have a question about psa increasing, but no mets

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kak
Regular Member


Date Joined May 2009
Total Posts : 85
   Posted 11/24/2009 5:58 PM (GMT -6)   
My husbands psa is going up on hormone treatment he will go for a bone scan etc., but the last one a year ago was clear. If this one is clear is chemo. still the treatment of choice?
AGe 54 diagnosed March of 2007
PSA 107
Gleason 8
Stage T2 or T3 (weren't sure was out of prostate capsule)
Bone scan march 2007 and Aug 2008 both clear
ct 2007 clear
started casadex/lupron March of 2007 (casadex only for 4 months)(lupron for 2 yrs)
Aug 2007 had 37 treatments (also radiated lymph nodes)
psa spr 07-107,went down to .34 by Dec 08, March 09 0.7, May 1.54
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 11/24/2009 6:12 PM (GMT -6)   
Chemo may still not be the best choice yet from what I understand, and there some guys with a better understanding her on HW. I believe there may still be some HT tricks in the bag.

I would second the advice to find a major cancer center and get some top notch help.

Have you said what part of the country you live in ?
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


kak
Regular Member


Date Joined May 2009
Total Posts : 85
   Posted 11/24/2009 6:15 PM (GMT -6)   
From Canada
AGe 54 diagnosed March of 2007
PSA 107
Gleason 8
Stage T2 or T3 (weren't sure was out of prostate capsule)
Bone scan march 2007 and Aug 2008 both clear
ct 2007 clear
started casadex/lupron March of 2007 (casadex only for 4 months)(lupron for 2 yrs)
Aug 2007 had 37 treatments (also radiated lymph nodes)
psa spr 07-107,went down to .34 by Dec 08, March 09 0.7, May 1.54
 
 


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2692
   Posted 11/24/2009 7:36 PM (GMT -6)   

I understand from some of the Canadian guys that Edmonton has a really great prostate cancer center.

It may be worth it to you guys to make a trip down into the states to Mayo, Cleveland Clinic, or Johns Hopkins, just for getting in to see a cancer speialist to get some direction for your choices in Canada.

You may want to open a thread entitled Canadian looking for some assistance, and get some of our Canadian guys to help out here.

Best of luck, and keep on posting here.  You will find some help.


Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared, but carved up a little.
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks .
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)
5 month PSA <.03 (undetectable)
6 Month PSA <.01
1 pad a day, no progress on ED.  Trimix injections


John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4268
   Posted 11/24/2009 8:02 PM (GMT -6)   
Kak,

I'm a little confused; you say no mets and also that you don't know if the PC was contained. This doesn't corrolate with your husband's stats. Just because the scans are clear doesn't mean that there are no mets; in fact with a psa of over 100 and the fact that his lymphnodes were radiated is a sign of mets as well as his reaction to HT.
You need to see a good prostate oncologist at this point.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DXed BPH and continue to get biopsies yearly. 13th biopsy positive in 10-08, 2 cores of 25, G6 less than 5%. Scheduled for surgery as recommended by Urological Oncologist.

2nd Opinion from Dr Sholtz, a Prostate Oncologist, said DX wrong, pathology 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. G7, 4+3, approx 16mmX18mm.

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. All staging tests indicate that tumor is local and non agressive. (PAP, PCA3, MRIS, Color Doppler, Combidex, tumor reaction to diet and Casodex, and tumor location in transition zone). Surgery a poor option because tumor is located next to the urethea and positive margin is very likely; permanent incontenance is also high probability with surgery.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and urgency; very controlable with Flowmax and lasted 4 weeks. Daily activities resumed day after implants with no restrictions. Gold markers implanted with seeds to guide IMRT.

25 treatments of IMRT 6 weeks after seed implants. No side affects at all.

PSA at end of treatment 0.02 mostly the result of Casodex. When I stop Casodex next week expect PSA to rise. Next PSA in November. Treatments and side affects have greatly exceeded my expectations. Glad to have this 11 year journey finally conclude.

JohnT


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/24/2009 8:38 PM (GMT -6)   
Agree with John T, as I feel cloned at times (lol) we apparently have alot in common with reading Dr. Strum and others. Once you are hormone refractive, insensitive (those drugs stop controlling psa levels) and such wording, you are in the domain of oncology if you wish to treat the PCa further. The best scenario is likely to find a PCa oncologist.

As for chemo on PCa the generalized thinking is it is not all that wonderful and is not considered at all curative for PCa cases, it is palliative and perhaps useful for some time frame...some published information puts that into months and not years. Big decision if you are going to use such. There is alot better control with fewer side effects than chemo (it appears), you have to look at everything out there and I have posted before the many types of drug therapies used against PCa, you may have to search hard and outside the 'box' but alternatives are available to use. Contact: www.paactusa.org for info on such.

geezer99
Veteran Member


Date Joined Apr 2009
Total Posts : 990
   Posted 11/24/2009 8:50 PM (GMT -6)   
Bone scans are a pretty rough tool and can miss small mets (micro mets) I think that the doctors have decided that the PSA shows that the cancer has spread. As far as chemo -- get the best advice that you can manage. There are new compounds in trial which show promise and you should see if there is an appropriate clinical trial for your husband -- not because you should do it, but because you need to know all your choices.
Age at diagnosis 66, PSA 5.5
Biopsy 12/08 12 cores, 8 positive
Gleason 3+4=7
CAT scan, Bone scan 1/09 both negative.

Robotic surgery 03/03/09 Catheter Out 03/08/09
Pathology: Lymph nodes & Seminal vesicles negative
Margins positive, Capsular penetration extensive Gleason 4+3=7
6 weeks: 1 pad/day, 1 pad/night -- mostly dry at night.
10 weeks: no pad at night -- slight leakage day/1 pad.
3 mo. PSA 0.0 - now light pads
6 mo. PSA 0.00 -- 1 light pad/day


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 11/24/2009 9:21 PM (GMT -6)   
Andrew that is a fact PCa is less than science to control it, it becomes more of an art. An oncologist is an artist as using drug therapies and related things on a biology level. Alot of these drugs work on most patients(how well and how long is the unknown), but for some it could be hardly effective in some cases...thus the variants in the gleason scores, the plodity analysis of the PCa cell structure (diploid be best type to be found with) etc....etc. Patients immune system, overall condition could also be factors in this mix.

DanielleS
Regular Member


Date Joined Jul 2007
Total Posts : 57
   Posted 11/25/2009 11:52 AM (GMT -6)   
My husband's case is similar to yours (I responded to your other post). Although very high initial PSA (174) and Gleason (9), bone scan was and remains normal. We realize there are probably micromets too small to show on scan. My husband's oncologist prefers not to begin chemo until all options for hormone therapy have been exhausted. Please ask about beginning a second-line hormone therapy as soon as possible such as Ketoconazole as I mentioned in my other post.

My best to you and your husband.
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