I was diagnosed with High Risk prostate cancer in Feb of 2018. PSA 8, Biopsy scores were T2a, GS 4+4=8, 4/12 cores positive for GS 8 disease, 4/12 cores positive for GS7. The rest of the cores were benign. My urologist wanted to remove but I opted for a second opinion and chose brachytherapy. I took my first 6 month shot of Lupron had 70 seeds implanted and 25 daily radiation treatments. I am on my 2nd 6 month Lupron shot and scheduled for a third in May 2019. I had my first PSA test a month after completing radiation treatments and it came back less than .01 so great news. My thought and goal is to avoid the last 6 month Lupron shot and get my life back.
So my question is this, what material impact will the last shot provide? My Oncologist (Terk Oncology) said I am in great shape and it is my choice not to take the last shot. Is there any scientific evidence to show the material benefit of the shot? He originally said a year to 18 months so am I making the correct decision not to take the last shot.
Thanks for reading. Thoughts?
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GoMonday
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There was one study TROG 03.04 RADAR that looked at long-term (18 months) of ADT in high risk men who'd had brachy boost, and found there was no difference in outcomes. They plan to report an updated study within the next year. It is a matter of judgment and your personal comfort for now.
Thank you for the reply. The link to the article was great.
Looks like the average ADT duration of 4 months is de minims to the outcome. I will have 12 months with prior and concurrent with the radiation treatment.
I know the Lupron has its own derogatory impacts. I have the hot flashes especially at night, no Libido and my workouts are difficult at best. Still push for 6 hours per week just to keep me sane.
That is the question to address to your oncologist. Recently the hormonal treatments with Lupron, etc. have been reduced from 36 months to 18 months. Earlier studies with six months of treatment were not so positive. You have to weigh that ahagainst the deleterious effects of the anti-androgen medications. Talk to your medical oncologist, not just your surgically oriented urologist.
Neither could I and that is why I rejected completely when I met the first time with the oncology team. They pushed;I pushed back. I had RP instead. If my PSA were to start to climb I would have to reconsider that position. One book (the Scholz book) says flat out that I should not have surgery for my type of cancer; problem is that I did not read that book until AFTER my surgery.
Mine wanted to do the surgery. I wanted a second option and went with Brachytherapy knowing I could handle a year of Lupron. The seed implants, radiation were less of a stress on my body than the Lupron. Thus I don’t want to take the last 6 month dose.
Thanks for the book recommendation. Does he take about diet changes after you have prostate cancer?
I have noted that there is little concensus when it comes to timelines / duration of ADT.
I've seen months to years to forever, when it comes to treatment. Some men cycle on and off for years once they've hit a selected number.
One thing is clear. IF you stay on ADT for more than 2 years (consecutively) there is a chance that thew side effects could become permanent. So the question might be - is it worth it to STAY on this 'drug' for 'x' amount of time and what might the benefit(s) be ?
IF you have the luxury of choice, less (time under the influence) is probably better.
I had brachytherapy in 2012 and my psa is now .46. I refused lupron injections as there is a 40% chance they will cause colon cancer. My father took lupron shots for years and died from colon cancer. I had high dose rate brachytherapy which is better than seeds as seeds can migrate to other areas of the body. I am 7 years from the treatment and the brachytherapy left me cancer free.
Update to my original post and question. Thanks everyone for your comments.
After much consideration I did not take my last 6 month Lupron shot due 4/1/2019. I met last week with my oncologist to discuss my most recent PSA results. We were pleased to see less than .01. So great news and I don’t have to see him until Dec. Still staying focused on my diet and exercise and looking for an increase in my T scores.
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