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Six years post radical prostatectomy, Gleason 7or 8, T2A, PSA now detectable at 0.34, 67 y.o. The highest PSA was 4.7 prior to s

grey ghost
Posts: 21
Joined: Jan 2012

Disappointing result after all this time. Will probably go on hormone therapy. Please offer any advice from those experiencing therapy. Will have my first meeting with urologist in early February. Many thanks.

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Grey

I would like to help you with my views on your case. However, the info you posted is not sufficient for the many guys here to understand what could be happening in your case.

One important piece of information in your status is the “pathological stage” attributed to you after the surgery (clinical margins, extra capsular extensions, seminal vesicle involvement, lymph nodes tested, etc.). Another would be to know about the chronology of your PSA along the six years up to the last test of 0.34. Another still is to know if you are asymptomatic.

The T2a was probably your clinical stage before surgery but the doctor who did the operation may have your pathological report with details on what they found on you, six years ago.
I would assume that the PSA since surgery has been at remissions levels lower than 0.06 and that it has increased slowly to the 0.34 level. If I am correct, you may be experiencing recurrence. The importance now is to check for any metastases and to find where they may exist.

Some doctors in such situation recommend image studies/testing such as an MRI and Bone scintigraphy scan to rule out far metastases, which would classify any recurrence as localized. Nevertheless, these tests are usually negative at lower levels of PSA because the equipment has not enough resolution to detect small tumors.

At your age (with no other health problem), salvage treatments are usually recommended to be started at PSAs close to 0.40 to avoid the cancer from spreading further and becoming systemic. The most recent typically recommended salvage treatment is for a protocol of a combination of Hormonal and Radiation, done with intent at cure.
This has proven successes for long survival biochemical free rates. But, some patients choose to have chemo therapy together with radiation.
Hormonal treatment alone is considered palliative. It does not cure but can hold the cancer “at bay” for long periods of time (some cases over 15 years).

If in fact you are in recurrence, I would recommend you to do some investigation on salvage treatments for similar cases and read about the side effects that each treatment may entail.
You should consult a specialist oncologist before making any decision.

Hope for the best.

VGama

grey ghost
Posts: 21
Joined: Jan 2012

Many thanks VGama for your time and observations.
To answer some of your questions, I am asymptomatic at this time. My PSA just exceeded 0.1 this January. The previous test was December of 2010, so it appears that it rose just this year so it looks like a recurrence.
I will look for folks who have experienced hormone treatments. I have already had radiation so I believe that it is not an option.
Again, thanks.

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Grey

Your descriptions in the title of this thread you indicate a PSA “now detectable at 0.34”, but you are saying that the test in January is 0.1. What is going on? Has the PSA decreased?

Regarding your comment on radiation, this can be done depending in which areas you have gotten the previous treatment. Radiation on top of radiation is not recommended but it all depends how long ago it was performed and if you have scar tissues at the areas to radiate. In some cases, a history with rectum colitis would also be prohibitive for radiation

Hormonal treatment (HT) may be a good choice for you. You should investigate on the protocols and side effects. An urologist may be not the proper doctor to administer HT. Some drugs interact with other medications so that you may look for an oncologist specialized on prostate cancer.
I had RP in 2000 followed by RT in 2006 and I am now on HT since 2010. So far my cancer is responding well to the treatment as seen by the decline in PSA. I will be starting my period off drugs (intermittent vacations) when the last LHRH agonist shot loses its effectiveness. The side effects have been numerous but mild.

I recommend you this book which explains well about HT;
“Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers.

Good luck in your journey.

VGama

grey ghost
Posts: 21
Joined: Jan 2012

Thanks again for your advice.
To clarify, my PSA was undetectable in January 2011 and now is .34 in Jan. 2012. I met with my urologist who talked strictly about biologic hormone treatment and did not mention orcheoectomy. Nor sure why because I would have no problem with it at my age and it seems so much easier.

VascodaGama's picture
VascodaGama
Posts: 1511
Joined: Nov 2010

Orchiectomy is not that simple. It got its risks; side effects and it becomes a permanent disability.

In HT the purposes is to avoid testosterone from reaching the cancer. The “work” is done with a series of blockades at several levels. Orchiectomy will “pull down the biggest factory” (the testis) where the majority (90 to 95%) of testosterone is manufactured. Other portion of T is conceived at other “factories” (adrenal glands, etc) that cannot be pulled down because we cannot live without their work.
Still many other body functions use testosterone and low levels of the stuff may cause a series of other illnesses. Heart problems and diabetes are consequences of low levels of testosterone (hypogonadism) which in some cases must be treated with TRT (testosterone replacement therapy). Listen to this video from the famous oncologist Dr. Myers;
(http://askdrmyers.wordpress.com/2011/10/05/male-hypogonadism-pca/)

Many still suggest orchiectomy as an easy and cheap way of treating prostate cancer but sex or fatherhood is not the only matter in play. The practice can be substituted by chemo castration with a LHRH agonist or antagonist which function will stop once the treatment ends. The testosterone will return to its normal levels again.

Typical protocols in hormonal treatments are for mono, double or triple blockades, referred frequently as ADT1, ADT2 and ADT3. Your doctor can explain details on the matter. Some guys do well with the mono-blockade but others require double or triple.
You can read about the protocols typing the name in a net search engine.

Another bump in your journey, another phase of self education on PCa.

Good luck.
VGama

grey ghost
Posts: 21
Joined: Jan 2012

Had my meeting with urologist and oncologist yesterday. Because my PSA is 0.34 and I am asymptomatic, the oncologist recommended a wait and see a few months while the urologist recommended that I get started on therapy now. Will get a third opinion at the Lahey Clinic in MA. I agree with VGama regarding pitfalls of orchiectomy. Thanks.

tarhoosier
Posts: 181
Joined: Aug 2006

Grey:
It is time for you to move your care from the urologist to an oncologist. The urologist has completed his work years ago (if he was the surgeon). He is not looking for your best interests now. If you have waterworks issues you can see him for that.
In the meantime the oncologist is the man for you. You need someone to look at the big picture and not see treatment profit in every patient, as I expect is the case with the uro. For such a moderate recurrence, with a disease with such a long lead time the advice of the uro is completely wrong. It is unfortunate to be so cold but the facts you state suggest my conclusion.
You have a long time to go and immediate treatment is uncalled for. Wrong advice makes bad medicine.

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