How important is missing 2 months of ADT?

[Eadgbe]

I'm one month into RT and ADT for 9 months. I chose monthly Eligard. The Urology office made a mistake and came in with a 3-month dose. When I told the nurse I had communicated my 1-month preference prior, she left the room. The Dr. came in, eyeballed the dosage, removed 2/3 and I received it.

I was to receive the 2nd dose Monday, but the office canceled because the insurance denied payment for the 2nd 1-month dose (obviously because they paid for a 3-month dose due to the office's error). Now the urologist is putting me off for 2 months for my 2nd dose.

How important is missing 2 months of ADT for the effectiveness of the RT?

I don't wish to be antagonistic, but I'm pretty pissed because of their mistake. I just don't know how important it is. Any data out there about gaps in ADT?

[jackwfrench]

Hi- Not an expert but I would ask if Casodex pills might be useful to help bridge the gap- I used them alone prior to my Lupron start up.

[Tall_Allen]

Very important!!! When you are using adjuvant ADT, missing even a few days can be deleterious. It is like taking antibiotics sporadically - it selects for more resistant subtypes.

[Eadgbe in reply to Tall_Allen]

Just asked my oncologist. He said a monthly Eligard shot has about 6 or 7 weeks of effect - enough time to get the matter settled and get another one. He said not to worry.

However your comparison-model puzzles me. There are subtypes of bacteria, but are there subtypes of adenocarcinoma?

[Tall_Allen in reply to Eadgbe]

A monthly Eligard shot lasts 28 days. Find a new urologist.

Everyone's cancer is different, or we would all have the same history with it. Cancer mutates freely - it's what cancer does. Hormone therapy kills the most susceptible clones first. Resistant clones enter into cell cycles where they are less susceptible.

[Don_1213]

I'll 2nd TA's comment - find a new urologist (I'm on my 3rd..) Way too many of them take a rather cavalier attitude towards patients disease. This is obviously his offices error, and his answer is to just forget it? I'd be very pissed and might actually go make a scene in the office after I got all my medical records from them and after I found a new urologist.

If you have a teaching hospital nearby - start your search there.

[maley2711]

what was your diagnosis...in terms of PSA, Gleason, etc?

[cancerfox]

I don't get it. If your insurance paid for a 3-month dose, why wouldn't your urologist go ahead and give you two more one-month doses? If I remember right, my 6-month dose cost 6 times what a one-month dose cost. Did your urology office just throw out the 2/3 of the 3-month dose you didn't receive and charge you for it anyway, even though it was their mistake? Seems like your effective care should come first and foremost, and the cost details second. I think I would be looking for a new urologist. 🦊

[Eadgbe in reply to cancerfox]

You are correct. They threw out 2/3. It was their mistake. They admitted it and ate the cost. I received the next shot yesterday.

Even though there were things that were done correctly, here is a list of orange flags in the last year since my diagnosis - some are minor some are major:

1) Uroloist's phones were not working for over a year so it was impossible to change appointments or speak with the DR. unless I traveled to the office (major);

2) During 1st visit urolift was pushed 1st without any tests; (minor)

3) Prior to 1st biopsy, I was offered nitrous but when I got there they said that wasn't available at that office so had to take valium and wait (major);

4) Releases for that biopsy weren't presented to me until 5 minutes prior to biopsy and I was under influence of valium (Major);

5) biopsy revealed suspicious pre-cancerous cells (a dna follow-up was done - good);

6) K4 test was never mentioned or suggested - I had to request it (minor?);

7) When PSA continued to rise after a year a directed biopsy was prescribed (good);

8) I asked about a transperoneal biopsy and was told there was no risk difference between that and a transrectal (major);

9) Office for directed biopsy was rather dirty, nurse in street clothes (it was a friday afternoon), stuck the nitrous tube in my mouth and left the room (I had never had it and didn't know how long to use it) - (major);

10) Became septic from that biopsy and nearly died in ICU (pretty major);

11) after recovery, on my portal, received a chart from someone else with a similar name (wondered if my chart was on someone else's portal). That got the firm's attention (major);

12) Office invoice was incorrect - charging me for something I had already paid for (minor);

13) Made an appointment for the pet scan at a location that didn't have the machine (major);

14) didn't communicate I wanted the monthly Eligard to either the Dr. or the nurse. Once the order was checked Dr. eyeballed the amount in the vial and removed 2/3 (major);

15) Nurse who have me the 2nd Eligard had never done it before (?);

These are some of the things I can think of that happened that didn't give me a lot of confidence in the firm's management. Apparently these kind of snafus are not uncommon in big firms but this is my first health challenge in my life and, as a business man, there are just too many little errors that indicate a lack of managerial conscientiousness and oversight. However, I have been vocal about these things and the partners are beginning to pay attention as they are calling me, now, instead of the other way around. We'll see...

My oncologist's office, which is associated with the firm, is very conscientious in their practices and communication. I'm on week 5 of 9 weeks of RT and have been told bowel side effects will be less after this week.

No road trip is without its challenges.

[cancerfox in reply to Eadgbe]

Is this what your urologist's diploma looks like? Sounds like a comedy of errors to me! 😜

Diploma