Prostate cancer treatment choices

Posted by Ronoir @ronoir, Jul 29, 2016

Hello everyone, new member looking for some experiences/advise on post radical prostatectomy treatment. my stats: Gleason 9, lymph nodes, seminal vesicle, margins, fat tissue cap all positive for cancer. 5 of 41 lymph nodes removed were positive also seminal vesicle was removed. p.s.a. 3 mos. post op .08, .10 .12 @.15 presently. Prostatectomy was part of protocol for immunotherapy vaccine clinical trial. Would appreciate any input you may have on radiation and/or hormone therapies. Thanks

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@james1951

Ok thanks had 2 3 month Lupron shots how long before last shot is out of
Your system?

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As long as you were on it (6mo), it will take at least another 6mo to get off. In other words, you will feel the effects twice as long as you are on it.

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@cdcfbw

As long as you were on it (6mo), it will take at least another 6mo to get off. In other words, you will feel the effects twice as long as you are on it.

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So r u saying a 6 month PSA is still influenced by the Lupron?

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My number 6 months after 3 month Lupron was 0.00. Next was <.02

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@james1951

Ok thanks had 2 3 month Lupron shots how long before last shot is out of
Your system?

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My doctor is very concerned I get my next Lupron injection right at 6 months after the last, so I think it's safe to assume it's in your system 6 months.

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@remington

My doctor is very concerned I get my next Lupron injection right at 6 months after the last, so I think it's safe to assume it's in your system 6 months.

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Just remember to exercise regularly and use weights or other forms of resistance training to keep your muscles as strong as possible. Without testosterone muscles can weaken. I’ve also found that exercise lifts my spirits too. Win-win.

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@remington

My doctor is very concerned I get my next Lupron injection right at 6 months after the last, so I think it's safe to assume it's in your system 6 months.

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U was told it has a 6 month half life.
On the other hand if it is one day early insurance refuses to pay so its a financial issue also

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You have not yet hit the standard definition of BCR, PSA of .2 or higher on consecutive tests.

With the ultra sensitive test, there is a lot of different thoughts about the definition of BCR.

You could image with the recently approved scans but they tend to work better when PSA hits .5 or higher. That's not to say they won't find anything at .15.

If you snd your medical team believed based on your current clinical data that treatment is necessary now then radiation to the prostate bed with short term ADT is common.

When I say common it's the less aggressive choice which may be the right one…

You may choose to be more aggressive and include the pelvic lymph nodes in your treatment. If you do, discuss how high in the PLN system the treatment field will be. Once again you'll have a choice of standard treatment fields or be aggressive and expand them.

Finally, you could add another ADT agent such as Zytiga to the treatment plan, triplet therapy.

Your decisions may rest on your personal preferences, do you want to take an incremental approach to your treatment or be aggressive and combine treatments early in your disease and "overwhelm" it when it may not be widespread.

Attached is my clinical history. After trying the minimalist approach which didn't work, I went for the triplet therapy which so far has brought me three years off treatment.

If you elect to do ADT then understand the longer you are on it, the longer it takes to completely clear your system. I did 18 months snd I was fortunate, took roughly two months which may have been in part to a strong exercise program I do, but, I'm a layman, read some studies about the impact of exercise in testosterone recovery so maybe…

Kevin

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@james1951

So r u saying a 6 month PSA is still influenced by the Lupron?

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Yes….

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