salvage cryotherapy and hormone therapy

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aerolite21
New Member


Date Joined May 2010
Total Posts : 3
   Posted 5/24/2010 3:17 PM (GMT -6)   
I am 75 years old and was treated for prostate cancer in 2004, PSA 5.2, Gleason 7, with seed implants and IMRT. My PSA was never below 1.6 and is now rising from 3.8 to 5.5 in two months. Otherwise in good health and no symptoms. I have now had bone scans, CT scans of the pelvis, and a liver ultrasound which are all interpreted as no evidence of spread outside the prostate. I am now undergoing a biopsy of the prostate in a few days and if there is evidence of local tumor then the urologist is proposing cryotherapy.

Since the scans may have significant false negatives, the question in my mind is should I also consider hormone therapy along with the cryotherapy rather than waiting to monitor the PSA results of cryotherapy? Anybody have any experience or information on this idea or any other suggestions?

medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 5/24/2010 3:28 PM (GMT -6)   
Hello. I would talk with a medical oncologist who is very experienced with prostate cancer before you decide how to proceed. If you tell us where you are located, someone here can probably suggest such a doctor. I would ask the onclogist what the likelihood is that your disease is systemic. I would not just want his guess, but instead for him to base his conclusion on the various nomograms that exist for predicting such things. If the conclusion is a high likelihood of systemic disease, then I would serious consider doing a hormonal treatment. In that event, I would also at least consider not doing the cryo. I am not a doctor and am not qualified to give medical advice, but these are some things i would personally be thinking about. When talking about recurrent and potentially systemic disease, I do not think it is adequate to get advice from a urologist, without also consulting with an oncologist. Best wishes, Medved
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/24/2010 4:05 PM (GMT -6)   
I agree fully with the above poster, now is the time, if you don't have one, to get a really good medical oncologist, one with a lot of experience with Prostate Cancer, and let them go over your case and journey up until now. Does seem based on your numbers that recurrance has reared its ugly head up at you. Please keep us in the loop when you get additional info, and good luck to you.

david in sc
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


aerolite21
New Member


Date Joined May 2010
Total Posts : 3
   Posted 5/24/2010 6:14 PM (GMT -6)   
Thanks for the suggestions. I am located in south Louisiana. If anyone can suggest a good oncologist in this area that would be great. I'll try to keep you posted.



medved said...
Hello. I would talk with a medical oncologist who is very experienced with prostate cancer before you decide how to proceed. If you tell us where you are located, someone here can probably suggest such a doctor. I would ask the onclogist what the likelihood is that your disease is systemic. I would not just want his guess, but instead for him to base his conclusion on the various nomograms that exist for predicting such things. If the conclusion is a high likelihood of systemic disease, then I would serious consider doing a hormonal treatment. In that event, I would also at least consider not doing the cryo. I am not a doctor and am not qualified to give medical advice, but these are some things i would personally be thinking about. When talking about recurrent and potentially systemic disease, I do not think it is adequate to get advice from a urologist, without also consulting with an oncologist. Best wishes, Medved

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 5/24/2010 7:51 PM (GMT -6)   
perhaps cajun jeff will see this thread and give you some names, as he lives outside of the New Orleans area.
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery, no problem post SRT
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, next one:  July
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out 38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, 12/7 - Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12  same time, 2/8-Cath #11 out - 21 days, 3/2- Cath #12 out - 41 days, 3/2- Corr Surgery #5, 3/6 Cath #13 out - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, 5/24 put in Cath #17


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 5/24/2010 9:23 PM (GMT -6)   
Try Oliver Sartor -- one of the nation's leading experts:

http://tulane.edu/som/departments/medicine/medhemonc/people/osartor.cfm
Age 46.  Father died of p ca. 
My psa starting age 40: 1.4, 1.3, 1.43, 1.74, 1.7, 1.5, 1.5
 

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