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howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 4/19/2011 12:00 PM (GMT -6)   
 
I just got back my latest PSA test and it shows an increase from .20 to .32. This is after 9 months post srt. My question is do i wait another 3 months for the next PSA or do I start hormones now. I will also be traveling to Italy next month if I wait till then will this cause a problem.
DX age 58
PSA 5.4
Gleason 5+4 = 9
City of Hope Clinical Trial (punch protocol). 6 sessions textore every 3 weeks + lupron
PSA .1
RP Oct 2009. Seminal Invasion positive margins. Lymphnods clear.
1 month PSA post op undetectable.
4 month PSA undetectable.
7 month PSA .5
Bone scan and CT scan negative. Prosticint scan mild activity in prostate bed.
EBRT May 2010. 39 sessions 70gy. On number 37.

James C.
Veteran Member


Date Joined Aug 2007
Total Posts : 4463
   Posted 4/19/2011 12:19 PM (GMT -6)   
howard, welcome. The srt guys will be with you shortly, I bet.... tongue
James C., Age 64, Kingsport, E. TN
Gonna Make Myself A Better Man tinyurl.com/28e8qcg
4/07: PSA 7.6, 7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS6
9/07: Nerve Sparing open RP, Path: pT2c, 110 gms., clear except:
Probable microscopic involvement-left apical margin -GS6
3 Years: PSA's .04 each test until 04/10-.06, 09/10-.09, 12/10-.09, 02/11-.08
ED-total-Bimix 30cc

Fairwind
Veteran Member


Date Joined Jul 2010
Total Posts : 3892
   Posted 4/19/2011 12:24 PM (GMT -6)   
If it was me, I would wait until I returned from Europe, do another PSA at that time and if it's up again start the ADT at that time..I'm 3 months into HT and the side-effects are not that bad, but they are there, mostly hot-flashes..But different men react differently..In the end, it doesn't seem to make much difference if you start HT early or wait until your PSA moves past 10...The experts argue about this, so you can expect a spirited discussion on this board..

If you do not have a medical oncologist you like, time to find one now and talk it over with him....
Age 68.
PSA age 55: 3.5, DRE normal.
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 3rd biopsy positive, 4 out of 12, G-6,7, 9
RALP Sept 3 2010, pos margin, one pos vesicle nodes neg. Post Op PSA 0.9 SRT, HT. 2-15-'11 PSA 0.0

Old Sailor
Regular Member


Date Joined Aug 2009
Total Posts : 209
   Posted 4/19/2011 12:29 PM (GMT -6)   
Howard, I agree with Fairwind.  My Mayo doc felt that waiting for me was not a good idea since I was a gleason 9.  He felt when the psa reached 1.0 after SRT,  it was time time for HT, which I am doing. So far, so good. He felt hit it early when pca volume lower.   The Old Sailor

Sonny3
Veteran Member


Date Joined Aug 2009
Total Posts : 2448
   Posted 4/19/2011 12:44 PM (GMT -6)   
I guess I am from the other side of the early or wait scenario.

My PSA never reached zero after surgery and I went to Radiation just 3 months following surgery. Currently my PSA is 3.8. Which is down from 4.2 in one month. I have an appt with my Onco in May to do a one year scan for mets since my last one.

He is of the opinion that we will hold off on the HT until I see something that indicates that my PCa is causing or close to causing issues.

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 Radiation for MET
9/7/10 PSA 2.2
1/5/11 PSA 3.9
3/7/11 PSA 4.2

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4269
   Posted 4/19/2011 1:48 PM (GMT -6)   
Howard,
There are two opposing thoughts. The larger cancer centers feel that starting HT later doesn't make a difference. They have also been well behind the curve in HT treatments.
The private oncologists like Strum, Myers and Scholz all say that hitting it hard and early is the best course of action. All have many years of experience treating patients with advanced PC.
Scholz and Stum's reasoning is that if the tumor burden is low, HT has a much better chance of working. Myers believes that only one cell in a million is a mutaion and becomes hormone refactory. If you kill the cells before they have a chance to mutate the HT will last much longer.
Take your pick. I personally side with the oncologists that treat tens of thousands of patients.
JohnT
66 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, 4 weeks of urinary frequency and urgency; no side affects since then. 2 years of psa's all at 0.1.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25393
   Posted 4/19/2011 1:53 PM (GMT -6)   
Howard, Sonny and I am in a similar positon, I am taking his position on the subject for now. My post-SRT PSA has gone now from .06 to 3.81 in 8 months time, with most of the jump being in the past 2 months. Good luck, its a tough decision to make, because both sides are so convincing.

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 margin
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, 2/11 1.24, 4/11 3.81
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 9/10

howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 4/19/2011 2:06 PM (GMT -6)   
 
Thanks to all for your answwers and support. You are all a wealth of information. My leaning is to wait for the next test since PSA is still very low and as of now is about a 6 month doubling time which would put me at about .5 in three months. Some thought is that you will get a bounce or two before you each nadir with srt. I know for sure that I will start HT as soon as PSA reaches 1.0. Again thanks.
 
FIGHT ON
DX age 58
PSA 5.4
Gleason 5+4 = 9
City of Hope Clinical Trial (punch protocol). 6 sessions textore every 3 weeks + lupron
PSA .1
RP Oct 2009. Seminal Invasion positive margins. Lymphnods clear.
1 month PSA post op undetectable.
4 month PSA undetectable.
7 month PSA .5
Bone scan and CT scan negative. Prosticint scan mild activity in prostate bed.
EBRT May 2010. 39 sessions 70gy. On number 37.

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 4/19/2011 10:17 PM (GMT -6)   
Howard,
You've got a similar plan going either way you do it. I'd probably lean to enjoying the trip and then get back to business when I got back. However this is coming from a guy who didn't want to wait for any relapses at all when I was initially treated four years ago.

Have a great time.

Tony
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:
Da Vinci Surgery ~ 2/16/2007
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.
Undetectable PSA.

Blog: www.caringbridge.org/visit/tonycrispino

howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 4/20/2011 9:59 AM (GMT -6)   
All my tests have been done at COH. At this time Dr. Twardosky feels wait for one more PSA and see what happens. I to am in the belief Tony that the sooner the better. I will fight this with every inch of my being.

F8
Veteran Member


Date Joined Feb 2010
Total Posts : 3996
   Posted 4/20/2011 10:19 AM (GMT -6)   
you never did say how long your trip will be.  it'll take about a month before you feel the effects of the HT and the side effects are gradual.  i would not wait.  good luck.
 
ed
 
 
age: 56
PSA on 12/09: 6.8
gleason 3+4 = 7
HT, BT and IGRT
received 3rd and last lupron shot 9/14/10
2/8/11 PSA <.1, T= 6 ng/dl

howard l
Regular Member


Date Joined Aug 2010
Total Posts : 152
   Posted 4/20/2011 3:26 PM (GMT -6)   
I will be leaving on the 12th of May and returning the 22 of May. Another question for all please. SHould I start triple blockade or save that for later.
DX age 58
PSA 5.4
Gleason 5+4 = 9
City of Hope Clinical Trial (punch protocol). 6 sessions textore every 3 weeks + lupron
PSA .1
RP Oct 2009. Seminal Invasion positive margins. Lymphnods clear.
1 month PSA post op undetectable.
4 month PSA undetectable.
7 month PSA .5
Bone scan and CT scan negative. Prosticint scan mild activity in prostate bed.
EBRT May 2010. 39 sessions 70gy. On number 37.
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