Hormone treatment after IMRT and when PSA goes up

Post Edited (zufus) : 1/17/2009 8:25:28 AM (GMT-7)

Chuck

PSA 7/7 5.8, 7/8 12.3, 9/8 14.9, 10/8 16.4

3rd Biopsy 9-2008 Positive 7 of 7 cores positive, ranging from 40 - 90%, G 4+3 & 3+4

Open RP surgery  November 14, 2008 at St. Francis Hospital, Greenville, SC, Dr. Ronald Smith - Surgeon, Non-nerve sparing, 4 days in hospital, staples removed 11/24/8, Catheter out on 12/15/8 on day 32.  Day 33, urine stopped flowing, new catheter put in 12/16/08, Catheter out 12/29/08.  After 7 hours, complete stoppage again, emergency room put in Catheter #3 early evening of day 45, still 12/29/08. 1/5/9 - Cath #3 out, dr. did cycloscope, saw potential blockage, put in Catheter #4, 1/13/9 - Had operation St. Francis - removed blockage, put in Cath #5, suppose to be removed 1/19/9

Post-surgery Pathlogy Report:

Gleason 3+4=7, pT2c pN0 pMx, Prostate 42 grams, tumor 20% cancer

Contained in capsular, neg. margins apex, bladder neck, right lobe, neg. in seminal vessels and lymph nodes.

First PSA Post Surgery  Scheduled now for 2/9/9

Age 58

PSA 21.5 (first and only test resulted from follow up visit to emergency room for kidney stone. first time for kidney stone too)

Gleason 4 + 3

DRE palpable tumor on left side

100% of 12 cores positive for PCa range 35% to 85%

Bone scan clear

Chest x ray clear

CT scan shows potential lymph node involvement in pelvic region

Started Casodex on May 2 and stopped on June 1, 2008

Lupron injection on May 15 and every four months for next two years

PSA test on July 14, 08 after 8 weeks hormone .82

Started IMRT/IGRT on July 10, 2008. 45 treatments scheduled

First 25 to be full pelvic for a total dose of 45 Gray to lymph nodes.

Last 20 to prostate only. Total dose to prostate 81 Gray.

Completed IMRT/IGRT 09/11/08.

Second Lupron shot 09/11/08

Next PSA test by oncologist 03/09

Pre-op PSA was 19.8

Surgery on Feb 16, 2007 @ The City of Hope

Post-Op Pathology: Gleason 4+3=7, positive margins, Extra Prostatic Extension (EPE)

Bilateral seminal vesicle invasion (SVI); Stage pT3b, N0, Mx

HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)

IMRT radiation for 38 Treatments ending August 3, '07

Current PSA (January 13, 2009): <0.1

You can visit my Journey at:

Tony's Blog

Tony's Prostate Cancer InfoLink Page

STAY POSITIVE!

Age 73.  Health excellent (work out five days a week) except for prostate cancer and colon cancer, the latter was 12 years ago and seems to be fine as evidenced by continuing colonoscopies. 

Four biopsies.  Two positive and two negative.  Positive reflects involvement in one area (Left Apex 3%).  Gleason 3+4=7, T1c,  negative DRE.  Received 40 doses of IMRT delivered by Fox Chase affiliate.   PSA history below:

Combination of drug therapy (i.e. Trelstar, Lupron, Zoladex) & the antiandrogens (i.e. Casodex) which work by preventing the cancer cells from using testosterone?  Lots to learn.

Thanks for recognizing my service.  My twenty-five years as a Marine NCO & commissioned officer were the best years of my life.  I felt I was doing something really important. 

I truly hope your husband's condition improves and his quality of life gets better.  Decisions we make so much affect the quality.  I was lucky to have a very conservative urologist who is not too quick to treat.  He encouraged me to hold off treatment after the initial positive biopsy due to the small involvement of cancer (3% in only one area).  So for three years I had a better quality of life before IMRT, some do good for many more years before treatment.  Everybody is different.   The IMRT didn't adversly affect me at all.  Unfortunately, my PSA didn't go down to under 1.0.

Chuck

Age 73.  Health excellent (work out five days a week) except for prostate cancer and colon cancer, the latter was 12 years ago and seems to be fine as evidenced by continuing colonoscopies. 

Four biopsies.  Two positive and two negative.  Positive reflects involvement in one area (Left Apex 3%).  Gleason 3+4=7, T1c,  negative DRE.  Received 40 doses of IMRT delivered by Fox Chase affiliate.   PSA history below:

My husband was diagnoised with prostate cancer 2 and a half years ago. His PSA was 9.8 with a gleason of 8-9. The Dr. did not reccommend surgery since the cancer had already spread outside of the prostate. He also felt that seeding would not work because of the aggressiveness of the cancer.

We opted for IMRT, which was experimental then, and hormone therapy (Lupron injections) for two years. My husband experienced some hot flashes, but his PSA went down to 0.5 almost immediately.

He completed his hormone injections in July 2008. His PSA was still 0.5. The PSA slowly went up to 0.6 then 0.33 then 0.48 (in March 2009). I received a call today from his oncologist office stating that his level as of Monday had jumped to 4.8. I am sitting here on pins and needles waiting for the oncologist to call and let us know what to do next.

You may be able to get a lot of good information and some comfort from those who share in this journey none of us planned. 

Chuck

Chuck,

welcome to the site from an ex grunt. From everything I have read about reoccurrances, psa doubling time is the most important factor. If it is over three years, which yours seems to be then it is very controllable for a long time and you will probably die from something else.

The best protocol is ADT3, which is Lupron, Casodex and Proscar. You may want to ask your oncologist about Casodex as a mono therapy as your psa is not rising fast and the side affects are about 20% of Lupron. The best thing is to get a good prostate oncologist even if you have to travel to see one. His recommended treatments can be done locally so you may have to travel only once per year for followups if at all. My neighbor has been on Lupron since 1996 and is doing fine.

Good luck,

JT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT