Hello! I’m googling in the night and trying to learn about PC. I’ve read some about orchiectomy (this is a really interesting previous post by pjoshea13 healthunlocked.com/advanced...
Then I started thinking “what the hell, the pituary gland?” and thought of a friend of mine who got a hypophysectomy because of a small tumour located there and have to take pills every day for hormone replacement therapy.
I felt a little clever for a second until I googled it and understood that it is no longer in use and snapped out of the imaginary white sparkling robe and became a worried daughter with insomnia again. So then I started reading the original articles from the 60’s and 70’s (hah!) and I found out they stopped doing it because only 7 procent showed any response at all (still some did?? I have to understand more in detail).
My father said yesterday that he would gladly remove anything that would make him live a little longer, and I guess I interpreted that very literally since I’m now doing this...
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4 x60mg evry day...in titan trial...stuffs $$$...12grand a mo....but on janzens dime for now....i was irish lucky as ive been on med. Not placebo since i got in trial...i havent had t results since start...but i know its low as i now am a nice c cup...and like to do needle point....🙄
No...mets 2....titan trial is for mets, spartan was for non....my mets have stabilized for 2 yrs...although...i have developed cple oglioblastic suspicios spots on ribs...last bone scan....
Intermittent is still an option, and maybe with oligometastatic SBRT it may be good. But the treatment will make all the traditional PSA benchmarks for vacations useless and I'm not sure how iADT would work without PSA. Same for BAT.
“The benefit of intermittent therapy is considerable when the indication for ADT is biochemical failure without bone metastases. These patients have a much longer median sur- vival (10–15 years vs. 3–5 years) and a much more durable response to ADT. They have a longer off-treatment interval. PR7 was the only study confined to patients with non-metastatic disease and showed absolutely no difference in OS. IADT for PSA failure is non-inferior to continuous lifelong therapy with respect to survival, offers significant QOL benefits, and is a standard of care in Canada.
Patients with bone metastases have a shorter life expectancy, a shorter off-treatment duration, and therefore, on average, less benefit of intermittent therapy. Further, in 2020, most of these patients receive an ARAT or chemotherapy. In selected patients, IADT may still have a role. For example, patients treated with the CHAARTED regimen of six months of docetaxel and ADT who have a complete biochemical response (PSA <0.2) may have a prolonged off-treatment interval, and the QOL benefits of discontinuing ADT in these patients is appealing.”
This, besides being really depressing, confused me even more. But is oligometastatic another thing to take into account besides bone mets?
All these studies that you read are NOT based on a PSMA detection. Your father is an M0 according to the detection criteria of these studies. You have to wait for the Firmagon to ware-out and have a new scan to check for the outcome of his recent treatment. Then you can decide what to do or not to do afterwards.
Could you explain why BAT could not accompany an orchiectomy? Say, monthly injections of T-cypionate? And why would PSA not function in its usual role?
I wasn't clear in the above statement. What I was saying is that oligometastic SBRT treatment interferes with the biomarker (PSA) used to determine start and stop points when one is on iADT or BAT. That is true for chemical or physical castration.
Yep, that is the main issue. But for my father, who is a hypochondriac who has had his worst fears come true, he would take any side effects if he had more time with my sisters children. So it mostly comes down to what’s more effective.
Your father can live for a long time and he may change his mind regarding side effects. If you monitor the testosterone value you can see how effective the drugs are and you can change them if needed.
I know a patient who had orchiectomy and is terminally ill now. He adds testosterone every day because he no longer wants to live with a low testosterone level.
I had the orchiectomy done in the mid-90's. Back then all of the other options were not available.
The orchiectomy worked for me. It gave me the added years needed to allow for all the drugs available now.
Having the orchiectomy removes most of the testosterone produced by the body. Testosterone is produced by the pituitary gland. ADT drugs block that remaining testosterone from the cancer.
Today Lupron works as well as an orchiectomy and the other ADT drugs block the rest.
Thank you for sharing! Glad it gave you more years!! You are a G-9 like my father (and also with bone mets it I remember correctly?) would you have done the orchiectomy if you were newly diagnosed today?
I do have a Gleason score of 9. At my first surgery the cancer had spread to the lymph nodes next to the prostate. The orchiectomy was recommended. I did not have any bone mets at that time.
Today, I would probably choose Lupron or some other Gonadotropin-Releasing Hormone Analog/Agonist (GnRH).
After 27 years I am a believer in monotherapy, one drug at a time and milk it for all its worth.
May I ask when did you have bone mets and what your treatment of choice was then? I told my father that I talked to someone who had Metastasis Gleason 9 survival for 27 years but his reply was ”then he must have been Young at the time of diagnosis, and probobly exceptional in more ways” but I do think there is lessons to learn.
Thank you! If you don’t mind me asking: my father has had radiation to prostate bed + mets, PSA went from 0.20–>0.14 in 4 weeks of radiation, 3 weeks to go. He has gotten a one time triple dose of Firmagon. Would you advice him to start on ADL now or wait and see after next PSMA scan and PSA-test when Firmagon is out of the body?
Yes it was used as a ”one time” dose along with radiation. But we are getting second opinion in August. I’m feeling torn between early ADL and wait and see on the next scan. But either way the one shot of Firmagon has gotten me a little relaxed since he gotten SOME systemic treatment.
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