Re: Re: I don't know who to thank

[Guest guest]

>

> My husband went see an Oncologist to see if his cancer had

> spread to the bone, he has tor have a MRI to rule that out now.

> But the Oncologist told him not to have the surgery but to have

> radiation and Hormonal Therapy for three years. He also said he

> would be a candidate for a Clinical Study Trial which would

> consist of chemo, radiation and Hormonal Therapy. He said no to

> that. He is doing more research on the radiation therapy now,

> He is so confused. I'm against it because some of the side

> effects are permanent. All I can do is support what ever his

> decision will be. Any input would be greatly appriciated.

Hello Sheila,

Are you against the radiation, the hormonal therapy, both, or any

treatment of any kind (i.e., surgery too)?

You haven't said how old your husband is, what his general health

is, or what his disease characteristics are (Gleason score, PSA,

PSA doubling time, staging). Those are important things to

consider when trying to decide for or against treatment.

Given your husband's age and general health, you may be able to

make an estimate of how many years are left to him assuming no

cancer. Given his Gleason score, PSA, etc., his doctor may be

able to make an estimate of how long it would take before he

starts to suffer cancer pain, and how long before he dies of

cancer.

In my personal opinion, unless there is reason to believe that

his life expectancy is less than it will take for the cancer to

get to him, or unless there is reason to believe that the cancer

has already spread and is no longer amenable to primary

treatment (which his doctor is trying to figure out with the

MRI), then it should be treated. The side effects of any of the

treatments are not as bad as having advanced cancer.

Treatment may not work. The doctor can give you odds of success

based on your husband's disease characteristics. But a good

doctor normally won't recommend treatment at all unless he

thinks there is a reasonable chance of success.

Don't be too afraid of the side effects. I went through

radiation and a short course of hormone therapy and I came out of

it relatively okay. There were side effects. It would have been

nicer not to have them. I particularly disliked what the HT did

to my libido and my ability to exercise. But they have not

really affected my life long term. Now, four years after

treatment, my PSA is very low and I'm looking forward to life

without feeling that it's just a matter of time before prostate

cancer kills me. I know something else will get me before too

many years, but maybe there will be a few more years than I would

otherwise have had.

Best of luck to both of you.

Alan Meyer

ameyer2@...

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[Guest guest]

....

> If your husband has a Gleason 9 cancer, the odds are very

> great that the cancer is outside the prostate. In that case,

> removing the prostate would only affect the cancer in the

> prostate and not the cancer that may be outside it.

Aubrey is clearly right about this. BUT, some cases of Gleason 9

cancer apparently ARE cured by primary treatment.

The odds go down as compared to Gleason 6 or 7, but not to zero.

A lot depends on individual choice. If the odds of a cure are

25% - 60% (radically different numbers I know, but I seem to

remember seeing both of them), is that worth taking the

treatment?

Only you and your husband can decide.

If you decide for it, go with the very best doctor you can

to get the highest odds for success.

> If it were me, I would stay on the hormone ablation therapy,

> which would include Proscar or Avodart. Dr. Leibowitz has

> had some very good success with his triple hormone therapy.

> He has his patients stay on the triple therapy for a year, then

> if their PSA is undetectable, has them go off the therapy except

> that he keeps them on Proscar or Avodart as a maintenance

> therapy.

>

> Of course he monitors their PSA and if it begins to rise, then

> the patients go back on therapy as Intermittent Therapy. It

> seems to work very well for most patients.

This also seems like reasonable advice. However, do bear in mind

that some men have highly hormone sensitive cancers and survive

many, many years on ADT, and others don't. Some only get a

couple of years from ADT. I think one published study claimed an

average of 18 months. That's the number quoted in the NCI

treatment summary for PCa. However that may have been for

ordinary ADT, not triple ADT, and may have mostly been for men

who didn't start ADT until after their cancer was metastatic.

I respect Aubrey's approach. It's perfectly valid. However my

own, highly personal, inclination would probably be to try for

the cure even though the odds aren't great.

> I wish you all the best.

I second that.

Alan Meyer

ameyer2@...

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