ADT OR RADIATION FIRST

[Metaldraft]

Soc suggest[by some] that adt done first followed by proton or other radiation modalities.however different medical professionals views have been choreograph to suggest otherwise.I'm assuming in all depends health and disease that person may be or have become.I understand there's no free rides in this evolving disease. Has anyone confronted this with there consultations?

[AlanMeyer]

I'm no expert. Tall_Allen and others can probably weigh in with more scientifically accurate information. However, from what I have read, ADT should definitely come first for two reasons. First, it weakens the tumor response to radiation, making it more likely that the radiation will kill off tumor cells. Second, it shrinks the prostate, enabling the radiation oncologist to focus the radiation more narrowly, delivering a stronger dose to the tumors without increasing the total dosage. I have seen different numbers for how long ADT should be administered before radiation treatment but the numbers that I recall most are 6-8 weeks.

ADT should be continued throughout the radiation treatment and for some time afterwards. The value of continuing ADT drops off with time. The highest value is in the first few months after treatment, after which the value slowly declines until, by three years, there is no benefit to continuing ADT. The numbers I've seen most range from six months to two years.

Alan

[dixiedad in reply to AlanMeyer]

That's exactly what I did/am doing.

[Tall_Allen]

There's nothing in your profile. What is your situation? Salvage? PSA? Stage? Gleason score? if contemplating salvage after prostatectomy, pathology results? You are posting on an "advanced prostate cancer" site - where are your metastases and how many? Are you talking about metastasis-directed radiation?

[Metaldraft in reply to Tall_Allen]

On feed back g9 on December 2018 psa was 6.0 had RP on April 2021 pathology report ece(may have breached wall) 3trmi showed cancerous cells in prostate gland no edema carcinoma in lymph node but psa was rising in 1/12 to injectable to present 1.8.I decided to take psma pet scan found abnormal avidity In prostate bed neat surgical clips in addition right pelvic node probably metastatic according to report but I ask for over read from two institutions john Hopkins and Ucsf I’m waiting for results on affirmative report and clarification.Msk oncologist directed to do Sbrt and adt. There no free ride here but the fight is one

[Tall_Allen in reply to Metaldraft]

Thanks for clarifying. So, to summarize: you have a recurrence after RP, and you are stage pN1 (cancer in lymph nodes).

So you need whole pelvic salvage radiation. With PSA of 1.8, you definitely need ADT starting 2 months before radiation and continuing for 2-3 years after.

The radiation is usually IMRT - typically done in 40-44 treatments. During the pandemic, you may have a preference for completing it in just 26 treatments, or experimentally in just 5 treatments (SBRT). If you can get it done there, MSK is excellent.

[Metaldraft in reply to Tall_Allen]

Out of curiosity how can one pelvic node be metastatic and not prostate bed be prostatic usually it comes from the primary lesion.The surgeon indicated he extracted many lymph nodes I guess he most of forgot the one that is metastatic .

[Tall_Allen in reply to Metaldraft]

Prostate cancer has to undergo a change in order to live outside of the prostate environment. Once the cancer can live outside of the prostate, it is called "metastatic." Often the cells travel to pelvic lymph nodes first. When the cancer becomes metastatic there are thousands of such cells in the lymphatic drainage area. You probably have over a hundred lymph nodes in the pelvic area. The surgeon only extracts a few of them to see if they are there. If one is there, there are many in the area. Most clumps are too small to see on any kind of scan. But they are certainly there. That's why the entire area has to be irradiated. Hopefully with radiation and hormone therapy, they can destroy all the cancerous cells before they travel outside of the area.

[Metaldraft in reply to Tall_Allen]

Okay thanks to every one… so now we know the herd is loose on the highway Msk wants pet done after I have initiated psma pet/ct scan for any other parts of suspicion but the gremlins can still hide especially micromets but it has to be done.Well I will update anything that could be of value even the slightest God bless your time to all who listen and embrace

[E2-Guy in reply to Tall_Allen]

Wish I had consulted with T_A prior to allowing my urologist to remove 8 sacral LNs...a costly mistake!

[Metaldraft in reply to E2-Guy]

With respect to you did parents/loved ones passed from pc or underline issues.So hearing from you specifically in retrospect what would have altered…Thanks to all for their helpful insights

[E2-Guy in reply to Metaldraft]

My grandfather, father, his two brothers, and my older brother all had RPs. Everyone with the exception of my brother experienced BCF and lived into their 70s and 80s on ADT. My brother is 83 and doing very well. Since my RRP has left me impotent, incontinent and resulted in BCF, I would have chosen either brachytherapy, or SBRT. My nephrectomy, and LN excision were definitely major mistakes. I lost the kidney because of a harmless, benign cyst, and the LN surgery simply lowered my PSA for about 7 months at which time I began using the tE2 gel. Had I elected SBRT or brachytherapy, and the cancer recurred, I would have just started using the gel and probably been where I'm at today.

[Metaldraft in reply to E2-Guy]

Thank you for your support and supportive info and unfortunate circumstance however we can’t push forward if there is nothing in the past to look ahead most upon important thing is your state of happiness though very difficult at times.Our ancestors were born fighters you are definitely without a question the same Love all you do to share

[Metaldraft in reply to E2-Guy]

Ron if you don’t mind what was the name of Richard w you spoke with and conferred with?

[E2-Guy in reply to Metaldraft]

Professor Richard Wassersug in Vancouver, Canada. He has been my tE2 mentor for four years. I can get you in touch with him if you would like.

[Metaldraft in reply to E2-Guy]

Thanks again but let me do some research first

[Metaldraft in reply to Tall_Allen]

Thank you for your dedication and supportive info

[E2-Guy in reply to Metaldraft]

Bro,

I didn't mention that my family members were on DES (and experienced little to no side effects) until it was replaced in 1985 with Lupron. The Lupron made most of them miserable which is why I chose the tE2 (transdermal estradiol) gel. The gel works similar to the old, oral DES, but without the cardio vascular risks since it bypasses the liver.

Wishing you a favorable report from Hopkins and UCSF.

[Magnus1964]

If your cancer is confined to the prostate, the ADT started a few months before the radiation will weaken and confine the cancer into a smaller area so the radiation can do a better job.

[Don_1213]

A paper I read last week covered ADT and radiation timing. The conclusion was 8 weeks of ADT before radiation starts is optimal (and continued after radiation depending on the grade of the cancer.) If I happen to spot the paper I'll post a link here.

[JRPnSD]

My doctor's all asked for 2-4 months ADT prior to starting 38 sessions of salvage radiation.

[SUPERHEAT12]

I immediately began with Lupron in 2003 when diagnosed Gleason 9 (5+4). Started IMRT radiation 45 days later. Continued with more ADT with Dr. Myers. Seemed to work well as I seem to be in remission now 18 years later.

[Metaldraft in reply to SUPERHEAT12]

How was your Lupron tolerance including how many sessions of Irmt in addition was your diagnosis metastatic and could have proton or sbrt worked. Thanks for reaching out

[SUPERHEAT12 in reply to Metaldraft]

Frankly I hated the lupron and casadex even more. Dr. Myers carefully monitored it, but i was often sick. Really glad when I got off it. Reason for ADT and radiation, Dr Myers felt that with a 9 it was out of the prostate. Years later I got off ADT and it went to the bones. Beat that back with infusions.

[j-o-h-n]

To the new kid on the block.... Greetings!!!

Please tell us your bio. Age? Location? When diagnosed? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)?

All info is voluntary, but it helps us help you and helps us too. When you respond, copy and paste it in your home page for your use and for other members’ reference.

THANK YOU AND KEEP POSTING!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 11/26/2021 12:56 PM EST - Black and Blue Friday.

[Metaldraft in reply to j-o-h-n]

On feed back g9 on December 2018 psa was 6.0 had RP on April 2021 pathology report ece(may have breached wall) 3trmi showed cancerous cells in prostate gland no edema carcinoma in lymph node but psa was rising in a year and half from 0.05 to present 1.8.I decided to take psma pet scan found abnormal avidity In prostate bed near surgical clips in addition right pelvic node (1) probably metastatic according to report but I ask for over read from two institutions john Hopkins and Ucsf I’m waiting for results on affirmative report and clarification.Msk oncologist directed to do Sbrt and adt. There no free ride here but the fight is on.Age:66

[j-o-h-n in reply to Metaldraft]

Thank you for your quick and detailed response. You should add it to your home page for future reference. You've come to the right place for info and camaraderie. Right no free ride, but we all have a paddle in the water trying to stay afloat. Make sure you have a good M.O. to guide you and if you need a different one, ask the group and they may know a good one in your area. Pca is slow growing so you have time to research and make decisions. You will be around for such a long time that your friends will think you're a Pain In The Ass,,,,, That's what they think of me....... Stay with us and post often.

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 11/26/2021 10:36 PM EST - Black and Blue Friday.

[Hidden in reply to Metaldraft]

Welcome Metaldraft! However ,what am I missing ? I don’t get it ? Dxed 2018 but RP in 2021? Did you do any adt or treatment in that time ? You need the adt to whittle the pc down so the imrt can kick its ass . It’s SOC because it can work . Good luck in healing !

[Metaldraft in reply to Hidden]

I missed type rp done in 3/2019

[Hidden in reply to Metaldraft]

Still, did you do adt between ?

[Metaldraft in reply to Metaldraft]

Looking back I missed typed date of rp that was done in April 2019 my RO consult is now 12/7/21 by the way I think you can’t have a pet scan to early right after psma pet/ct I assume it is 1 week or 6 weeks…Thank you for your continuous feedback

[SViking]

A conditioned hardcore athlete, at the age of 59 I had Da Vinci surgery in 2010 with Gleason 4+3=7, PSA 9. Post surgical biopsy showed all margins clear with no seminal vesicle involvement. I had no incontinence and an active sex life for ten years when cancer suddenly went active again with PSA rising from zero to 2.0 in 18 months. PET scan revealed two lesions in my seminal vesicles so I went on Lupron for six months then at four-month mark, hit it with 35 Proton treatments. A few months later when Lupron wore off, and testosterone rose, PSA crept up immediately. A new PSMA scan at UCLA June of 2020 revealed a microscopic lesion in right pelvic bone.

Three treatments of SBRT was used 6/20/2020 without ADT because several doctors said it wouldn’t be needed on such a small matter. But PSA continued to rise monthly from .29 to 4.9 over six months. New PSMA scan 10/18/2021 indicated two small lesions in my lower spine and one in my hip bone.

Started Orgovyx 10/27/2021 with three treatments of SBRT performed at UCLA 18 days later. Bloodwork performed the day before SBRT showed PSA had dropped to .070 along with testosterone in 17 days. Head of RO, Dr. Steinberg, stated that in my case waiting for Orgovyx to work longer was not necessary. (Prior proton therapy RO recommended to wait a few months then go with 35 proton treatments.)

Obviously spinal involvement changes the game with the possibility of micro tumors existing after current treatment that were just too small to see on last PSMA scan. We are hoping that those can be starved with Orgovyx and possibly a secondary agent not yet selected. I agreed to six months of ADT but MO says maybe a year is better. The big question is what caused the dramatic PSA rise from .29 to 4.9 within six months?

I'm anxious to hear experiences and advice.

[j-o-h-n in reply to SViking]

Long and detailed post which is good, now copy and paste it in your home page under "WHAT'S YOUR QUESTION" and it will post as a separate query for members to reply to. Your post here will unfortunately be overlooked. So post it again.

p.s. I too am a conditioned hardcore athlete (my specialty is breaking dishes at Greek musical gatherings) OPA!

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 11/26/2021 10:49 PM EST - Black and Blue Friday.

[Metaldraft in reply to SViking]

I’m assuming of course is it sometimes things we eat or exposed to or maybe those scans are limited to locating really small Mets that is as simple as I can put it of course I’m no expert.Was proton or Sbrt any different did you feel one works better than the other and out of curiosity did you ever try Te2 I’m aware of se(possible boobs)Thanks