...in 1 of 8 specimens...

Your Gleason score of 8 was probably the reason why your doctor
suggested the drugs might have to be continued indefinitely.   But you
should ask him and the other doctors just how they will decide if it is
necessary for you to continue indefinitely.  I would guess that one
method would be to take you off the drugs and see what happens to your
PSA.  I can't imagine another method, but there may be one.

Maurice's Gleason is only 7.  It might make a difference whether it was
7=3+4 or 7=4+3, with the latter being more like an 8.  Also, he didn't
give the stage.   And of course both of you had initial PSAs greater
than 10.   On the other hand, I've known other men who have had Gleason
7=3+4 cancers treated by radiation who are not on long term hormone
suppressing drugs.

I have also seen some varying views on this.  Publications citing clinical
trial
data are ambiguous.  Some indicate benefit from long term treatment, some
don't.

There are negative side effects of long term treatment.  The most serious
one I'm aware of is osteoporosis.

Another concern is that, if the treatment is extended beyond some limited
period of time the ability of the body to produce testosterone may be
permanently impaired.

Still another is that long term hormone suppression is just not adequately
studied or understood.  A mechanism as complex as the human body
can undergo all sorts of unrecognized effects when something as
fundamental and powerful as hormone balance is disturbed.

I have seen the figure of one year bandied about as a cutoff point for
these concerns.  People treated for less than one year with hormone
suppression are not likely to suffer long term effects.  After one year
the long term effects become an increasing possibility.  But of course
mileage varies with each individual.  Some may be at risk when treated
for less than a year and some may endure many years without damage.

Intuitively, intermittent therapy makes the most sense to me.  Take
the hormones before radiation to shrink the prostate and (hopefully)
increase the effectiveness of the radiation (there is debate about that).
_Maybe_, continue the hormones for a short period after radiation on
the theory that radiation does not do all its work against the tumor
cells during the period of radiation itself - maybe.  Then stop.

After radiation, the PSA will go down, maybe up, maybe down
again and, if the radiation was successful, settle at a low value (but
probably not undetectable as with successful surgery).  If, instead
of settling at a low value, the PSA starts climbing and continues to
climb, resume hormone treatment to get the PSA down again.

Hopefully, the PSA will never start climbing and you'll never need
hormone therapy again.  Only if that fails, then resume hormone
therapy.  If the radiation killed all the cancer, it seems crazy to me
to continue taking hormones.  You'd be treating a problem that isn't
there.

However even after PSA failure, I'd personally be inclined to get
the PSA down with Lupron and then stop the Lupron until it starts
to rise again.  From what I've read, doing that does not lead to
earlier death than continuous treatment - though there is argument
as to whether it leads to later death.  The intermittent approach
apparently will prevent the negative long term side effects.

It is rare, but not unknown, for a person not to need repeated doses
of Lupron.  There have been cases reported of PSA brought down
with Lupron, the Lupron stopped, and the PSA never rising again.

According to Dr. Strum's book, the better a person's reaction to
HT (i.e., the more it brings down his PSA), the longer he can go
between doses.  He says he's seen people who get HT after PSA
failure and then go four years before they need the next dose - after
which they can go more years.

A urologist's opinion on all this is certainly more educated than
mine, but I wonder if some of the uros that advocate HT forever
are doing it without adequate knowledge.  Maybe some of them
imagine that they're being conservative - not realizing that it's
not conservative to administer powerful drugs to treat a problem
that may or may not be there.

   Alan

Sounds like good advise Steve. No sense in getiing too far ahead of yourself.
Have to take this thing is steps. Treatment options will change (hopefully
improve) with time anyway (we hope)

Steve

I've just seen an Urologist in Harley St and a medical Oncologist at the
Middlesex in London and both say that the average time to hormone escape(
refraction) is between 18 and 24 months.
I've been on Casodex for a year now and my PSA has started going up from 0.3
to 5.2. I'm now on Zoladex. My fingers are crossed.

I see lots of posts here from people who are in the early stages of PC but
very few from those who are in the later stages. It would be interesting to
hear from these experienced people.

Jamie

PSA 6.2 1/00
PSA 8.7 11/01
Gleeson 4+3
Casodex + Zoladex 1/02
Radiotherapy 6/02
PSA 9.1 9/02
PSA 24.0 1/03
Casodex 1/03 PSA 3/02 0.3
PSA 5.2 12/03 Started Zoladex

Snip

Here's a list of side effects I found on the Net.
http://www.hypertext.org/ENGLISH/HB.html#sfx
I started Flutamide and Lupron a month ago and so far have only experienced
headaches, some joint aches, some drowsiness and insomnia. It's quite a long
list and should vary depending on the individual, but at least I know what I
might expect as time goes on. Hope this helps.