My dad is having his first treatment since his Davis I surgery in 2010. Due to a rise in psa and a spot on his spine he is now in this new stage. He has met with his oncologist and radiologist and the plan is to commence hormone treatment at the same time as radiation to the spine met then extensive radiation to the prostate bed.
Several people on here and another forum have told me that he should commence hormone therapy for a few weeks/months prior to starting radiation. Should I phone his radiologist to query this??
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Mish80
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If the cancer has metastasized and there are less than 5 mets, then he should definitely add Zytega and prednisone. Early use of that combo priced in clinical trials to reduce deaths by some 40%. Do not let any dr tell you to save the Zytega in the bullpen to use later. Proven far more effective early along with ADT
That you need to discuss with your dr. I’m not sure. Your dr needs to be consulted anyway to be sure he doesn’t have a good reason not to start the Zytega prednisone. He will also need to monitor your liver and for other potential side affects. I had no bad side affects but I do weight training session at least 3 tines a week.
There is no evidence that radiation to the prostate bed and a spinal met post-prostatectomy accomplishes anything. He should understand the side effects of the radiation. The standard of care would be to start him on lifelong hormone therapy.
If the PSMA PET/CT shows no cancer in the prostate bed I see no reason to radiate that. Radiating bone mets is usually done when there is pain, otherwise it will provide no benefit.
If the PSA value is 1.4 now, I would not start with ADT already.
For me the entire plan is overtreatment and will cause side effects only. So far your dad has no symptoms that would require immediate treatment.
I had a solitary met at L5 radiated almost 5 years ago. It was unusual for the radio-oncologist to agree to that, since I had absolutely no pain. While he said there was no proof that it would extend my life, he felt that it was a reasonable request.
Apparently, when there is no pain, one is supposed to ignore a serious bone met until a fracture occurs. Makes no sense to me. Hate to think what might have happened within those 5 years had he not agreed to treat.
I tried to provide a simple post and therefore did not to get into the details of metastasis directed treatment of bone metastases. Mish80's dad will do what his doctor recommends. On the other hand, you have done a lot of reading and decide for yourself how you want to be treated.
I would also get the bone met radiated if I had one. It may harbor resistant cancer cells and, as we know from the Gundem study, can spread new mets as well. However, the RO with his IMRT machine will radiate you with 8 Gy and this is usually an insufficient dose to destroy all the cancer cells in this met. It is intended to stop the pain. You can achieve local control of the met with SBRT/Cyberknife if you do e.g. 20 Gy in one fraction or three fractions with 10 Gy.
It would be a good idea. I just finished radiation and my radiologists wanted to ensure I was on Lupron prior to treatment. The idea is that they want the PSA number to be as low as possible prior to radiation. I'm not a medical person so I don't know why this is important though I'd assume it allows the radiologist to target the cancer.
Radiology and hormone therapy at the same time is challenging because you get tired. It is really important to walk and exercise regularly if possible. Because hormone therapy has the potential to weaken and waste muscles, and because the radiation will make him tired, it is doubly important that exercise become a part of the treatment.
I did find this article which is not a direct correlation to your Dad but did issue a suggestion that prior ADT with radiation was beneficial in localized disease... 2 months prior....
I had one met and got on ADT --Zytiga, Lupron, and Prednisone...waited 6 weeks and had PSA which was likely undetectable--(had gone from 3 to .23 in 3 weeks)...and then had stereotactic radiation... If I had to do it over, I might have waited the 2 extra weeks... but the wife wanted it done quickly and I did not know this info...
I like the idea of getting the PSA down and then hitting it hard with radiation... I agree with Schwah about getting on Zytiga....the STAMPEDE trial definitely showed survival benefit from getting on Zytiga right away... With this disease, timing is important....Try and persuade them to get him started on ADT with Zytiga.......wait.....and do the stereotactic radiation... in my opinion... not an MD...
If your dad starts hormone therapy, he might find the educational resource at LIFEonADT.com helpful. The free program they offer has been shown to reduce the side effect burden from hormone therapy, but best if taken accessed before the side effects settle in. Te program is formally endorsed by the Canadian Urological Association.
Thank you all greatly for your replies. The loneliness of this ride is lessoned by all of you who take the time to respond. I phoned my dads radiologist today. To be honest I did not expect him to answer a random call from a patient’s daughter but he did and he was lovely, with so much time to answer my questions. I can see why my dad likes him so much. He could not answer why the hormone treatment had not started already prior to the radiation which will start on the 15th April so I’ll have to track down the oncologist for that information. He did assure me though that there was a conference call and discussions with other radiologists, prostate c specialists and urologists to determine a treatment plan for dad. For now, I have to go with it but question every thing along the way. My dad lives remote so he will be away from home for over two months having treatment. If he were to travel to a larger cancer centre in a bigger city I know that his mental health would suffer.
I am currently on ADT, and am looking at radiation to the prostate bet in about a month. I had a PET scan prior, and at that time the doctor told me the reason for that scan was that if they found any mets they would skip the radiation. I did not so we are proceeding. Obviously different doctors have different opinions, it never hurts to get more than one.
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