My husband was diagnosed with prostate cancer in December of 2007. His PSA was 8.2 and his Gleason was 3+4. After the MRI he was told that there was possible extension in one place and probable extension in another. He chose to start with three months of Zolodex followed by 25 days of IMRT radiation at Virginia Mason hospital in Seattle. His Radiation Oncologist was Dr. Alex Hsi and his medical oncologist is Dr. Vucy. We also are working with Dr. Russell at the Cancer Care Alliance. After the external radiation he had a seed boost and has had shots of Zolodex every three months for almost two years. His PSA has stayed at less than 0.01 for the past two years, but I know that that is due to the hormone therapy. I am so afraid of what is going to happen after he comes off the shots. I forgot to mention that there was no sign of the cancer in other parts of his body, but there must be cancer that is not visible. His urologist keeps saying that we are working toward a cure, but it seems that all the literature suggests that that is not the case with locally advanced disease. I want to know if he has any chance of beating this and if the cancer does come back what new options are out there. We are willing to travel to another place to get the care he would need. I wish that he had had surgery followed by radiation, but he didn’t want to do go that way. Do you think that his choice was a good one?
Worried wife
Your physicians are working for a cure. And if the radiation was done appropriately, his chances of cure are quite good. I do not have all the details that I would like to have, but would roughly estimate his chances of cure at better than 50%. Dr. Dattoli has published greater than 80% of patients like this disease free at greater than 16 years. We used to think that once the cancer was out of the prostate gland, it was probably everywhere. We now know that is usually not the case. In fact, in a large portion of men with intermediate or high risk disease, the cancer is still confined to the pelvis and adjuvant hormonal therapy plus the aggressive use of radiation can commonly be curative. The decision to limit hormonal therapy to two years was based on very sound thinking. Hormonal therapy of longer duration has no clear added benefit as far as cancer control is concerned, but does very significantly increase the risk of cardiovascular disease. In other words, the risks of hormonal therapy outweigh any benefit.