Hormone Suppression

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Comment by Kevin D. Cooper on November 21, 2009 at 8:18pm

Hello Ralph,

Yes my testosterone was checked and it was around 10 at the time ADT failed. Like Michael Altholz below, I had a ferocious doubling time at least before ADT, about 23 days so I was not surprised when ADT only worked for me for about twelve months. It seems like my cancer has been ahead of fleet average every step of the way so far but I am hoping that this med will be effective at least for the 6-12 months that is the men.

Comment by Michael Altholz on November 21, 2009 at 2:58pm

Yes Ralph I did. My urologist immediately retested. The result was the same.
I have since moved to NC and see a Geniourilogical Oncologist at Duke. He strongly believes that this waiting period allowed the cancer to spread to my bone. I now have 9 mets that thank g-d are dorment due to the ADT.
As per Dr. Dan George my cancer is extremely aggressive and will be trouble to control "later on".

Comment by Ralph Valle on November 21, 2009 at 2:14pm

Kevin, was your testosterone checked when you said that ADT failed? Glad to see you are responding to Keto. Good going!

Comment by Ralph Valle on November 21, 2009 at 2:09pm

Michael, by any chance did you have that high PSA result retested? For that exponential increase your PSA had to be doubling every 12 days. Hard to believe when your PSA responded so well to further treatment.

Comment by Michael Altholz on November 21, 2009 at 12:17pm

My Dr. tried intermittent treatment. My psa was 0.2 at the end of my 3 month Lupron cycle. After an additional 3 months of waiting I came in for my psa test. I was shocked to find out that my psa had shot up to 26.8. So, intermittent treatment is not for everyone. I guess it depends on how aggressive your cancer is. I now receive my "dose" by the calandar and my psa remains at 0.2.

Comment by Kevin D. Cooper on November 20, 2009 at 9:36pm

For those wwho have been following my story "On Beyond ADT";

For me, ADT failed in May, started HD Ketoconazole in June, at 5 month check-up, PSA was halved again, down from .41 to .20. All side effects have continued bearable though coping with the fatigue has been hard, especially since we are moving this month.

Comment by Ralph Valle on September 27, 2009 at 1:34pm

Hello RayAnthony,
Hormone suppression is not a cure. The normal process is androgen independence. Many men respond to this therapy for years. Some do as continuous and others as intermittent. Intermittent results appear to be equal to continuous and therefore in its effect on quality of life is a preferred method.

You have been on a cycle of six months on and six off. You could continue to respond for years. As you mention in your post, these off-cycles tend to be shorter in time as androgen independence (AI) develops. Have you noticed slower PSA responses in your on-cycles? Are your off-cycle PSA rising faster? These are signs that AI is developing. As far as getting of the threadmill, it all depends of how your PSA doubling time is during an off-cycle. Hope that can be measured in years rather than months.

Comment by RayAnthony on September 26, 2009 at 6:10pm

Hi Ralph, I was under the impression that each time that one has the hormone implant that it decreases in its ability to be effective, is this so?. I have one month to go on my latest implant of six months duration and my psa has gone down to 1.4 which is the lowest it has been in six years,this gives me hope that maybe I can get off this treadmill one day. BWAH.

Comment by Ralph Valle on August 21, 2009 at 10:37pm

Dr. Wilson,
Your PSA doubling time (PSADT) should be a guide to resume androgen deprivation. You are so very young! I saw you experimented with Androcour (an steroidal antiandrogen) without much success. Intermittent androgen deprivation rather that permanent deprivation is probably your best shot at this point.

Use a non-steroidal antiandrogen like Casodex before a shot of Zoladex (two weeks at 50 mg qd should do it). Consider adding a 5-alpha reductase inhibitor to reduce your dihydrotestosterone (DHT) and promote maximal deprivation for a period of at least 12 to 16 months. Be sure to have your level of testosterone measured 4 months after the Zoladex shot.

There is a descriptive article at the PCRI site at:
http://www.prostate-cancer.org/resource/pdf/Is2-4.pdf

Wish you the very best,

RalphV

Comment by E. Michael D. ("Mike") Scott on August 21, 2009 at 7:23pm

Brent:

If you had one Zoladex injection 5 months ago and then no further injection, it makes perfect sense to me that your PSA could have gone back up to a value of 6+.

Under normal circumstances, people in your situation who start hormone therapy don't come off it again for at least 9 or 12 months before trying an intermittent regimen.

I don't think you need to try the Taxotere yet ... but you probably do need to think about another shot of Zoladex ... possibly with an antiandrogen like Casodex at the same time.

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