Meeting with Oncologist and laterest PSA

Jerry:  I would second what John T. says, in Meyers book he talks about long term remission, starting HT and having your PSA drop to below .05 and staying there for at least 2 years I believe at that point he suggests an off cycle of HT to see what type of progression you have.  You have a much better chance of achieving those statistics starting at a lower PSA.

I personally have been to 2 of the top Prostate Centers in the U.S. (M.D. Anderson and University of Washington) Drs. at both facilities strongly believe you have better control of the cancer the earlier you start on it.

It sounds like you are happy with the Onc. you have but it might be worth a trip to one of the major Prostate centers to get their opinion I think you'll find a different opinion than what your Dr. has.

Get Dr. Meyers book, I think you'll be positively surprised by his opinions.

Good luck on whichever direction you decide to take.

David

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 54 y.o.

 Diagnosed 4/10/08

 DRE Normal

 PSA-5.5

 Biopsy- 12 cores, 4 positive highest 4+4=8

 Bone scan, CT scan and Chest X-ray clear 4/16/08

 Urologist suggested surgery 4/16/08

 MRI on 4/24/08 clear no suggestion of lymph node   involvement.

 4/24/08 -Started on Lupron and Casodex preparing for HDRT and IMRT in late July.  This treatment will not preclude me from surgery if I change my mind.

Decide to have DaVinci surgery after another consult with surgeon.

6/19/08- DaVinci surgery at University of Washington.

6/25/08- Path report, clear margins, no noted extension

9/12/08- PSA <0.02 

12/05/08-PSA <0.02 Six months after surgery 

3/02/09-PSA <0.02 Nine months after surgery

5/02/09-PSA .10

8/17/09-PSA .21 Begin HT and set up for SRT to begin in 2 months.

I wouldn't depend on Strum, Myers or Scholz to tell me the best way to conduct surgery for the same reason I wouldn't listen to Walsh to tell me the best methods of HT. Walsh is a brillient surgeon, but works with very few advanced PC cases where as oncologists see tens of thousands.
When it comes to advanced PC there are only a very few doctors who truely understand it and have made it their life's work. These are the ones I would listen to.

Jerry, Casodex is a mono therapy. Most oncologists use a combination therapy of ADT3 or ADT4 which is much more effective. Using Casodex only will rarely result in complete hormone blockade which is what you are looking for in any HT therapy. If you don't get complete bolckage the cells will mutate and HT will no longer be effective. Understanding how PC works at the biological level is key to treating advanced PC and most doctors just don't have this type of training.

JT

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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

ditto on comments by JohnT and dkob. I even believe that Walsh has changed his mind on HT with SRT for high risk individuals. Although there is clearly no concensus, I believe that more docs are leaning to early HT for high high risk individuals.

Best of luck in whatever treatment you chose. BB

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Dx with PC Dec 2008 at 56, PSA 3.4


Biopsy: T1c, Geason 7 (3+4) - 8 cores taken with 4 positive for PCa, 30% of all 4 cores.

Robotic Surgery March 2009 Hartford Hospital, Dr Wagner
Pathology Report: T2c, Geason 8, organ confined, negitive margins, lymph nodes negitive - tumor volume 9%
nerves spared, no negitive side effects of surgery

One night in hospital, back to work in 3 weeks

psa Jun 09 <.01
psa Oct 09 <.01
psa Jan 10 .07 re-test one week later .05
psa Mar 10 .28 re-test two weeks later .31

psa May 10  .50

Aril 10 MRI and Bone Scan show lesion on lower spine, false positive. 

Started HT 5/25/10 with 3 month shot of Trelstar. SRT scheduled for late July

Agree with John T - concerning hormone therapies, first off the bit about survival times as being the same and make no difference....well this data or doc thinking is based upon "averages" so individually some people live longer and some don't, some live shorter too. (Welcome to the Jungle of PCa- disease level, aggressiveness, volume, ploidy DNA and more as variables). I know of people whom have broken this bullshirt about 2-5 yrs. life span, it includes me....I should have been dead long ago based upon those experts whom say 2-5 yrs., Oh I had light duty PCa?????? NO WAY- total urinary blockage in an emergency room, bPSA 46.6 12/12 biopsies how many guys to you see with 75-95% found in all 12 of those (statistically the gland should be about 90-100 cancer logically), Gleasons scores found 7,8,9's two sets like that. Now I am at year 8.3+ right now and not yet in any serious trouble(I know that can change), all my tests show normal ranges, T-test now at 26 which you want it zero or low.

Now I did not do standard protocol that the uro-doc suggested (Lupron) for life, did (ADT3)2 yrs., then switched to alternative estrogenic drug been on that sometimes random like intermittent for about 5 yrs. Dr. Fred Lee has been on his therapy approx. 8-10 yrs. atleast, so this PCa doc wouldn't agree with the 2-5 yr. gig and probably that is why he didn't do standard sold protocol for his case, so would his peers call him crazy for doing estrogenic drug? (he didn't do Lupron or other LHRH drugs). That type of thing sure interests me and seen others do such things as more evidence.

Howard Hansen is at year 17 in his PCa battle, he now has brain mets, which the leading oncologists mentioned in their conference that this the first patient they know of whom has acquired brain mets after such a long period of time, and they seemed to conclude his success in managing his PCa for this long via alternative protocols has gotten the PCa to show up here rather than alot of his bones, or such. He is a testimony for why the 2-5 yr. thing and 'it makes no difference' should not be told as 'FACT' maybe an averages thing, not FACT. Like in other cancers some people do better, even with worse stats than someone else....alot of factors go into this. So, probably good for the patient to decide your choices or when or what....your doctor doesn't die, you do! I admire those whom quest and do whatever in trying to win the battle regardless of the odds. There are PCa warriors on Yananow whom had much lesser stats than mine (maybe even similar age group) whom died within the 2-5 yrs. thing, their are some others with stats worse than mine and still fighting or were fighting recently (not very many listed on yananow). Like John T mentioned the leading onco-docs know much more about protocols to use and try, they likely can get someone more results, nobody has been cured that I know of, but living even months, or years longer....you got ask yourself what is it worth to you. Also with these onco docs they can address quality of life along the way and help with easing pains and issues, perhaps more compassionately than some other docs. Like Dr. Strum recent put on the internet- 5-8% of docs are experts or very good, 70% are average and 20% are dangerous. So whom knows the most about PCa from all angles, surgeons, radiologists or oncologists? So who's advice would you seek for terminal scenario and why??? Do have an average doc or an expert, are you sure? Do you want to find a better doc?

Jerry I see your stats posted, did you see mine and my scenario from 2002 April, posted above? You should probably atleast try those second line drugs and see what results happen , before jumping into clinical trials (huge unknowns), or chemo protocols.

Fairwind- Orihectomy shouldn't be as good as ADT3 or ADT2, because? it shuts down production only from testicals, not the adrenal glands that make some testosterone and some of that your body naturally converts to dihydra-testostorone which is like 10 times more potent and PCa prefers it, in effect for growth issues. I could be wrong, but I believe that is what I gleened from readings. Orichetomy can be effective and doesn't cost that much, especially in the long run. I think alot of men cringe at the idea of those jewels being put on the guilleotine and chopped. Proscar in ADT3 is used to block dihydratestostorone.
(LOL).

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

Post Edited (zufus) : 7/11/2010 3:27:39 PM (GMT-6)