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After many attempts, I could not respond under Steve's column so I decided to go this route as I have been through the same scenario Steve now faces. Also having a gleason of 9 things happen pretty much as laid out in the Partin Tables. I do differ with Terry as once a total prostatectomy and ultimately followed by radiation, there is no such phonema as a radiation bump, that occuring ONLY if you had radiation..., not surgery. So in my case 5 years after surgery, than radiation, and another 2 years PSA started rising at .11, 3 mos. later .17, etc. Being concerned I wanted a second opinion as to when start ADT as my oncologist wanted to wait until until the 20 range which I thought was too high.
After consultion with an oncologist at John Hopkins, it was pretty much the same story, being the psa in my situation was not a "bump", it will continue to rise which it did, and, out of their thousands of PCa patients, the average starting point for ADT is a psa of 31. He advised me that they will not administer the drug until the cancer shows up in a bone or C-Scan. Of course there are exceptions.
Started Casodex in September, Lupron in October and we'll see in January what the results are.
I am supprised that no one mentioned intermittent ADT, as that is what my doctor suggested to hold off any immunity, or at least slow it down. Steve, may want to check into it.
so the agreement in the prostate cancer community now is to have patients with Metastatic high Gleasons to go on intermittent hormones?
im not aware of any studies that would prove the theory that intermittent therapy delays the onset of hormone resistence
i know it sounds wise in general, but studies failed till todasy to show any such benefits (im not counting such benefits as temporary lack of ADT side effects or treatment cost) as far as I know
I haven't seen anyone saying so the agreement in the prostate cancer community now is to have patients with Metastatic high Gleasons to go on intermittent hormones?
There is no evidence that Steve has metastatic disease, so your comment is immaterial to this discussion. I seem to recall seeing a recent study that refected the growing view that in some cases intermitten ADT produced a similar outcome to non-stop long term ADT. And as I read Jack's post that is what he suggested that Steve should investigate.
I'm not too certain what you object to in my post, Jack, when you say I do differ with Terry as once a total prostatectomy and ultimately followed by radiation, there is no such phonema as a radiation bump, that occuring ONLY if you had radiation..., not surgery.
This is what I said to Steve:
Were you given any specific reason for the suggested delay in starting ADT?
The only thing I can think of is that your doctor might be thinking that what you are seeing is a radiation "bump" which sometimes occurs about two years after radiation therapy is concluded. This sees the PSA lelevls slowly climb to a zenith - a high point - and then head back down to your nadir - your lowest point which should in your case be undetectable with a normal PSA test.
You might like to ask him this and then weigh up the probabilities/consequences of your options.
As you will see, I was suggesting to Steve that his doctor may have been thinking of this aspect of radiation therapy - but mainly I was saying that he should find out from his doctor why he was suggesting a delay - and if Steve was happy with that he should make up his own mind as to what was best for HIM.
It is always important to bear in the mind the fact that, as the late Aubrey Pilgrim used to say The Golden Rule of prostate cancer is that There Are No Rules. Added to which is the fact that an average or mean in a study is ess important than the range. So when you say the average starting point for ADT is a PSA of 31, I'd say - "What is the range to arrive at that average? And how did the men at either end of the range go? Did they have a similar outcome to those in the mid point?"
