Follow up PSA - Interesting Quandary

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LV-TX
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Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 11:55 AM (GMT -6)   
Had blood work done last week and the PSA rose to 0.44 from the .32 three months ago.
Background, Surgery in Sept 2008 - Positive margin - pT2C NOMX Gleason 7 (3+4) PSA rising since surgery. 6-7 months doubling time.
 
Uro has given three choices.
 
1. Wait another three months..but that wouldn't be beneficial and I would be in the same shoes as today with higher numbers
2. Begin a 4-month shot of Eligard (administered by him)
3. Radiation to full pelvic area
 
I was a bit surprised about the Eligard shot as an option with my low psa numbers.  But he mentioned that at this low level it would also present a cure in as much as the radiation would.  He is leaning towards radiation however, but added that the side effects from Eligard would revert after stopping the injection treatments.  I asked how many shots and over how long a period of time, and he said probably just one shot that would last about four months.
 
This puts me into a bit of a quandary (Zufus Twilight Zone).  It would seem on the outset to take the shot and have as good of a chance of a cure without the risk of radiation.  However on the flip side, I am not so optimistic with the HT either...much less being administered by the uro rather than a medical oncologist.
 
I am scheduling the usual consultations with the radiation and medical oncologists and will make my decisions from there.
 
But if anyone has any inputs or suggestions, it would be much appreciated.  And I know that nobody here is a medical doctor and I will take your responses as a brother in this disease and any advice that is given is in support only.
 
Thanks to all here...

tatt2man
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Date Joined Jan 2010
Total Posts : 2842
   Posted 1/18/2011 12:02 PM (GMT -6)   
LV - when reading your posting the word "cure" raised the hairs on my neck - I went to the Eligard website -
Eligard website said...
ELIGARD - A Hormonal Therapy for The Management of Advanced Prostate Cancer

ELIGARD is a prescription medication for the palliative treatment (management of symptoms) of advanced prostate cancer. ELIGARD is an LHRH (luteinizing hormone-releasing hormone) agonist. It is designed to reduce the amount of testosterone in the body by reducing the testicles' production of testosterone. It is not a cure for advanced prostate cancer.


I am aware of your numbers being "low" compared to those with advance PCa... but would not the use be just a slow-down of the PSA rising and not a cure...

Not trying to sound pessimistic - but there has been much debate on combining HT and RT and various options - and am concerned about your short-term as well as the long-term benefits.

Wishing you all the best.
BRONSON

Post Edited (tatt2man) : 1/18/2011 11:07:05 AM (GMT-7)


F8
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Date Joined Feb 2010
Total Posts : 3800
   Posted 1/18/2011 12:07 PM (GMT -6)   
>> It would seem on the outset to take the shot and have as good of a chance of a cure without the risk of radiation.<<
 
sorry for your problems but i'd seek other qualified opinions ASAP.
 
ed
 
 
age: 55
PSA on 12/09: 6.8
no symptoms, no prostate enlargement
12/12 cores positive....gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10

LV-TX
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Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 12:09 PM (GMT -6)   
Thanks Bronson,

I too was under the impression that Eligard was for the advanced cases. But the uro stated that it blocks the testerone and the few pca cells that are lingering will die out and thus provide a cure.

Sounds good...but I am skeptical until I review this with the medical oncologist.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

Sonny3
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Date Joined Aug 2009
Total Posts : 2447
   Posted 1/18/2011 12:12 PM (GMT -6)   
LV,

Within the parameters set forth by you, I am no an MD, I offer the following.

You know that I have been through surgery, SRT, METS radiation and have a PSA of 3.9 (up from 2.2 in SEP 2010). My meeting with my ONCO the other day I expected him to start with HT discussions and he surprised me by saying let's wait until May and have a one year follow-up on Bone Scans and such.

I am not a fan of going on HT for my own selfish QoL reasons, but still this surprised me.

Something you said struck a cord though, your doc said that the shot now "would present a cure as much as radiation would".

This is from the Eligard Web Site;

"ELIGARD is a prescription medication for the palliative treatment (management of symptoms) of advanced prostate cancer. ELIGARD is an LHRH (luteinizing hormone-releasing hormone) agonist. It is designed to reduce the amount of testosterone in the body by reducing the testicles' production of testosterone. It is not a cure for advanced prostate cancer."

Even the drug manufacturer states that it is only palliative. So that is something I would chew on for a little while.

There are a great many medical papers out there that discuss the whys and when of SRT and their value. You should take a look at some of them also.

I know that this doesn't answer some of your questions, instead it may raise a few, but that is what we are here for also. We provide support and bring things up for discussion and discovery.

Good luck my brother in your quest for the right answer for you and your PCa,

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Completed Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 12:12 PM (GMT -6)   
Thanks ED,

Don't worry, I have the consultations lined up with others the oncologist.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

Sonny3
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Date Joined Aug 2009
Total Posts : 2447
   Posted 1/18/2011 12:13 PM (GMT -6)   
So I see that in the time it took me to write my post our brother Bronson arrived at the same conclusions. I gotta learn to type a little faster or at the least be less verbose. LOL

Sonny
60 years old - PSA 11/07 3.0 PSA 5/09 6.4
da Vinci 9/17/09
Post Surgery Pathology: GS 4+3=7
Stage: T3a
Tumor Volume 12.5% positive margin, extra-prostatic extension
30 day PSA 0.4, 50 day psa 0.53, 64 day psa 0.6
IMRT completed 1/15/10 35 treatments- 70Gy
2/23/10 Post IMRT PSA 1.0
3/22/10 PSA 1.5
4/19/10 PSA 1.2
5/22/10 PSA 1.3
8/9/10 Completed Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9

tatt2man
Veteran Member


Date Joined Jan 2010
Total Posts : 2842
   Posted 1/18/2011 12:22 PM (GMT -6)   
Sonny-
- no worries - your confirmation of my thoughts - is of benefit....
-it only gets scary here when two or more people are documented as posting at the same time!
non-hormonal hugs
BRONSON
Age: 55 - gay with spouse of 14 years, Steve
location: Peterborough, Ontario, Canada
PSA: 10/06/09 - 3.86
Biopsy: 10/16/09- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy: 11/18/09
Pathology: pT3a -Gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
PSA: 04/08/10 -0.05 -Zero Club
PSA: 09/23/10 -0.05 -Zero Club
PSA: 03/12/11 - TBA

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 12:25 PM (GMT -6)   
Thanks Sonny,

I agree it seemed a little odd as the company stated it was for advanced cases. If it wasn't for the clout that my uro has in the medical field, I would have taken a different approach.

But I think what I understood from him, was that in cases where there is a very small amount of cancer remaining that this could be as effective as radiation. I have never heard of this method and was wondering if this is a new approach in dealing with the disease.

Interesting concept anyway, even though it is out there in left field.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/18/2011 1:16 PM (GMT -6)   
Les,

Sorry for your increase, but I guess it was more expected than not.

I find the HT advice from the doc a bit odd too, I am agreeing with bronson's and sonny's line of thinking. Not saying that its not possible, but wouldn't seem like there would be any curative chance with the HT drug.

RT, a sore subject with me anyway, still might be your best next hope. Side effects or no side effects, though the percentages might look low on paper for a cure, at least its a chance for a cure. With your PSA being where it's add, I personally feel that letting it grow higher and higher, is only going to lessen any possible curative hope for it. Just my take.

This is the time for a top notch medical oncologist for opinion.

David in SC
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

John T
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Date Joined Nov 2008
Total Posts : 4225
   Posted 1/18/2011 1:32 PM (GMT -6)   
Les,
There are a lot of experienced doctors that are convinced that early HT can result in a cure for a certain % of patients. probably somewhere in the 30% range. Liebowitsz, Strum, Scholz and Myers all believe this and have seen enough of these cases in their paractices. If I were to get HT I would get it from an experienced medical oncologist that is very familiar with PC patients and not from a urologist or normal medical oncologist.
JT
65 years old, rising psa for 10 years from 4 to 40; 12 biopsies and MRIS all negative. Oct 2009 DXed with G6 <5%. Color Doppler biopsy found 2.5 cm G4+3. Combidex clear. Seeds and IMRT, no side affects and psa .1 at 1.5 years.

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 1:57 PM (GMT -6)   
David,

Thanks for the reply. I had hoped with alot of optimism that I would be able to postpone the mopping up treatments until further down the road. But that ole velocity issue trump card was played instead. You already know my feelings about SRT, so when the HT was presented it was very thought provoking to say the least.

JohnT

I was hoping you would chime in. You seem to have alot of knowledge with the treatment options and current thinking in the medical world. I am glad that you have heard of this option before as well. Your previous advice about having an experienced oncologist providing the HT therapy, is what caused me to be so skeptical about my uro, even though he stays up to date with the various treatment options.

It will be several weeks before anything is done. I am really looking hard at the two available options and keeping an open mind to possibilities of both good and bad. The biggest advantage I have right now is this is a local recurrence and some time to mull things over.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 1/18/2011 2:02 PM (GMT -6)   
Les, it is thought provoking at the least, and presents you with at least the possbility of an alternative to SRT (the gift that keeps giving and giving, lol). My body has been perm. damaged by SRT, and will never be the same again. Rare case? Perhaps, but there are lots of cases of people having severe reactions to radiation. Least you have an option on the table to consider. But you will need the best of the best medical oncologist, as JohnT suggested, to help thinkn through this option.

David
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 Not taking it
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, 21 Catheters, Ileal Conduit Surgery 9/23/10

JNF
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Date Joined Dec 2010
Total Posts : 3745
   Posted 1/18/2011 2:05 PM (GMT -6)   
I am on Eligard as part of my adjunctive treatment. I had a six month shot lkast October. It is an alternative to Lupron, Zolodex and other LHRH drugs that supress testosterone. I am also on Jalyn (to supress DHT) and had IMRT and HDR radiation therapy. As I was G7 and a T2b my docs decided on a multi-pronged more agressive approach in case it was more advanced than any of the studies indicated. I have read reports from some of the best prostate oncologists that it is better to start HT earlier when the cancer is at a minimum rather than wait until it has become more established.

As to the pharma website and information, no drug anywhere says it will cure the disease or condition it is designed for. Even aspirin doesn't say it will cure your headache. In practice we don't know for a long time if a cure has been realized. Walsh, Critz and others use a level of PSA <.20 after ten years, but even then it still can start going up indicating a recurrance.

According to my doctor, had I had surgery and the margins were positive, he would have quickly started me on SRT and HT to stop it in its tracks. His concern was that I had a significant probability of positive margins and thus he didn't want to operate and suggested the RT and HT. It made sense to me and to several other docs that I consulted with.

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/18/2011 2:08 PM (GMT -6)   
I like John's thinking about whom should treat a BCR patient. Brief words from me (lol).

Post Edited (zufus) : 1/18/2011 1:21:11 PM (GMT-7)


LV-TX
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Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 2:11 PM (GMT -6)   
JNF,

Thank you for posting. I am greatly interested in your opinions regarding the Quality of Life while on the Eligard. It sounds like you are on the 6 month program and my uro is suggesting only a 4 month shot. Which is lower dosage, and possibly not as hard on the body with side effects. With the very low psa right now, a lower dose might do the trick.

If you don't mind sharing your experience with the Eligard, I would appreciate it very much.

Thanks again.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 2:16 PM (GMT -6)   
Zufus....thanks, but am I suppose to read between the lines. Are you saying I should fire my uro? He said that HT is an option, however he said in the same converstation that he was leaning towards radiation. Didn't sound like he was thinking about profit only to me. Sure he would make a profit on the shot, but not the radiation.

Would you mind maybe speaking in terms that someone like me (who is dumb) could understand better what the jist of your post was about.

Thanks,
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

zufus
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Date Joined Dec 2008
Total Posts : 3149
   Posted 1/18/2011 2:22 PM (GMT -6)   
Yeap I shortened my diatribe, I do think John T's words of wisdom are righteous. Best to you in what ever you decide, it is never easy. I altered  the prior post and made it short and sweet.

Post Edited (zufus) : 1/18/2011 2:53:05 PM (GMT-7)


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 2:29 PM (GMT -6)   
Zufus....thanks for the clarification. I had already decided before I even posted this thread, that if I go the HT route, it will be done by someone other than my uro. (From JT's advice that he has given over and over as well as yourself from many posts in the past)
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

bsjoplin
Regular Member


Date Joined Feb 2010
Total Posts : 308
   Posted 1/18/2011 3:00 PM (GMT -6)   
just another quick experience: when i was post surgery and PSA started rising, the URO referred me to the RAD ONC, and both of them, when questioned about HT, said i needed the curative power of RT, and HT was something that might be necessary in the future, but radiation was what i was needing NOW. [sorry about the mixed-up tenses, but i think you get the idea....]
anyway, their advice made sense to me...
bob
Age@dx:55
5/05 PSA:1.8
12/07 PSA:3.7
7/08 PSA:4.7
8/08 Biopsy#1:3 of 6 irreg
11/08 PSA:6.5
12/08 Biopsy#2:of 12,3 cancer,other 9 irreg;Gl:3+3=6
1/22/09 RRP
1/25/09 Released
1/28/09 Path: PCa on 10%, lymph & SV benign, Gl:3+4=7,stage T2c
2/13/09 PSA:0.1
6/09 PSA:0.1
10/09 PSA:0.1
2/10 PSA:0.3
4/10 PSA:0.4 Referred to RO
5/4/10 First RT
6/25/10 Final RT;ended up 36 treatments,64.8 Gy.
8/10 PSA:0.2
11/10 PSA: 0.1

compiler
Veteran Member


Date Joined Nov 2009
Total Posts : 7203
   Posted 1/18/2011 3:09 PM (GMT -6)   
I am in a similar situatio, although my pending BCR will be much shorter time-wise. I also asked about HT in conjunction with SRT. The experts I spoke with recommended RT and NO HT for now.
 
Let us know what the other experts you speak with think
 
Mel
PSA-- 3/08--2.90; 8/09--4.01; 11/09--4.19 (PSAf: 24%), PCA3 =75 .
Biopsy 11/30/09. Gleason 4+3. Stage: T1C. Current Age: 64
Surgery: Dr. Menon @Ford Hospital, 1/26/10.
Pathology Report: G 4+3. Nodes: Clear. PNI: yes. SVI: No. EPE: yes. Pos. Margin: Yes-- focal-- 1 spot .5mm. 100% continent by 3/10. ED- in progress. PSA on 3/10/10-: 0.01. PSA on 6/21/10--0.02. 9/21/10--0.06; 1/4/11-0.13 CRAP!

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 3:10 PM (GMT -6)   
Thanks Bob,

That is exactly what I thought as well. Recurrence after surgery is SRT. Even my own surgeon two years ago when we talked about surgery and the "what ifs" back then stated that SRT would be the standard protocol for followup therapy if needed.

Now after a couple of years, his thinking has altered somewhat from his original position, which was quite a surprise, but at the same time made a little sense as well.

Someone is thinking outside the box...either he is....or the Sammons Cancer Center group of associates that he is associated with.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

Steve n Dallas
Veteran Member


Date Joined Mar 2008
Total Posts : 4829
   Posted 1/18/2011 3:20 PM (GMT -6)   
Hey Les - only thing I can offer is a couple (or more) COLD Ones. Just say when yeah

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 3:22 PM (GMT -6)   
Mel...no problem buddy. I know you are in a similar situation. Kinda like watching that radar blip move closer and closer to the center of the screen. It just doesn't help with the anxiety. The only comfort I got was trying to guess how high it would go between tests. (Even thought of starting an office pool...but the football game was more practical)

What is going to be interesting....is the consultations with the group I currently go to and what the "other guys" down the street will say.

Heck there has been so much debate between doctors about any form of treatment, I doubt very seriously I will get the same conclusions between any two cancer centers no matter who I talk with.
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months

LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 1/18/2011 3:22 PM (GMT -6)   
Steve...is that before or after or both...lol
You are beating back cancer, so hold your head up with dignity

Les

Robotic Surgery Sept 2008
PSA increasing since January 2009
Current PSA .44 (29 months)
PSA Doubling time approx. 6 months
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