Neoadjuvant ADT prior to radiation for high-risk

We have differing opinions coming in from two of my husband's doctors.

-One is recommending 24 months of ADT with Tomotherapy beginning immediately for 8 weeks.

-The other is recommending 24 months of ADT, with Tomotherapy commencing in 8 weeks, for 8 weeks. 

He has already started ADT with almost no side effects except maybe having a little less energy.

The surgeon says wait 8 weeks.  The radiation oncologist says start treatment right away because some subcomponents of the Gleason 9 tumor may not be sensitive to the radiation.

Does anyone know of studies that indicate better outcomes either way? 

Sorry - meant to say some subcomponents may not be sensitive to the hormone therapy (ADT).

 

On Jan 23, 2012 7:11 PM rebeccap wrote:

We have differing opinions coming in from two of my husband's doctors.

-One is recommending 24 months of ADT with Tomotherapy beginning immediately for 8 weeks.

-The other is recommending 24 months of ADT, with Tomotherapy commencing in 8 weeks, for 8 weeks. 

He has already started ADT with almost no side effects except maybe having a little less energy.

The surgeon says wait 8 weeks.  The radiation oncologist says start treatment right away because some subcomponents of the Gleason 9 tumor may not be sensitive to the radiation.

Does anyone know of studies that indicate better outcomes either way? 

I couldn't imagine being chemically castrated for 2 years, the three month injection that lasted six months for me  was a living hell . The bad and sometimes unusaul side effects don't normally start for 8 weeks. By the way I had unusual side effects. Everyone is different and I hope your husband doesn't experience them.

Back to your question, there is a study that states short hormone tratment, 6 months has similar results as the 2 year treatment. It was done by Dr. Anthony D'Amico in 2004 at Dana - Farber. Normally the give the Hormone treatment for 8 weeks before starting the radiation. The rational behind it, is your shrink the tumor allowing the radiation to be more effective.

With a Gleason of 9 most likely this won't be enough to beat this. I strongly suggest diet, supplements and life style changes.

Hope this helps

Dan

Thanks Dan.  I understand that the side effects may not have presented themselves yet.  I will look up the D'Amico study.  Thanks.

Me again.  Looked through the studies.  The big question is whether to wait 8 weeks for radiation.

The D'Amico studies don't mention starting the ADT prior to starting the radiation.  Do you know specifically if they started it two months prior?

Another study,RTOG 9408, Early Stage Prostate Cancer, Published in NEJM , does start 2 months of ADT prior to radiation but it does not state what difference it made for the high risk groups. 

My husband's prostate is only very mildly enlarged - his doctors actually say it is very normal size for his age so there is no need to shrink it before starting the radiation.

This is soooo frustrating.

Rebecca

On Jan 23, 2012 8:48 PM rebeccap wrote:

Me again.  Looked through the studies.  The big question is whether to wait 8 weeks for radiation.

The D'Amico studies don't mention starting the ADT prior to starting the radiation.  Do you know specifically if they started it two months prior?

Another study,RTOG 9408, Early Stage Prostate Cancer, Published in NEJM , does start 2 months of ADT prior to radiation but it does not state what difference it made for the high risk groups. 

My husband's prostate is only very mildly enlarged - his doctors actually say it is very normal size for his age so there is no need to shrink it before starting the radiation.

This is soooo frustrating.

Rebecca

I think D'Amico waited 8 weeks before starting the radiation.

as far as your doc saying his prostate is average for his age, so was mine( translation it is big compared to a 30 year old man) however the hormone treatment shrunk it about 30 to 50 percent. However it took about 7 seven weeks for it to really shrink. I would wait for the shrinkage before you radiate it. If your not sure get more opinions and continue your research. I would wait for 8 weeks.

Dan

Hi Rebecca, My husband's Gleason is a 10. He started ADT only a couple of weeks before starting radiation. His prostate was not enlarged, even though the cancer is present in at least 3/4 of his prostate. Scans show no metastasis, though they suspect it has probably spread locally since it's a 10, which is the worst... fast moving and aggressively spreading. With your husband's Gleason score being a 9, I suspect his radiologist wants to hit it big right away, just like my husband's doctor does. I'd say it's something to seriously consider. Good luck, Sal

On Jan 23, 2012 7:11 PM rebeccap wrote:

We have differing opinions coming in from two of my husband's doctors.

-One is recommending 24 months of ADT with Tomotherapy beginning immediately for 8 weeks.

-The other is recommending 24 months of ADT, with Tomotherapy commencing in 8 weeks, for 8 weeks. 

He has already started ADT with almost no side effects except maybe having a little less energy.

The surgeon says wait 8 weeks.  The radiation oncologist says start treatment right away because some subcomponents of the Gleason 9 tumor may not be sensitive to the radiation.

Does anyone know of studies that indicate better outcomes either way? 

This post may be of some assistance: http://myprostatedoc.blogspot.com/2011/05/combining-hormonal Prostate Doc Myprostatedoc.blogspot.com Prostatedoclibrary.blogspot.com