Introduction

[rhbishop2]

Diagnosed 2009 - PSA 7.2, Gleason 4+3 - RP Nov 2009 - EBRT 2010 - Neither treatment brought PSA below 2.3. On intermittent Triptorelin (Trelstar) since 2010 - six month shot, wait for PSA to reach double figures then repeat - PSADT in off phase 6-7 weeks. No sign of mets. Suffered from urethral stricture - several dilations led to urinary incontinence. Artificial urinary sphincter fitted 2015 - still some leakage but manageable with one pad a day. Erections still possible and libido recovers in off phase. Comments, please.

[JoelT]

Thanks for the introduction.  My concern is about your being on intermittent ADT given your quick doubling time and that you have not gotten your PSA below 2.3 when on treatment.

Have you also been monitoring your testosterone level to be sure that the Trelstar has actually made you castrate?  Have you considered adding Casodex (bicaludamide) to your drugs?

Joel

[rhbishop2 in reply to JoelT]

Hi Joel, Thanks for your comment. The Trelstar seems to be effective - the aim is to bring the PSA below 1 each time and so far it has got well below that on each cycle. The PSA responds very quickly to Trelstar so I'm pretty sure the testosterone production is being brought well down although over here in London they don't seem to check it unless I specifically request it. My rationale is that being without testosterone is hazardous in itself, so as there is no evidence that intermittent use of ADT has a worse outcome, I'm happy to let my hormone levels return to 'normal' in between treatments. I've talked to my consultant about adding dutasteride in between Trelstar shots and he's OK with that if I want it but so far I've decided against it. My general health seems good so we seem to have made the right decisions so far. It's great to have sorted out the incontinence. I have absolutely no idea how long this phase will last but I'm certainly optimistic.

Bob

[JoelT in reply to rhbishop2]

Bob, Optimism is very important, I feel much the same.

Joel