Treatment prognosis

First, a bit of background.

I'm 74 years old, and in March 2021, after an MRI and biopsy, I was diagnosed as having T3b prostate cancer with involvement of the left seminal vesicle, Gleason 7 (4 + 3) ISUP group 3, PSA 11.

The Radiation Oncologist told me that treatment was going to be 6 months Zoladex, then radiation, followed by 12 to 18 months Zoladex post radiation.

As it happened, radiation treatment (60 Gy over 20 weekdays excluding weekends) commenced a month early at five months of Zoladex in November 2021, I can only assume because of Christmas. I had my third injection of Zoladex on 15 December 2021 as scheduled, just after the completion of the radiation treatment, with the next one due in March - or so I thought.

In February I met the Radiation Oncologist who told me that my pre appointment PSA and testosterone blood test results (at 0.7 and undetectable) were such that no more Zoladex was required and they wouldn't need to see me for the next 9 months .

This seems such a radical change from the pre treatment prognosis, I wonder if anyone out there can explain. The oncologist and my GP could only say that that was what the blood tests indicated.

[Tall_Allen]

The pre-radiation ADT does its job when the PSA is undetectable. Post RT Zoladex should go on for 24 months according to this:

prostatecancer.news/2022/01...

[Hidden in reply to Tall_Allen]

Thanks. From the paper it does appear that 24 months seems optimum. But from my understanding anyway, that is the prescribed timescale, not necessarily the actual timescale because people drop out of treatment. And I can't say I was enamoured of the treatment in the relatively short time I was on it.

Anyway, I'll keep a sharp eye on psa and testosterone levels going forward and, if any change in levels upwards, I'll try and bring the oncology appointment forward - not always easy in a state health system.

[Tall_Allen in reply to Hidden]

Unfortunately, that's not how it works. Stopping ADT when it is used adjuvant to RT is like stopping an antibiotic before it is finished killing off bacteria- it only selects for the most resistant types.

Kishan used the actual durations.

[Hidden in reply to Tall_Allen]

Thanks, I think I will write to the HoD and ask for a second opinion on the cessation of Zoladex.

[Hidden]

I wonder if some Docs are rethinking how long for ADT. It takes so long for T to come back to begin with for many. Yours is so low, my guess is they figure it will stay low for a long time anyway.

[Hidden in reply to Hidden]

Thanks for the answer, it does explain things a little perhaps. I'll keep an eye on PSA and testosterone levels and if one gives even a twitch upwards, l'll try and bring forward the oncology appointment.

Problem is, in the state health system, the customer is not always king and the specialists don't jump as quickly as they would at the drop of a $ bill.

[Hidden in reply to Hidden]

Normally, the docs will keep you on it as long as you can stand it, since studies tend to show that as far as prostate cancer goes, the longer the better. But there are rumblings of some that it may not be good for you that long, for a number of reasons. Maybe you have some heart issues? Maybe you had a genomic test showing the cancer was low risk? Maybe they decided the scans were inconclusive of localized spread? Scans really are not the end all and be all. Maybe you have one of those doctors that just doesn't believe in long term ADT? There are a number of possibilities, which is why you need to get a firm answer from the doctor and let us know.

[Hidden in reply to Hidden]

No to heart issues and the cancer was described as high risk because it had spread outside the prostate (T3b) on the MRI which had been looked at by at least four specialists.

So I would have agreed with your third reason - non believer in long term ADT, except that he was the one who initially told me that he expected 12 to 18 months ADT post radiation.

So, as I said to TA, I will ask the HoD for a second opinion.

[Hidden in reply to Hidden]

Seminal vesicle is just barely outside. I think he looked at your PSA after treatment and said 18 months was overkill

[maley2711 in reply to Hidden]

The study of optimum duration arrived at a number based on actual ADT treatment duration...not ADT for a shorter period and then assume an additional x months of low/no T. SO, if you are a prescribing Doc, you would wna to prescribe for that study-derived dosage....not guess at how long T might stay low after last injection?

[Hidden in reply to maley2711]

so you're saying it doesn't matter if your T remained at castrate levels off the ADT, you would want to take it anyway?

[maley2711 in reply to Hidden]

Did I say that? Please reread....the studies find that best results when the average man does injections for x months, so that T is near 0 for x months plus some average number of months after last injection. Yes, total months at zero will vary from man to man. You do raise one good question, which I haven't see answered, but may have missed the answer. When a study found 24 mo ADT provides best results, does that mean eight 3 mo Lupron shots, or 9 3-mo Lupron shots?

when a man takes 3 -mo Lupron shots, does he not take his 2nd 3-mo shot if his T is still at zero after 3 mo? No, that is not what happens per my understanding.....Docs don't wait until T has increased before doing the next injection. But, always open to new info!

[esperandrich]

What state health system are you in?

[Hidden in reply to esperandrich]

Not sure how that's relevant. I don't think the differences of treatment in public health and private health schemes varies much worldwide.

In the former you are a patient, in the latter, a valued client.