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Palyn
Regular Member


Date Joined Dec 2008
Total Posts : 25
   Posted 11/24/2010 8:14 PM (GMT -6)   
My husband was off lupron (intermittent treatment) then his psa rose to 28.5 in less than a year, so he went back on Lupron. PSA went down to 22.8 in a couple months but then rose to 23.3 on one month. The oncologist said he's plateauing but I can't believe with a rise of one point that this is plateauing. When he was diagnosed 2 years ago, his gleason was 9 (5 +4) with metastasis to the lymphs. I'm thinking that with the rise of l point in l month that this could be leaning to hormone refractory and am very worried. Any thoughts?

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/24/2010 8:26 PM (GMT -6)   
Palyn,
Your husbands case is definitely appearing hormone refractory if after two months he is still registering a detectable PSA. He needs to be on a 2nd line hormonal therapy and if his oncologist isn't on board with that then your husband needs to expand his medical team. I know of no reason that "plateauing" is a good thing when the PSA is so highHe can still do very well but this development indicates that this is not going well.

At this point I would also see is your husband can get DES, Keto, Nilandron, Abiraterone or Provenge as well but there may be better options right now.

My treasurer at my UsTOO group had the same thing happen last December. He tried DES, Nilandron and was placed on Provenge. His PSA is down to 2, but he may be headed to chemotherapy if the Provenge does not work. But as of now he looks good and is a wonderful man. He just completed his run on Provenge and it is still too early to tell what effect it has had on him. He is getting his next PSA after Christmas.

Don't panic but rather start questioning everything. There is still plenty of hope...

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/24/2010 8:31 PM (GMT -6)   
One more note about my treasurer,
He was on ADT3 for 5 years as prescribed by Mark Scholz. He also underwent Cryotherapy by Duke Bahn. He stopped the ADT3 when he held an undetectable PSA after the 5th year. When he relapsed last year his PSA had shot up to over 20 in 3 months. He is now using Nicholas Vogelzang who first tried the DES, Nilandron and then returned him to Lupron. He came off the Lupron and then started Provenge.

Tony

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3747
   Posted 11/24/2010 8:42 PM (GMT -6)   
This is just my OPINION, but I question the wisdom of intermittent treatment with metastasized Gleason 9 PC.. To me, the best course of action is to get the PSA down as far as possible and keep it there..Do you know his PSA when he started his HT vacation? How long has he been on HT?

Sometimes Lupron is combined with other drugs like Casodex and Avodart to completely eliminate the effects of any residual testosterone..

At this point some men are treated with one of the old-line PC therapies, DES, an estrogen compound..Even refractory PC can sometimes respond to this positively..The risks are increased, but more PC patients die from heart attacks than any other cause anyway, so you just have to play the odds....Your oncologist may very-well be right. I would not jump to conclusions just yet...Best of luck to you both...
Age 68.
PSA at age 55: 3.5, DRE normal. Advice, "Keep an eye on it".
age 58: 4.5
" 61: 5.2
" 64: 7.5, DRE "Abnormal"
" 65: 8.5, " normal", biopsy, 12 core, negative...
" 66 9.0 "normal", 2ed biopsy, negative, BPH, Proscar
" 67 4.5 DRE "normal"
" 68 7.0 third biopsy positive, 4 out of 12, G-6,7, 9
RRP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT, Dec

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 11/24/2010 10:22 PM (GMT -6)   
Fairwind,
You keep questioning things. That's a good idea. I know many guys that have done very well with intermittent hormone therapy and it is prudent that we give it a try. As we are learning lengthy terms on any form of HT is also a risky business. With the recent warning label requirement by the FDA on LHRH agonists, there is potential that the therapy can be more fatal than the cancer.

When I saw Snuffy Myers speak at a PCRI event last year he stated that if you are able to achieve a remission with HT then he owes it to the patient to try to stop the therapy and improve QoL.

My oncologist agrees with that philosophy thus i am now not currently being treated and showing a durable remission...And let me say it sure was nice to see my little friend again. ;-) And I don't miss my 2 years of "personal summers" either.

BTW ~ Lupron is the only testosterone reducing drug as part of ADT3. Casodex is an anti-androgen drug. What it does is make it more difficult for the cell walls to absorb testosterone and dihydrotestosterone. Avodart and Proscar (dutisteride and finesteride respectively) are a 5-alpha reductase drug that affects the prostate cells and encourage apoptosis thus reducing the conversion of a more potent hormone ~ dihydrotestosterone. And it also helps grow hair...:-)

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 11/25/2010 6:40 AM (GMT -6)   

Hi Palyn,

 

Has your husband had a testosterone test?

HT main aim is to lower the testosterone in the body, and in the process it also affects the PSA. However, PSA alone cannot rule plateauing. Also if your husband is only on a single blockade drug (LHRH agonist Lupron), according to Myers reports, success is still possible by adding other blockade drugs such as an Anti-agonist and a 5-α reductase Inhibitor. LHRH agonists alone put the patient on TIP (castration levels of serum of total testosterone <50 ng/dL). There will be still plenty of testosterone to feed cancer cells, therefore promoting a higher PSA.

ADT3 stands for Androgen Deprivation Therapy Triple blockade. That is a cocktail of drugs working at the same time, with the aims of reducing testosterone in the body to the lowest level possible, at <10 ng/dL.

Once PSA or T tests increase, these drugs are given to patients on higher doses, before Hormone refractory prostate cancer is ruled. A good example is Myers protocol were he puts his patients on 150/200 mg/daily anti androgen Casodex, aiming to get those low low levels.

Hope these helps you in understanding other possibilities to discuss with your oncologist.

Take care

Baptista

Post Edited (Baptista) : 11/25/2010 5:43:29 AM (GMT-7)


Palyn
Regular Member


Date Joined Dec 2008
Total Posts : 25
   Posted 11/25/2010 11:58 AM (GMT -6)   
Thank you everyone for your posts to my question. My husband was on ADT3, had IMRT, chemo, and testosterone was very low, and PSA was 0.01 when he went on intermittent therapy. Would rising PSA alone be enough to indicate cancer is refractory?

Post Edited (Palyn) : 11/25/2010 6:27:47 PM (GMT-7)


Baptista
Regular Member


Date Joined Aug 2010
Total Posts : 84
   Posted 11/26/2010 2:26 PM (GMT -6)   
Hi Palyn,
According to a study done By Oliver Sartor, M.D., a respected hematologist at LSU Medical Center, the definition for androgen-independent or hormone-refractory prostate cancer involves a patient with progressive prostate cancer and serum testosterone of less than 50 ng/ml (castrate level).
In your husband case the rise in PSA with a low testosterone may indicate progression of the disease, therefore HRPC.
A withdrawal of the anti-androgen usual responds to lower the PSA. Oncologists call it AAWR. The mechanics behind are theoretically assumed that androgen receptor of cancer cells will mutate in time so that, a withdrawal of anti-androgens bound to the receptors, will stop feeding the cancer.
You may find in the net information regarding your question by searching with the string; “How Should We Treat Hormone-Refractory Disease”.

Hope you get more answers to your quest.
Wishing you both the best
Baptista
Age: 50 at Dx on May/2000; PSA=22.4;
6x cores biopsy positive; Gleason score (2+3=5)
RP in Aug/2000, PSA=24.2
Negative S-vesicles & lymph node (9); capsular penetration
Voluminous Adenocarcinoma, well-differentiated, Gs (3+2=5); pT3apN0
Post-op lowest PSA=0.18 on Oct/2000; Classified as Micro Metastasis
Jan/2001 PSA=0.26 Biochemical recurrence
AS (Watchful W.) until PSA=3.80 on Oct/2006; MRI & Bone scan negative
Nov/2006 SRT (3D IMRT; 68Gy / 37 fractions)
Feb/2008 lowest nPSA=0.05
May/2009 PSA=0.26 Biochemical recurrence
Oct/2010 PSA=0.95 (doubling at 9.6 months)
Nov/2010 ADT Cyproterone 100mg/day + Eligard 45mg 6-month depot
Asymptomatic, never incontinent, ED since RP
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