Hormone Refractory

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Willie B
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Date Joined Jul 2010
Total Posts : 155
   Posted 7/7/2010 8:32 PM (GMT -6)   
Hi,

I was just told that I'm hormone refractory and that when my PSA hits 4.0, it'll be time to start experimental drugs and maybe chemo later.

My Gleason is 9, doc says it could only be worse if it were a 10.

Had a RP and radiation in the last 2 years.

The reports showed that the cancer was in my glands, more bad news but still hopeful.

After the radiation, my PSA dropped to 0.02 in December 09, 0.2 in March 10 and 0.34 in late June.

I'm wondering why the doctor is continuing to inject me with hormones if they're not working and also concerned about how much time I should expect to have left.

We are going to lose our home, must move soon as we can not longer afford our home but don't want my family to move and then lose me within a short period. We know no body in the areas we can afford to buy a home.

Might be better to rent an apartment nearby, so that family don't have to travel far for my medical care and support systems are here for them.

Any thoughts??

Thanks in advance for any timelines. Doc is very reluctant to state anything along that line.

Monday was the shortest conversation we've ever had, all factual. Then he left the room.

My family is quite upset, daugher went into shock for two days but called to ask questions today, crying her eyes out.

She says she wants me to walk her down the ailse, see her children etc. Very emotional.......

Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 7/7/2010 8:43 PM (GMT -6)   
Please don't sugar coat it, I'm pretty practical about death, just don't want to suffer a lot.

We have had discussions of when to cease treatment/powers of attorney etc.

Daughter might find it difficult but has promised to do as I wish.

Does a doubling time of approx 3 months seem at all hopeful?

Not in a rush to die, have lots of things to still accomplish but time isn't on my side or so it seems.

sorry for the lenght of these posts but I *do * need some answers so that our family can move forward.

Thanks again.

Willie Be

Squirm
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Date Joined Sep 2008
Total Posts : 744
   Posted 7/7/2010 9:12 PM (GMT -6)   
I suggest you consult with Dr "Snuffy" Myers.
 
My dad lived for quite a while after Hormone Refractory, he was also a G9 (Although I didn't know anything about PC at that time.

Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 7/7/2010 10:16 PM (GMT -6)   
Had contact with Dr. Snuffy Meyers office before my radiation, they didn't seem too anxious to take me on with my stats.

I got the impression that he'd basically be doing what my own doc was suggesting at the time.

A lot of money, if I remember correctly, was required up front, even for phone consults.

Haven't worked in over a year, debilitating side effects etc.

We are losing our family home due to lack of income, sure can't pay Dr. Meyers.

Just wondering if anyone one this forum has had much luck with the experimental drugs and how long they've survived after hormone refractory.

Glad to read that your father survived for quite a while. Any idea how long it was? Tx.

Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 7/7/2010 11:11 PM (GMT -6)   
Willie_
I am devastated to hear what you are going through. Being hormone refractory does not mean the end. What are your stats? Where do you live? I also believe in Dr. Myers. Even though BF was treated at top hospital, Sloan in NY, we are still seeing Dr. Myers in Sept. Also, I read about Dattoli Care Center in Sarasota that has the best success rates for advanced cancer. Dont give up! Also look at alternative treatment. B17, diet, supplements, exercise. There is alot of trials out as well. Look into MVD3100, Abiraterone, Ketoconazole.
Boyfriend dx at age 44 with Stage 4 PC on 11/09. Gleason 4+5, 11 of 12 cores +; PSA 51.34
DaVinci surgery on 12/09

Gleason 4+5 confirmed. Lymph and vesicle invasion, right nerves spared.
pT3c N1 Mx
HT: Casedox and Lupron started 1/10

PSA 1/13/10 23.15 2/8/10 .37 3/18/10 <.05 5/14/10 <.02

Bone metastasis

Radiation: 42 sessions ending 6/10


Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 7/7/2010 11:14 PM (GMT -6)   
Willie- Also talk to your oncologist about mixing up your hormone therapy. Maybe you can switch it around to see what works. Dr. Myers talks about different mixes of HT. Please let us know how you are doing.
Boyfriend dx at age 44 with Stage 4 PC on 11/09. Gleason 4+5, 11 of 12 cores +; PSA 51.34
DaVinci surgery on 12/09

Gleason 4+5 confirmed. Lymph and vesicle invasion, right nerves spared.
pT3c N1 Mx
HT: Casedox and Lupron started 1/10

PSA 1/13/10 23.15 2/8/10 .37 3/18/10 <.05 5/14/10 <.02

Bone metastasis

Radiation: 42 sessions ending 6/10


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/8/2010 4:40 AM (GMT -6)   
 Sorry for anyone dealing with PCa at the hrpca levels.  Although your doubling time is serious, I have seen a couple patients whom had doubling times in weeks or one month. They had no way to feel comfortable waiting a few weeks to hear from their doctor or next protocol.  So, it could be even worse is that message.  Why don't you try the estrogenic drugs or Ketoconazole and see if they work for you, atleast awhile...should be way better than the chemo as to side effects and lot less costly too.  Better yet contact:
www.paactusa.org   (616-453-1477)they help hrpca all the time, their phone number is on the website, free phone discussions, too....Rick Profitt is the guy...(profitt is not his motivation-fyi).
 
 
 
 


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 7/8/2010 4:47:50 AM (GMT-6)


Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 7/8/2010 6:25 AM (GMT -6)   
Thankyou for your replies.
Thought my doc would switch to another hormone type drug if/when hrpca happened but apparently not.

Our family doc said that changing drugs would be the answer, for awhile at least.

The doubling time is very concerning, seems to be about 3 months or less.

Tenfold on the second reading and a bit less in June.

I will look into the other drugs mentioned and check out paactusa, thanks again.

Hope and Prayer, thankyou. I have been on supplements and alternative therapies (some at least) since my diagnosis.

Daughter has had me eating everything she could find that was anti-cancer. Lots of anti oxidants and healthy foods.

We thought we'd try alternative along with regular treatment, best of both if you know what I mean.

***Taxotere*** wrong .

Experimental drugs seem to be the next thing, according to my oncologist, when my PSA hits 4.

Then Taxotere, sorry for the error.

Does anyone have any idea of how long a person survives in this sort of situation? Months or years?



Thanks again.

Post Edited (Willie B) : 7/13/2010 10:56:27 PM (GMT-6)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/8/2010 6:50 AM (GMT -6)   
I would not jump into taxotere right away especially when there are other drugs with lesser side effects that might work decent atleast for awhile, quality of life is worth????

Different people respond way differently to PCa, why? Too many variables that some of your experts cannot define or didn't define: 18 variants types of PCa or more, 3-different types of ploidy analysis upon all types of PCa's, Gleasons scoring and errors in them, possible missed biopsy areas (probably very common)..did you know you can have completely different Gleason scores in different areas of your gland? I had 3 different ones found: Gleasons 7,8,9's and 2-sets like that 12/12 biosies all with 75-95% PCa, psa of 46.6....that was 2002 Mar-April.
It is possible they missed an area or unassessed your actual scenario (to common ask leading oncologists). Then variables of your body chemistry, DNA, immune system value...etc. Some others with lesser stats than mine, gone after 3-5 yrs*., alot of it has to do with overall treatment also (combined therapies).

Hey it is complex, did our docs tell us that? Very complex is what my onco-doc says. I got an onco-doc you might like for alot of reasons, maybe an office visit would be worth the price to you? Better start seeing some docs is in your best interest. Call Rick at Paact!
 
*comparisons that were found on www.yananow.net comparisons, yes nobody would know how long a certain patient will live. 


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 7/8/2010 10:17:54 AM (GMT-6)


medved
Veteran Member


Date Joined Nov 2009
Total Posts : 1096
   Posted 7/8/2010 8:19 AM (GMT -6)   
Willie B - there are a relatively small number of oncologists in the country with huge expertise in dealing with advanced p ca. Seems to me you want to consult with one of these docs, if possible. I certainly understand that Dr. Meyers may be out of the question, since he does not accept insurance and you have financial constraints. But there are others who do accept insurance or medicare/medicaid. Can you tell us where you are located? That might help recommend someone in your area. There are second-line treatments that have been very successful for some patients who are hormone refractory, or believed that they were hormone refractory. But many docs -- for whatever reason -- don't seem to use them. It may be a lack of knowledge. Instead, they seem to think the only options are Lupron/Casodex, then taxotere, then hospice. That is not the case. Nobody on this board can tell you how long you have to live. But we might be able to help you find a doc that can give you the best chance. Best wishes,
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
 


Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 7/9/2010 7:19 PM (GMT -6)   
Thankyou for your input.

Daughter and I saw our family doctor today and he does not understand why the onc isn't just changing the drugs/looking for something that *does* work.

We've had a meeting of the minds and decided to get another appointment with my onc and tell him that 0.34 is a very long way from 4.0 and that I'm not ready to be dismissed in this manner.

If he won't take care of this in a better way, we'll change doctors or go elsewhere.

We're in the north east, daughter thought Sloan Kettering might be good and our family doc will refer to another doc if necessary.

Must admit that when the doc said, 'we'll start experimental drugs at 4', it scared the heck out of me and I thought that was what he was expecting on the next blood test.

That's the only reason I let him inject me with the drug that's NOT working. It was fear based but this is a fearful disease.

Please pray that I can either make headway with my doc or find one who will have a better plan for my life.

Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 7/11/2010 11:24 PM (GMT -6)   
Willie- I hope you can get to Sloan. I know you will get good care there. BF is at Sloan and is a G9 with mets. Although they are very good to him, you need to walk in loaded with information and know what questions to ask. Sloan is going into a second phase of a trial for MVD3100 for hormone refractory PC with Dr. Scher. Another dear poster here discussed another trial. I have the info in my office and will post to you tomorrow. Dr. McKiernan at Columbia is supposed to be good as well. My best friend's father with G9 treated with him, was very happy with him and is fairly very well!!! Your daughter is awesome. Keep up the diet. We get Dr. Myers' newsletter and i just read about one man who was refractory but was able to play around with meds even at your PSA level. He has been doing it for 11 years. Keep the faith!!!
Boyfriend dx at age 44 with Stage 4 PC on 11/09. Gleason 4+5, 11 of 12 cores +; PSA 51.34
DaVinci surgery on 12/09

Gleason 4+5 confirmed. Lymph and vesicle invasion, right nerves spared.
pT3c N1 Mx
HT: Casedox and Lupron started 1/10

PSA 1/13/10 23.15 2/8/10 .37 3/18/10 <.05 5/14/10 <.02

Bone metastasis

Radiation: 42 sessions ending 6/10


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/12/2010 5:43 AM (GMT -6)   
Hope&Prayer- good reference example a patient whom is 11 yrs. via alternative protocols, this is why patients need to question or fire the current close minded doc and find someone else. I see this doc cashed in for himself in injecting Lupron on you-Willie B. (a vunerable patient, scared of course), I guess that is more important than letting you try Ketoconazole or other choices, that have no profits for him. (is that a reason to fire your doc?)

Am I being too harsh on this? Well when your life, quality of life, maybe longevity of life is played like a game...you analyze and decide. Hey it is your game and life to lose, not the docs. I bet you will have decent response on Keto, of course no money for the doc. Maybe you will try it and then come back and tell us, it would be great example of your testimonial and for others, so tell your doc, do not ask or beg for something. You hired them with your insurance/money and still have choices at this time. If Ralph V. is reading this maybe he can tell you some other patients whom did Keto and some responses or information concerning using it.


Youth is wasted on the Young-(W.C. Fields)


alf203
Regular Member


Date Joined Jun 2010
Total Posts : 52
   Posted 7/12/2010 8:30 PM (GMT -6)   
willie hi you just have to tell your doc to try new drugs . I have had to keep changing meds . they stops working. there is some new way to fight cancer dont know what they call it but they take your blood and find out what type cancer you have and have your own blood fight the cancer. good luck keep trying
AL     49  Found in Feb 2009   PSA 118  Gleason score 5-4=9            cores 11-12-90%  Stage T4m  Cat Scan -mri -Bone scan/ show caner has spread to spine/lung/liver. Treatmen; casadex + trellstar 3 months PSA droped to .054- pulled off casadex liver not handling med. PSA rose to 7.43 in three month next 2 months PSA 11.65 started lupron/and new drug tak700 PSA 5.46  PSA now 3.48  3/10      4/10 psa   3.34    5/10 psa 3.23 6/10 psa  3.36    drug starting to fail  wait till next month to see if still going up


montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 7/13/2010 2:15 AM (GMT -6)   
 
try this post, hope it works, this is Dr. Sartor at Tulane university who use to be at Harvard Medical, he specializes in cases like yours. 
diagnosed sept 2006 @ 54 years old, live in Georgia, gleason 3+4=7, (r) lobe only

psa 4.7 (psa rose 1 point per year for 3 years, urologist said still under 4 and no concern. If I can find out about PSA velocity, why didn't he know!)

Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT

RP Emory Atlanta December 2006. Path-negative margin, negative lymph nodes, negative SV, both Lobes involved, 40% gland involved
multifocal perineural invasion, Gleason 3+4=7

1st psa April 2007-<0.04, 6 mos-<0.04, 9 mos <0.04, 1yr <0.04, 21 mos <0.04, 2 yr 0.04 (rising?) 26 mos-0.05, 27 mos-0.04, 29 mos 0.06 Sept 09 ,<0.04 3 year <0.04 39 mo. 0.07 (rising again)


montee
Regular Member


Date Joined Mar 2007
Total Posts : 315
   Posted 7/13/2010 2:19 AM (GMT -6)   
 

A. Oliver Sartor, MD

Professor of Medicine

Dr. Sartor received his MD from Tulane University with honors in 1982.  After internship at the University of Pennsylvania, he trained in Internal Medicine at Tulane Medical School.  After completing fellowship at the National Cancer Institute (NCI) in Bethesda, Maryland in 1989, he served until 1993 as a Senior Investigator at the NCI and began focusing on novel therapeutics for advanced prostate cancer patients.  

Dr. Sartor returned to Louisiana in 1993 to serve as an Associate Professor at the LSU Medical School in Shreveport and then moved to the LSU Health Sciences Center in New Orleans in 1998 as the Patricia Powers Strong Professor of Oncology, Stanley S. Scott Cancer Center Director, and Hematology/Oncology Section Chief.   

Dr. Sartor was the Co-Director of the Louisiana Cancer Research Consortium, starting at its legislative inception in 2002.  In March 2006, he left LSU to join the Lank Center for Genitourinary Oncology at the Dana Farber Cancer Institute and the Harvard Medical School.  

In January 2008, Dr. Sartor joined Tulane University as the Piltz Professor of Cancer Research in the Departments of Medicine and Urology.  

Dr. Sartor’s interests have focused broadly on prostate cancer, predominantly in those patients who failed initial therapies. His publications range from genetic studies on prostate cancer to clinical trials involving novel agents.  He has been a lead author on two studies pivotal for FDA drug approval in prostate cancer and has been the PI or co-PI on a number of prospective international clinical trials evaluating new therapies for patients with advanced prostate cancer.   

Dr. Sartor has published over 100 scholarly articles, is the Medical Oncology Co-Chair of the Radiation Therapy Oncology Group (RTOG) Genitourinary Committee, is the Co-Editor in Chief of the peer-reviewed journal “Clinical Genitourinary Cancer”, and serves as Chairman of the Department of Defense Prostate Cancer Integration Panel in 2008-2009.  


diagnosed sept 2006 @ 54 years old, live in Georgia, gleason 3+4=7, (r) lobe only

psa 4.7 (psa rose 1 point per year for 3 years, urologist said still under 4 and no concern. If I can find out about PSA velocity, why didn't he know!)

Told not to have surgery at Dana Farber as cancer had already penetrated prostate, in seminal vesicles, would have positive margins. Would only treat with radiation and HT

RP Emory Atlanta December 2006. Path-negative margin, negative lymph nodes, negative SV, both Lobes involved, 40% gland involved
multifocal perineural invasion, Gleason 3+4=7

1st psa April 2007-<0.04, 6 mos-<0.04, 9 mos <0.04, 1yr <0.04, 21 mos <0.04, 2 yr 0.04 (rising?) 26 mos-0.05, 27 mos-0.04, 29 mos 0.06 Sept 09 ,<0.04 3 year <0.04 39 mo. 0.07 (rising again)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 7/13/2010 5:11 AM (GMT -6)   
Revised-   Willie you can tell us what you find or choose and about your journey with whatever it is, probably be helpful to someone else, looking at this same dilemna.
 
Bob cool

 


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 7/13/2010 7:52:21 AM (GMT-6)


Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 7/13/2010 7:51 PM (GMT -6)   
Thankyou for all of the help, esp. about Dr. Sartors' information.

May give him a call and see if we're covered for a consultation with him.

I will post/or daughter will if/when we get some other news.

Right now it's pretty depressing and I'm just not well at all.

Can't sleep, nausea is awful and my debilitating headaches are dreadful.

Lot's of weakness and having memory loss/lack of focus also.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/13/2010 7:57 PM (GMT -6)   
Willie,

I know you are in a tough situation with no easy answers. I hope something comes together to help improve your situation. We are all behind you, and hope only the best for you.

You got a lot on your plate right now, and while it might seem overwhelming, take one day and one piece at the time, there are still things out there that might help, and there is still hope.

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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, 7/2 - Caths #18 & #19


Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 7/14/2010 9:48 PM (GMT -6)   
Willie- This is much easier for me to say and hard for you to do but you cannot get down. This lowers your immune system and spirit and lets the "C" take over. There is something out there for you! I know there is. Nausea, headaches, etc are from stress that again lowers your immune system. Please let me know if you come to NY. I wish Sloan or Columbia was an option for you. Please have your daughter "talk" to us through your acct so that we can help you along the way.
Boyfriend dx at age 44 with Stage 4 PC on 11/09. Gleason 4+5, 11 of 12 cores +; PSA 51.34
DaVinci surgery on 12/09

Gleason 4+5 confirmed. Lymph and vesicle invasion, right nerves spared.
pT3c N1 Mx
HT: Casedox and Lupron started 1/10

PSA 1/13/10 23.15 2/8/10 .37 3/18/10 <.05 5/14/10 <.02

Bone metastasis

Radiation: 42 sessions ending 6/10


Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 7/16/2010 3:47 PM (GMT -6)   
Have had another chat with both my onc and family doctors.
 
Onc feels that I'll do better by waiting til I qualify for the trial drugs, says I'll live longer this way.
Has offered to send me to another onc for second opinion, up to me.
 
Family doc says onc could be right/wrong.
He thinks I should not wait til trial drugs but get another opinion, then decide.
 
I'm not sure what is best but am leaning towards a second opinion.
 
As my family doc says, 'you only get one chance to live'.
 
have a great weekend.
 
 
 
 
 
 

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 7/16/2010 4:41 PM (GMT -6)   
willie,

please go for the second opinion, you have nothing to lose and possible everything to gain. you have to know all your options in your situation. good luck
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 cath #6 - 41 days, 8/9 2nd corr surgery, 8/9 cath #7 - 38 days, mapped  9/9, 10/1 - 3rd corr. surgery - SP cath, 10/5 - 11/27 IMRT SRT 39 sess/72 gys ,cath #8 33 days, Cath #9 35 days, Cath #10 43 days, 1/19 - Corr Surgery #4,  Caths #11 and #12 ,Cath #11 - 21 days,  Cath #12 - 41 days, 3/2- Corr Surgery #5, Cath #13 - 4 days, Cath #14- 27 days, Cath #15 - 26 days, Cath #16 - 31 days, Cath #17 - 39 days, 7/2 - Corr Surgery #6, Cath #18 - 13 days, Cath #19 still in place


Squirm
Veteran Member


Date Joined Sep 2008
Total Posts : 744
   Posted 7/17/2010 10:20 AM (GMT -6)   
I agree, get another opinion.

Willie B
Regular Member


Date Joined Jul 2010
Total Posts : 155
   Posted 7/18/2010 2:49 PM (GMT -6)   
I have just left a message that we want another opinion.

Hoping it won't take too long for the appointment.

Thanks again.

Hope and Prayer
Regular Member


Date Joined May 2010
Total Posts : 59
   Posted 7/19/2010 9:56 PM (GMT -6)   
Willie- Good luck with second opinion and hope you let us know how it goes. Is it with a PC oncologist? I feel they are privy to PC information out there that other oncologists may not know about such as trials, drug variations, other treatments.
Boyfriend dx at age 44 with Stage 4 PC on 11/09. Gleason 4+5, 11 of 12 cores +; PSA 51.34
DaVinci surgery on 12/09

Gleason 4+5 confirmed. Lymph and vesicle invasion, right nerves spared.
pT3c N1 Mx
HT: Casedox and Lupron started 1/10

PSA 1/13/10 23.15 2/8/10 .37 3/18/10 <.05 5/14/10 <.02

Bone metastasis

Radiation: 42 sessions ending 6/10

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