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Thread: Casodex, Lupron, pelvic radiation and then prostate radiation as first treatment?

  1. #1
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    Casodex, Lupron, pelvic radiation and then prostate radiation as first treatment?

    We met with the radiation oncologist and due to my husband's psa of 27 and Gleason of 7 (3+4) he felt that my husband would probably end up having radiation even if he had the prostatectomy so suggested forgoing the surgery and going straight to radiation. Recommended pill Casodex once a day for 30 days which would put cancer in immediate remission and half way through the 30 days do injection of Lupron. A week or two after that doing 5 to 5 1/2 wk of pelvic radiation and then finally 2 1/2 weeks of radiation directly to prostate. He feels there is a chance cells may have already gone through the capsule due to high psa. He also introduced us to the nomogram by Dr. Partain at John Hopkins which calculates PSA, Gleason score and stage of cancer and then it suggests probability of recurrence which helps with determining treatment. Has anyone used this? Has anyone gone through the above treatment instead of surgery and had good results? What about side effects? We still have consult with another urologist to talk about surgery next week but I feel if radiation is probably going to be needed anyway, why go through the surgery at all.

    My husband is 52, DRE normal, PSA 27, Gleason 3+4 and I believe the stage is T1C

  2. #2
    Hello Jean,
    My stats were like your hubbies but there are a lot of blanks that we need before we can give a comment. Like how many cores were positive in your hubbies biopsy.
    The 3+4= 7 is better than 4+3=7G but any G is bad as far as I am concerned.
    My treatment started pretty much the way the doc is suggestion to your husband.
    My doc told me that he suspected a breach since it covered more than 75% of my prostate, and if he cut me open and saw that the PC had breached the prostate then he would just close me right back up.
    I had the external beam and I had the seed implant and have been on the HT for 14 months I think.
    I would post more information and in the mean time I would be setting appointments with Medical Oncologist, Radiation Oncologist and maybe get a second opinion from another urologist.
    There are some books that can help you make decisions as well.
    The forums have helped me get educated and a good place to meet people in the same boat.
    You guys hold each other tight at night and get ready for a long ride. Love, patience and plenty of laughs will be to your advantage. The laughs will be a little harder to find now, but if you look for them you will find them.
    Art
    DX 4-2010 T3 G-7 8 of 12 cores 75% +covered
    PSA 4-2010 4.1
    HT 5-2010 Lupron 4 month shots
    PSA .5 6-2010
    T >.3 6-2010
    External Beam 5-2010
    Heart attack 7-2010
    Seed implant 10-2010
    6 Month shot Trelstar Jan 21st PSA .1 March 2011
    T 1.0 March 2011
    PSa .1 June 2011
    July 2011 T level 8.0 started triple HT
    Casodex daily, 4 month shot Lupron, 6 Month Trelstar T level 4.0
    Told triple HT for 3 years
    I am Cured Battle is over
    Started TRT 11-28-12

  3. #3
    Tiredofbeingsick gave you some good advise...The Partin tables are widely used and respected. Dr. Patrick Walsh's book is a good one to fill in the background information you need..Another radiation treatment option is seeds plus IGRT which recent studies have demonstrated has the best overall cure (survival) rate...Talk to your R-doc about that..Better yet, talk to a R-doc who actually does seed implants. Yours may not and therefore will not offer that treatment..

    I must agree, with a PSA of 27, surgery is a long shot..But some men do it anyway, betting against the odds and willing to accept the side-effect load that comes with surgery...I have had all 3, surgery which failed, beam radiation on a new Varian RapidArc machine (fine accuracy) that included full pelvic with the last 6 treatments called "Boost" which were concentrated on my prostate bed. Now 2 years of HT...So I get to carry the full side-effect load of all three treatments within 8 months of each other...But that's pretty much standard with Gleason 9...Another doctor to talk to is a medical oncologist..You don't need his services yet, but you my gain from his insights about treatment choices...
    PSA at age 55: 3.5, DRE negative.
    65: 8.5, DRE " normal", biopsy, 12 core, negative...
    66 9.0 DRE "normal", BPH, (Proscar)
    67 4.5 DRE "normal" second biopsy, negative.
    67.5 5.6, DRE "normal" U-doc worried..
    age 68, 7.0, third biopsy (June 2010) positive for cancer in 4 cores, 2 cores Gleason 6, one core Gleason 7. one core Gleason 9. RALP on Sept. 3, 2010, Positive margin, post-op PSA. 0.9, SRT , HT. Feb.2011 PSA <0.1 Oct 2011 <0.1 Feb 2012 <0.01 Sept 2012 0.8 June 2013 1.1, Casodex added, PSA 0.04 10/2013. PSA 0.32 1/14. On 6/14 PSA 0.4, "T"-5. 10/14 PSA 0.6, T-11. 1/2015 PSA 0.106. 4/15. 0.4, 9/15 1.4, 3/16 Zytiga, 0.04, 5/17 1.4 may switch to Xtandi. 3/1/2018. PSA now 54, chemo will begin next month. 7/19, PSA 2000 starting Lu-177 tomorrow..77 years old now..

  4. #4
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    Thank you, Art, for your response. My husband's path report is as follows: Adenocarcinoma (Gleason score 3+4=7) involving 20% of the specimen (5 of 6 cores contain cancer). Gleason pattern 4 comprises 20% of the cancer. Cancer length 1.3 cm. --- (This is only from the right side. The cores from the left side showed only BPH in the six cores.) It is the high psa of 27 that worries me the most. It is interesting to see all the different treatment plans. I think my husband is ready to choose the treatment the radiation oncologist has suggested and not do the surgery. Good idea about getting ready for the long ride and keeping laughter in our lives.

  5. #5
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    Thanks Fairwind. We are going to buy Dr. Walsh's book. My husband's radiation oncologist does offer seed implant as a choice for the direct prostate radiation during the last 2 1/2 weeks of treatment. We will ask about IGRT. Thanks so much for all of your good information! Good luck to you!

  6. #6
    IGRT is just a form of beam (external) radiation. Image Guided Radiation Treatment..Often, it is combined with seeds to deliver a one-two punch that is very effective. Dr. Walsh is a surgeon and his book reflects that, but the hard information and treatment facts are all there in an easy to digest format...I will try to find the study that reveals the outcomes for ALL the treatment protocols and post the URL here...

    http://www.prostatecancertreatmentce...tudyGroup.aspx

    You may have to cut and paste the link..

    What makes this study important is the quality and status of the people who were involved with it.. Once you learn how to read the charts, the information they contain is stunning...
    Last edited by Fairwind; 09-23-2011 at 03:06 AM.

  7. #7
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    I am much like your husband (G7) except that my PSA was 59. My uro said absolutely no surgery. He, my rad-onc and med-onc settled on ADT3 (cassodex, eligard, and jalyn) with IMRT to the prostate and lymph nodes, and HDR brachytherapy (the temporary form not permanent seeds).

    I was dx one year ago and started my therapies in October 2010. I completed the radiation and two HDR procedures at the end of December. I continue to be on Eligard and Jalyn for at least another year. I posted <.1 PSA from February on and will have another test next week. The therapy has been working and side effects have been very minimal. Throughout it all I missed only three days of work and one of them was for a colonoscopy.

    Your uro is giving advice similar to what I received and I believe he is spot on. To learn more about the HDR brachytherapy go to www.cetmc.com, the website of Dr Jeffrey Demanes, the HDR pioneer and head of radiology at UCLA. I had my HDR done in Atlanta, and used the Demanes information as research and my knowledge basis to better work with my doctors.

    Let me know how I can help based on my experience,

    Jack

 

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