Johns Hopkins Info Re Advanced PCa

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Tudpock18
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Date Joined Sep 2008
Total Posts : 4080
   Posted 4/9/2009 5:35 AM (GMT -6)   
This report is from Johns Hopkins for anyone facing advanced PCa.
 
Tudpock
 
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 4/1/09.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 4/9/2009 7:26 AM (GMT -6)   
Tudpock, I can't seem to get that link to work.
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


Tudpock18
Forum Moderator


Date Joined Sep 2008
Total Posts : 4080
   Posted 4/9/2009 8:05 AM (GMT -6)   

Try this..

http://www.johnshopkinshealthalerts.com/reports/prostate_disorders/2940-1.html?ET=johnshopkins:e17387:260346a:&st=email&st=email&s=RPH_090409_005

 


Age 62
Gleason 4 +3 = 7
T1C
PSA 4.2
2 of 16 cores cancerous
27cc
Brachytherapy December 9, 2008.  73 Iodine-125 seeds.  Procedure went great, catheter out before I went home, only minor discomfort.  Regular activities resumed, everything continues to function normally as of 4/1/09.

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 4/9/2009 10:05 AM (GMT -6)   
Tudpock...nope that link doesn't work either
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal-Gland 38 cc
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral (Perineural Invasion present at base) - Gleason (3+3) 6  Stage T1C
August 23 - Bone Scan - Hips, Spine and ribs marked uptake - X-Ray showed clear -Hooray
Sept 9 2nd DRE - questionable - TRUS...shadow in base - Gland now 41 cc
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (4+3) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
4 tumors in prostate - largest being 6 cm 
PSA 5 week Oct 2008 <.05
       3 month Jan 2009 .06


flippin out
Regular Member


Date Joined Mar 2006
Total Posts : 137
   Posted 4/9/2009 11:28 AM (GMT -6)   
COPY THE LINK PASTE IT IN YOUR UPPER WINDOW IT SHOULD WORK THEN

http://www.johnshopkinshealthalerts.com/reports/prostate_disorders/2940-1.html?ET=johnshopkins:e17387:260346a:&st=email&st=email&s=RPH_090409_005
50 Diagnosed as type II Diabetic
54 Cancer Detected
55 Da Vinci City Of Hope California
57 Cancer rise in successive PSA's
57 Radiation Loma Linda Medical Center California


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/9/2009 1:47 PM (GMT -6)   
Just a note,
I was offerred Taxotere as an adjuvant treatment in a study by Sanofi-Adventis. The use of it as a salvage therapy is as stated above and can add several months even years to a mans life.  The clinical trial I alluded to was intended to see if Taxotere could improve suppression rates in Stage III high risk cases like mine.  I elected to not go into the study because it would have required that I skipped radiation, and also in part because I have played guitars for many years.  I had read where neuropathy would effectively end my work in music.  I was wrong about that, but not about the radiation piece.  Here is what Mike Scott recently blogged on the concept of adjuvant chemotherapy:
 
 
Tony
Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
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
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 4/9/2009 1:48 PM (GMT -6)   

I guess I am just dumber than a stump. rolleyes The following paragraph from the article indicates a three month survival benefit for taking a drug that has a serious impact on quality of life and at some cost I am sure. What am I missing that would have the medical community cheering for what appears to be a negligible benefit? (at least to me) ( I understand averages... like the old joke. A man has his feet in a fire and his head in a freezer but is quite comfortable on the average.)

"At least 50% of the patients who use the drug will get a remission of some duration. In the studies, the men who received Taxotere-based therapy lived, on average, about three months longer when compared to men who received the old drug combination of prednisone (a corticosteroid) and the cancer medication Novantrone (mitoxantrone), which was approved by the FDA in 1996 as a treatment for the pain of metastatic prostate cancer."

Don


Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and 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
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.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
 
 
 


don826
Veteran Member


Date Joined May 2008
Total Posts : 1010
   Posted 4/9/2009 2:02 PM (GMT -6)   
Tony,
I looked at the article you referenced but I am still mystified. When I was first diagnosed I asked my oncologist about chemotherapy. He was not in favor of it at the time and felt that HT was more applicable to my situtation. There was (maybe still is) a study going on that included all three treatments. RT, HT and CT. He asked if I was interested in doing the study and I replied that I would rather see where the first two took me.

Don
Diagnosed 04/10/08 Age 58 at the time
Gleason 4 + 3
DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85%
Bone scan clear and 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
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.
PSA 02/08 21.5 at diagnosis
PSA 07/08 .82 after 8 wks of hormones
PSA 10/08 .642 one month after completion of IMRT, 6 months hormone
PSA 03/09 .38 six months post radiation and nine months into hormones 
 
 
 


Amy41
Regular Member


Date Joined Jan 2009
Total Posts : 30
   Posted 4/9/2009 3:23 PM (GMT -6)   

Don

Chemo - is one of the next steps after hormone treatment stops working.  When we recently talked to my husbands oncologist about the Chemo treatment it was explained to us that the side effects with this type of chemo is not too bad - compared to standard chemo and also will help keep the tumor at bay and relieve some of the bone pain from the mets.  We will be deciding next month about Chemo or a stage 3 blind trial of Abereletone. 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 4/9/2009 3:26 PM (GMT -6)   
Great discussion. Everytime I read something like this it reminds that I will someday by refractory and have to make a decision of what to do next. In my personal research I do not like what taxotere has to offer at this point, however like Ohio said a drowing man will grab a sword. Thanks for this post and the responses it keeps all informed and does go to show that somewhere the medical community is still seeking new and better ways to treat this disease.

peace and love
dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
Testosterone keeps rising, the current number is 156, up from 57 in May
T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25364
   Posted 4/10/2009 9:23 AM (GMT -6)   
I am not an advanced case, and I pray I never will, but know that I could one day. From reading about that particular chemo drug, I am not sure that I would want to deal with such severe side affects for a 50% chance of living 3 months longer. Or perhaps I missed the point of the article. If I were in an advanced stage, perhaps I would view it differently. Each of us at some point in our lives, whether it be with PC, or some other malady, will always have to weigh out quality of life vs. quantity of life. This article I found very somber and disturbing, but needed to be seen and read, I am thankful for all knowledge. If my PC comes back one day, I don't want to be caught as off guard as I was with my original dx. My best to all the advanced brothers here, same enemy, but much different fight and perspective on life.

David in SC
Age 56, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
Post-surgery Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsular, clear margins, clear lymph nodes 
First PSA Post Surgery   2/9 .05, 6 month on 5/9
 
 


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4186
   Posted 4/10/2009 10:33 AM (GMT -6)   
You have to be careful in using average survival rates. In cancer 3-4 months extra is a big deal because survival follows a distribution curve. A few people will get no benefit and have zero and a few will get a lot of benefit 2-3 years and many will get 8-9 months. 3-4 months is an average not a mid point..
JohnT

64 years old.

I had an initial PSA test in 1999 of 4.4. PSA increased every 6 months reaching 40 in 5-08. PSA free ranged from 16% to 10%. Over this time period I had a total of 13 biopsies and an endorectal MRIS all negative and have seen doctors at Long Beach, UCLA, UCSF and UCI. DX has always been BPH and continue to get biopsies every year.

In 10-08 I had a 25 core biopsy that showed 2 cores positive, gleason 6 at less than 5%. Surgery was recommended and I was in the process of interviewing surgeons when my wife's oncologist recommended I get a 2nd opinion from a prostate oncologist.

I saw Dr Sholtz, in Marina Del Rey, and he said that the path reports indicated no tumor, but indolant cancer clusters that didn't need any treatment. He was concerned that my PSA history indicated that I had a large amount of PC somewhere that had yet to be uncovered and put me through several more tests.

A color doppler targeted biopsy in 11-08 found a large tumor in the transition zone, gleason 6 and 7. Because of my high PSA Dr. suspected lymph node involvement, 30% chance, and sent me to Holland for a Combidex MRI, even though bone and CT scans were clear.

Combidex MRI showed clear lymph nodes and a 2,5 cm tumor in the anterior. I was his 1st patient to come up clear on the Combidex which has a 96% accuracy,

I've been on a no meat and dairy diet since 12-08 and PSA reduce to 30 while I awaited the Combidex MRI.

The location of the tumor in the anterior apex next to the urethea makes a good surgical margin very unlikely. Currently on Casodex and Proscar for 8 weeks to shrink my 60 mm prostate. Treatment will be seeds followed by 5 weeks of IMRT while continuing on Casodex and Proscar. So far no side affects from the Casodex.

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/10/2009 11:02 AM (GMT -6)   
Couple things to respond:

Amy, Abiraterone is showing promise. I hope you draw the drug and not the placebo. My friend drew the placebo and had to opt out as his PSA continued a climb. The good news is that for every 3 people in the study 2 will get the drug and 1 the placebo.

Don, Most oncologists are not in favor of adjuvant chemotherapy with Taxotere. But that's what the study is about. With 3 to 19 months life extension as a salvage treatment, they are hoping to prove is more in the multi-years catagory as an immediate follow up to post prostatectomy high risk cases before relapse.

Having known a quite a few guys who were treated with Taxotere, I have learned that attitude helps when taking on chemotherapy. There is a degradation in QoL but many of the guys have fought through and done well and had good QoL with it. In the few guys I know that took on Taxotere right after surgery, they handled it better than those who went through the meriad of treatments that eventually failed. This I believe is because those treatments have there own long term side effects. There is much to be said for the possibility that early Taxotere is better than later Taxotere.

The available studies are trying to prove this. My oncologist believes that it is quite possible because he has already administere adjuvant chemotherapy and the early results have been strong.

Tony


Age 46 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
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
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!

Post Edited (TC-LasVegas) : 4/10/2009 11:06:09 AM (GMT-6)

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