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Post by redwing57 on Dec 23, 2014 9:47:32 GMT -8
This article link was provided in response to questions on another forum about length of ADT along with primary radiotherapy. It's very encouraging, and the statistics seem quite positive. A shorter course of ADT would really be wonderful. Right now I'm planned for the full 3 year tour, but it seems possible that when my next shot runs out in March I may consider stopping right there at 22 months.
meetinglibrary.asco.org/content/107219-134
Does anyone have a link to the full text of this article? All I can find are abstracts. If I need to purchase, I'll probably do that, but thought I'd ask here first.
Edit: Upon further investigation, this is an abstract from the ASCO meeting ASCO MEETING ABSTRACTS Feb 20, 2013:3. Is it possible to find the full text then of whatever was presented?
The study cohort is not defined well in the abstract, and as a G9 cT3 I have a couple of the risk factors. I'm curious what the actual composition of the study group was. Sometimes in such studies grouping people as "high risk" by G>7, PSA >=20, or cT3 or T4, they'll have broad conclusions. Then there may be a little asterisk for the always very small group that have G9/10 and/or T3/4, saying, "Well we did see a benefit for this subgroup though not statistically significant", or something like that. They'll lump the G8-10 together too, since there aren't usually enough G9/10 to work the statistics.
I like the proposed Prognostic Grade Group I-V system better for that. G9/10 are Group 5, a distinct category. It also helps keep the G6 folks from freaking out, if they're considered only "Group I". Here's a link to an article about that system. The pattern is copied below. urology.jhu.edu/newsletter/2014/prostate_cancer_2014_19.php
Five Gleason Groups Based on Prognosis
Prognostic Group I:
Gleason score <6,
Prognostic Group II:
Gleason score 3+4=7
Prognostic Group III:
Gleason score 4+3=7
Prognostic Group IV:
Gleason score 8
Prognostic Group V:
Gleason score 9-10
Thanks in advance!
Jerry |
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Walt Shiel
New Member
Completed HDR + IMRT/IGRT: 10/17/14
Posts: 7 
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Post by Walt Shiel on Dec 27, 2014 7:46:55 GMT -8
Jerry,
What's your interpretation of ADT duration? Does 18 months mean that you take the last injection at the 18-month point or that you take the last injection at 15 months (assuming 90-day injections) knowing that it will retain full efficacy for the next 3 months?
If my next scheduled PSA test (02/15) remains undetectable (<0.1), I am seriously considering not taking that 15-month Lupron injection. My med onc says she doesn't recommend it but would support my decision and monitor PSA more closely over the following months. She'd rather I stick with the Lupron for a full 18 months.
I am so fed up with this ADT crap that I feel ready to assume an extra risk by stopping it early, although I must admit to some minor trepidation about it.
The more studies I read about the "correct" duration of ADT, the more I am convinced that the medical community is just making a slightly educated guess, probably weighted towards a healthy dose of CYA for the doctors.
Maybe my own, far less than ideal, dealings with the medical community over the past 18 months have resulted in more than a does of skepticism and distrust.
Oh well, I am feeling better and stronger with every passing day now that my RT is more than two months in the past.
Happy New Year!
Walt
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Post by redwing57 on Dec 27, 2014 11:58:46 GMT -8
I'm with you, Walt - this stuff isn't very amusing anymore! As to duration, I'm considering it as the effective dosing window. So, if looking at 2 years, then the injection at 18 months for another 6 months would be the last one, completing a 24 month period under medication. I just had 18 months at the first of November, and received a 4 month shot then (going to a shorter period to see the med onc a little more often). So, my treatment plan will "end" at 22 months, unless I get a 2 month shot then or two 1 month shots to really finish 24 months. Of course, T can also take months to recover, so the effective period could be much longer than the medication plan. And of course that's always been true, so maybe it's one reason the longer durations were more effective. Maybe it's a necessarily extended part of the whole duration. Dunno... My consideration isn't based on how my PSA is responding, and only partly on how I'm feeling. The studies that determined long vs. short duration usually looked at 3 years vs. 4 or 6 months. The option of 2 vs 3 years is a more recent consideration, and it's aided by the higher radiation doses possible now. I understand there is even some question whether ADT is necessary at all now with radiation exposures like 79.2 Gy. Without IGRT they couldn't safely deliver doses that high in years past. I want the best chance at "cure" or at least durable remission. So, I'm leaning on what the studies have said. That's why it's exciting to see a study saying there's no difference between 18 mos and 36 mos. If, in my case, there's not a demonstrable difference, then I'd like to get off of it earlier (a BIG "if", with a cT3a G9 5+4). The percentage added survival benefit of I've seen claimed for ADT is more or less in high single digits anyway, but at this point I'll take every bit I can get. However, I don't want to enjoy these side effects any longer than really necessary!  Jerry |
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Walt Shiel
New Member
Completed HDR + IMRT/IGRT: 10/17/14
Posts: 7
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Post by Walt Shiel on Dec 28, 2014 7:24:51 GMT -8
Jerry,
I guess I look at it this way: if my PSA remains <0.1 in February and I decide to forgo the next 3-month Lupron injection (that would be at the 15-month point in ADT), we just monitor the PSA, possibly more frequently. If there is any indication of a significant PSA increase (realizing that there is always the possibility of a PSA bounce post-RT), I could go back on ADT, maybe with Casodex (with or without something like Avodart) rather than Lupron.
Or I could elect to do essentially the same thing at the 18-month point rather than the 15-month point.
To my mind, it seems like a reasonable approach with acceptable risks, unless I'm overlooking some critical factor.
Walt
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Post by redwing57 on Dec 28, 2014 11:49:38 GMT -8
I suppose it would be best to confirm with an oncologist, of course. Following the PSA closely seems prudent. I think a standard post RT definition of "failure", or recurrence is 2 points above your minimum. So, if you've been less then 0.1, you wouldn't have to worry unless it goes over 2.0. It will likely rise to some value since you still have a prostate though it's been pretty thoroughly cooked! I'm looking at the same considerations eventually.
The studies showed a significant difference between 4 or 6 months and 3 years. The best interval is somewhere in between probably. 12 months? 15 months? 18 months? 24 months? 36? It's just not known yet. By the time my sons reach an age to possibly worry about such things, maybe we'll know that answer. Right now it seems a crap shoot, though I do like the Canadian study's result showing 18 is equivalent to 36. Less than 18 may be ok too, but I don't think we know where that line is yet.
Jerry
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Post by lupronjim on Dec 29, 2014 9:41:24 GMT -8
I am at 21 months and 1 day but who is counting since I started Lupron on 3-28-13.
Dr. Turner an associate of Scholz and Lam is more interested in the 9 month point after Zytiga which will be end of May than the Lupron that will then be at 26 months.
I have an appointment with him on Dec 31 to coincide with when Mel (Compiler) is ther to meet with Dr. Lam. I will ask Dr. Turner the question on when the last Lupron shot should be to end on May 26. I am already planning to have the 3-month shot rather than my customary 4-month shot and then switching to monthly to wean off.
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