Saturday, October 20, 2012

Hormone Therapy Part I

My research effort into hormone therapy uncovered a bit of a medical controversy, namely, at what point should HT be initiated? Does one nip his cancer in the bud, so to speak, or does one wait until the disease evolves. This issue prompted me to pose the following question to a few knowledgeable others whose judgement I trust:
Would I be extending or jeopardizing my quality of life by delaying treatment until my disease progresses, i.e., as indicated by a higher PSA ( if so to what level?) or there is evidence of metastisis?
In raising this question I reminded my advisors of the following factors:
1, My PSA is fairly low
2. The cancer is limited to my prostate and limited in size (1.1 cm), but
3, Evidently I have a virulent form of cancer since it withstood 8 weeks of proton radiation
4. My Gleason score indicates a moderately aggressive form of cancer 7(4+3) or according to a recent review of my slides by Mayo Clinic 8(4+4)
5. I have a rapidly rising PSA ( from a nadir of .8 two years post treatment on 3/11/11 to 3.1 on 7/2/12 .
The first advisor to respond said the answer depended on my propensity for risk taking. He also suggested that I consider HIFU. Upon reflection I had to admit (to myself) that at this stage in my life I was  neirher adventuresome nor much interested in risking what remains of my quality of life. I did, however, undertake a little research project.
HIFU stands for high intensity focused ultrasound. I found little information on how this procedure is carried out. My impression is that the procedure is associated with infections and bladder obstructing treatment "residue". As a first line therapy I reviewed anecdotal testimony ranging from rave reviews to cautionary admonitions.
I did locate a study on the use of HIFU as salvage therapy, more particularly, for men who experiencd biochemical failure following external beam radiation (IMRT). A summary of the outcome of the 84 patients appears below:
-- 43%, less than half ,  had a 2 year "progression free" survival
--62% were "pad free"
--50% experienced an erosion of their potency
--20% required intervention for bladder outlet obstruction
-- 2 patients experienced a fistula 1 each in their urinary tract and rectal wall
These results appear to be less favorable than either treatment option offered by Mayo Clinic, i. e.,( a) lupron followed by seed implantation or (b) cryotherapy. As the reader may recall I declined Mayo's offer and, quite frankly at this juncture, I am not predisposed to accept what HIFU has to offer.


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