drug) which generally looks better per research results, and testosterone reducing drugs alone. Unfortunately, it's more complicated than that :(, but fortunately, that means you have more sound options. :) The Primer is a good source to learn about them, and so it Dr. Charles Myers' recent book "Beating Prostate Cancer - Hormonal Therapy & Diet." Here are some of them:
(1) Combination of a testosterone reducing drug (such as Lupron, Zoladex, Viadur, Trelstar, or surgical castration, which is not done much in circumstances like yours) plus an antiandrogen drug (typically Casodex - most desirable, but also sometimes flutamide instead, in the US). Typically a bisphosphonate drug with calcium and vitamin D3 supplementation is needed in support.
(2) Adding a third drug, probably Avodart but possibly finasteride to achieve triple hormonal blockade (I've been on intermittent triple blockade for my challenging case for over eight years and am doing well). Typically a bisphosphonate drug with calcium and vitamin D3 supplementation is needed in support.
(3) Just the antiandrogen probably with Avodart or finasteride. This has a milder side effect profile that does not need as much countermeasure effort to enhance tolerability, but research indicates it is not quite as effective in controlling the cancer. One leading doctor says it gives his patients 80% of the benefit for 20% of the side effect burden. It becomes a judgment call whether controlling the cancer or quality of life is more important. The bone density treatment would probably not be necessary.
(4) Emerging treatments like estrogen patches.

If the unaffected PC stem cells continue to produce the PC cells does the hormonal drugs kill these daughter cells or does it simply put them in a dormant state?

[COLOR="darkgreen"]There is strong evidence that the hormonal drugs actually kill the daughter cells, but unfortunately they probably do not kill the stem cells. It may put them in a dormant state though. Dr. Charles Myers, an eminent medical oncologist specializing in prostate cancer, has noted research indicating that hormonal blockade can make it easier for radiation to actually kill the prostate cancer stem cells that are within the range of the radiation (so I suppose it would need to come first, and then continue ?), and he has also emphasized the fairly recent great news that prostate cancer in many recurring men is still within the range of radiation. :)

Is there any way to tell how many years hormonal treatments can be affective for varying degress of PC?

[COLOR="darkgreen"]You are likely to hear some highly pessimistic myths about that, especially from urologists, though I think that doctors treating many prostate cancer patients and trying to keep up with developments are learning that hormonal therapy is highly effective long-term therapy for most of us. As a personal example, I was given a prognosis of five years for my challenging case by two respected urologists back at the turn of the year 1999/2000. I'm now in my nineth year and doing fine, with a good quality of life, with good health and physical ability, and with good prospects for at least a third successful on-therapy/off-therapy round of intermittent triple blockade therapy. If that fails, I can fall back to second line hormonal therapy, then to other non-chemo approaches, and then to chemotherapy, with hope of development of a cure or even better control during some of those future years. The Primer has a table on page 148 of men in the Strum/Scholz practice who were on triple and combined blockade after recurring following surgery and/or radiation; more than half were doing fine - not needing a second round of triple blockade, at the five year point since stopping the heavy duty drugs and just maintaining with Proscar (now generically available as finasteride). There is more data, but that's probably all you want to see for now.

Thank you


Don't forget the nutrition and physical activity tactics to help control the cancer. I realize that someone from the Dairy State might rather die than publicly follow some of that advice, but research indicates strongly that it can make a substantial difference. (Maybe you could eat soy burgers and pass them off as real beef; the same for soy milk, though that would be unlikely to get past your sharp eyed friends. LOL) For instance, 8 ounces of POM Wonderful pomegranate juice extended PSA doubling times of recurring patients from an average of about 15 months to over 50 months! (And pomegranate juice would even be acceptable in Wisconsin! ;) ) (The POM Wonderful company funded the study, which raises a small doubt, but it was conducted by a highly respected team at UCLA, which is reassuring. I'm looking forward to follow-up confirmation by other, independent researchers, but am taking pomegranate extract capsules in the meantime.)

I hope this helps you and is reassuring.

Take care and hang in there,