Re: Lupron, Radiation and Opinions

[Guest guest]

Fuller, Or anyone

It seems that for patients with a Psa of 10 or over that Adt is added to

, or prior to , having radiation.

The radiation can be either Photon or Proton. Or in combination with Brachy.

All this brings up another question. Can Chemo be added to the mix for increasing

the odds.?

d.

Fuller wrote:

Lupron, radiation, and opinions

A recent post indicated that a urologist told a patient that

(paraphrasing) "you can avoid side effects of Lupron and shrink your

prostate with radiation."

In my opinion, there are three roles in the use of ADT (Lupron,

etc.) in fighting prostate cancer. One is to shrink the prostate

gland to a size that permits or facilitates the proposed treatment

such as cryotherapy or brachytherapy. The second is for the purpose

described below: to assist in the overall attack against the disease

and possibly improve outcomes for those with more advanced disease.

The third is as the primary treatment in the case of those that have

advanced disease and are seeking to hold the beast in check.

As Larry indicated in a later post, there is evidence that a

neoadjuvant course of ADT before and during radiation treatment for

prostate cancer is beneficial. There is need of additional evidence

(see http://www.medscape.com/viewarticle/417010_4

) but several well

respected institutions and physicians subscribe to this

thinking: "ScienceDaily (Jan. 2, 2008) — Researchers report that just

four months of hormonal therapy before and with standard external

beam radiation therapy slowed cancer growth by as much as eight years-

-especially the development of bone metastases--and increased

survival in older men with potentially aggressive prostate cancer.

This "neoadjuvant" hormonal therapy may allow men most at risk of

developing bone metastases avoid long-term hormonal therapy later on.

Furthermore, the short-term hormonal therapy did not increase the

risk of cardiovascular disease--a potential side effect of long-term

hormonal therapy."

(see http://www.sciencedaily.com/releases/2008/01/080102222947.htm

).

There is also discussion regarding use of ADT prior to surgery

(see http://www.medscape.com/viewarticle/417010_3

).

Now to my point: I am not sure that the patient is being well served

by a urologist that believes that radiation alone can shrink a

prostate gland that is large and thus more difficult to treat by

whatever modality. Yes radiation will shrink tumors, but it is not a

methodology used as the primary way to "shrink the prostate."

According to most information that I have found, the shrinking role

is primarily by ADT. Furthermore, standard radiation use alone for a

large oversized gland might well subject surrounding body tissue and

organs at risk to unnecessary radiation and increase the possibility

of longer term negative side effects.

The treatment of prostate cancer is controversial. It seems that

regardless of the method of treatment we choose, there are patients

and doctors that disagree with that choice in favor of "their" own.

That is just the way it is, and is all the more reason to do the best

job of studying the disease and treatments that we can, including all

possible side effects, before we commit.

In my case, my gland was about double normal size and my initial uro

administered a four month Lupron shot "to shrink the prostate" so

that his recommended cryotherapy could be done. Although I hated the

side effects, I am now glad that I had the Lupron, because the

waiting period while the gland was "shrinking" gave me the

opportunity to do enough research to find the treatment that I

believed was "best" for me, proton beam therapy.

Now I know that the Lupron may have been beneficial in my overall

treatment. My doctor at Loma prescribed and additional one

month shot of Lupron to extend the effects of the ADT until the end

of the proton treatments. He was one of those who believed in the

beneficial effects of the neoadjuvant ADT during radiation treatment.

Fuller

[Guest guest]

Chemo can indeed be added to the mix. either with or without the ADT.

From PubMed: " The data currently available from nonrandomized trials

have not yet established the exact role of neoadjuvant and adjuvant

chemotherapy and its potential impact on survival. However,

preliminary data suggest that chemotherapy, when administered in

concert with definitive local therapy, may be promising in patients

with locally advanced prostate cancer. Randomized clinical trials are

ongoing to see if neoadjuvant and adjuvant chemotherapy will

translate into an improved clinical benefit for the patient, and

participation by patients is paramount. We review the recent

literature regarding the use of neoadjuvant and adjuvant chemotherapy

in patients with locally advanced prostate cancer. " (PMID: 15341673 )

[PubMed - indexed for MEDLINE]

I know for a fact that one such protocol is currently in use at the

new Shands proton facility at ville because a friend of over

forty years completed such a protocol at that facility in 2007.

Another reference discusses this:

http://www.prostate-

cancer.org/education/andind/Guess_ChemotherapyForPC.html

I quote an extract from this very informative article:

" What About Chemotherapy in Earlier Stages of PC? "

" With the benefit of a docetaxel-based therapy in advanced PC now

well established, its potential role in earlier-stage PC becomes a

much more important question. There are several groups of earlier-

stage PC patients to be considered. The first group is men who have

been newly diagnosed with " high-risk " PC. Generally speaking, high-

risk PC is defined as having a PSA > 20 or a Gleason score of 8 or

higher or a Clinical Stage of T3 or higher determined by a digital

rectal exam (tumor is already extending outside of the prostate

gland). Men with high-risk PC have a high chance (usually > 50%) of

disease recurrence even after definitive local therapy such as

surgery, radiation or cryotherapy. The primary reason for this is the

presence of microscopic disease outside the prostate and beyond the

reach of the local prostate treatment. Clinicians and patients are

now better able to identify those men at high risk through the use of

nomograms (see Dr.Glenn Tisman's article " Using Nomograms to Predict

PC Treatment Outcomes " in PCRI Insights Nov 2005 Vol. 8, No. 4).

The use of chemotherapy in high-risk patients takes place in

a " neoadjuvant " or " adjuvant " setting. (Neoadjuvant chemotherapy is

the use of chemotherapy prior to any other treatment such as surgery

or radiation. Adjuvant chemotherapy takes place at the same time as

one or multiple other therapies.) Recently, pre-clinical data

evaluating the optimal timing and combination of chemotherapy and

hormone blockade supports the use of simultaneous therapy.6 "

Another reference:

http://www3.interscience.wiley.com/cgi-

bin/abstract/112723250/ABSTRACT?CRETRY=1 & SRETRY=0

Keywords chemotherapy • adjuvant chemotherapy • prostate cancer

Abstract

" Even though surgery and/or radiation has been the treatment of

choice for early carcinoma of the prostate, there is conclusive

evidence that tumor may recur in a certain number of patients at the

primary site and/or at a distant location. The only way to achieve a

complete cure in these patients with localized cancer appears to be

by addition of relatively safe, effective chemotherapeutic agents.

Estracyt and/or Cytoxan appear to be such agents. These two drugs

showed definite activity in the treatment of patients with advanced

prostatic carcinoma. Chemotherapeutic agents appear effective as

adjuvant in the treatment of other solid tumors. It is worthwhile

that this modality of treatment be tried in patients with early,

curable prostatic carcinoma. "

Another:

http://theoncologist.alphamedpress.org/cgi/content/full/10/suppl_2/18

There are others that may be found with searching key words.

Fuller

--------------------------------------------------------

>

> Fuller, Or anyone

>

> It seems that for patients with a Psa of 10 or over that Adt is

added to

> , or prior to , having radiation.

> The radiation can be either Photon or Proton. Or in combination

with Brachy.

>

> All this brings up another question. Can Chemo be added to the mix

for

> increasing the odds.?

>

> d.

>