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PSA rising again after Radical Prostectomy in Nov 2009

musclenz
Posts: 7
Joined: Jul 2012

Hello I'm new to this board & would appreciate any advise that might be useful as the fight goes on :) Thanks in advance for your time.

I'm a 59 yr old otherwise healthy man that had surgery in Nov 2009 on my prostate after being diagnosed with cancer - Gleason 3+5=8 Adenocarcinoma - acinar type, capsular invasion - level 3,non confined, 11% involvement.
Surgery was -left wide resection with some right nerve sparing. urologist wanted fast action due to the activity going on. I recovered well being a "young man" & was only left with ED issues that I can work with using ED drugs & Cavaject.
Subsequent 6 month PSA levels have been 0.1 until 6 months ago when it went to 0.2 & is now six months on at 0.6

My Urologist wants me now to look at radiation which I'm against for the same reasons why I sought surgery over radiation treatment initially...further invasion on potency & ED & possible bowel involvement. I'm also fundamentally against using radiation or Hormone therapy. I'm waiting to speak to Radiology in the next few weeks though to discuss it further.

A little background to complicate things.... I am an active Bodybuilder & have been for 20 yrs. It is my life & my passion. I use AAS (Anabolic & Androgenic Steroids) & have been for many years. I am very well acquainted with the use & effects of doing so. I am knowledgeable & interested in the physiology of how AAS works in the body & as how it can be used as a PED (Performance Enhancing Drug) & as TRT (Testosterone Replacement Therapy). I worked closely with an Endocrinologist leading up to my surgery & subsequent recovery running compounds that enabled me to deal with the physical aspects of minimising gear (slang term for AAS) whilst still maintaining a level of physiological focus & physical size. I'm also well aware of the medical opinion with using exogenous administration of testosterone & cancer of the prostate. If anyone here can link me to clinical analyses that conclusively show this is the case, then I will be very interested. More on that if required.

I split up with my wife one yr ago after becoming involved with a 39 yr old woman...yes there is still hope after prostate cancer :). My wife & I had not been getting on very well for some yrs before the cancer but the issues after it brought everything to a head & we finally parted after over 30 yrs together. I am currently single again after a year with my new girlfriend & no it was not ed issues that brought us down :) I continue to train as a Bodybuilder & are thinking of doing a competition in 12 weeks although I'm not sure if my head is in the right space to continue.

Any comments about my course of action would be appreciated. I prefer to look at non conventional & self healing avenues in preference to going further down the traditional medical approach.
Cheers,
mnz

VascodaGama's picture
VascodaGama
Posts: 1549
Joined: Nov 2010

Muscle (man)

I am sorry for the pitfalls you’ve gone through while a PCa survivor. Your PSA increase may indicate recurrence and you should care for the problem the soonest. The Gleason grade 5 is for the highest aggressiveness which is difficult to treat. You should try to stop any spread, and hormonal manipulations have shown to work.
In any case, you seem to know about the problem well and the best shot is to follow what one believes to be better and feels confident.

There are several books on nutrition and in this forum you can find several threads related to the experiences of PCa survivors.
A good book I recommend you to take is “Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers, which is a biological researcher and food analyst, and is a specialist medical oncologist on prostate cancer. He is also a survivor of PCa.
You can also listen to his videos on diet and supplements and their effect in the treatment of prostate cancer. Just scroll in this link;
http://askdrmyers.wordpress.com/category/diet-prostate-cancer-2/

From the site below you can download the “Challenging Prostate Cancer - Nutrition, Exercise and You” pamphlet from Princess Margaret Hospital (posted in this forum by Beau2.
http://www.prostatecentre.ca/index.php/wellness-and-survivorship/nutrition-program

Wishing you luck in your journey.

VGama

musclenz
Posts: 7
Joined: Jul 2012

Tks Vgama. I will have a look at your suggested links in the next week.

Samsungtech1
Posts: 350
Joined: Jan 2011

Musclenz,

I am a little confused regarding your inquiry for conclusive proof of testosterone and PCa. Alot of us on this board have metastic cancer, or agressive, like you, cancer. Hormone therapy and the pills, like casodex, have one focus and that is to stop the production of testosterone.
It seems to me that you have a real problem. You can continue your body building, and take the steroids, which will increase your testosterone levels or you can stop bodybuilding and start on hormonal therapy.

I am surprised that your doctor would ne talking radiation. Your PSA is rising but you did not mention any tests to determine if it is spreading. Have you had any CT scans, or MRI's? Why are you talking radiation? You need to know where it is before you can radiate it.

Good luck with your treatments.

Mike

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Mnz,

Welcome to the forum and I expect that the questions you pose in this thread will generate a lot of responses.

A couple of things that should not be surprising in your situation: First, since your biopsy indicated that the prostate cancer was not contained within the gland, surgery never had a chance of eliminating it completely. Prostate cancer tends to grow more quickly when it is outside the prostate gland and in your case you are now seeing a progressive rise in PSA levels, which almost surely correlates to cancer growth somewhere else in your body. This should not be a newsflash to you and your doctors should have explained that your PSA levels would eventually rise because the cancer was not contained.

As you know, a Gleason 8 cancer is serious. You threw gasoline on this fire when you made a conscious choice to continue to use testosterone boosters to enhance your bodybuilding program. The links between testosterone and prostate cancer are well known and have been understood for a long, long time. Refusing to acknowledge this may be convenient for your priorities but it doesn’t mean that increased levels of serum testosterone are not fueling cancer growth.

I do not understand your conclusion that radiation would be more apt to cause bowel or potency problems than the surgical removal of your prostate. Studies suggest exactly the opposite, particularly when treating a more advanced cancer such as yours where wider margins must be taken at surgery. While a very small percentage of men do experience bowel issues immediately after initial radiation treatment, these symptoms almost always pass within a few weeks. Surgery runs a much higher risk of near and long-term incontinence but fortunately you seem to have dodged that bullet.

I do agree with your conclusion that radiation at this point could have a detrimental effect on sexual potency. The nerve bundles necessary to achieve an erection are very fragile and yours have already been damaged from surgery. Radiation could further injure those nerves over the next few years although drugs like Viagra have been shown to be quite effective in restoring potency to men who have seen a decline in sexual ability after radiation.

The biggest question about radiation at this point is where to apply it. Since your cancer was not contained at the time of surgery, the rise in your PSA levels could be caused by cancer growing almost anywhere: liver, lungs, brain, bones, etc. Salvage radiation therapy is most often applied to the area in the pelvic region adjacent to where your prostate used to be although that’s just a good guess as to where the cancer is. Unless they can pinpoint any tumors through various imaging techniques it’s a shot in the dark but studies have shown it to be a pretty good choice when you don’t have anything else to go on.

Your urologist is applying conservative, conventional wisdom in recommending radiation treatment in conjunction with hormone therapy. The combination of these two procedures to treat recurring prostate cancer has been shown to be effective in many cases but you must keep in mind that with aggressive cancers such as yours any treatment will carry a larger risk of failure than when used against a cancer that is lower risk and less aggressive (like say, a Gleason 6 cancer).

I get that you want to avoid HT because it will significantly interfere with your bodybuilding regimen. In fact, I would hazard a guess that two years of HT at your age would probably pretty much end your bodybuilding goals permanently. We all must make choices about what is most important: quality or quantity of life and you seem to have made the decision that bodybuilding trumps conventional treatment methods.

Regarding unconventional or self-healing techniques for prostate cancer. My opinion is that they don’t work. Sure there are anecdotal stories out there but no serious studies that can confirm any of the many alternative methods for treating cancer. I understand that there’s plenty we don’t understand about our bodies and that physicians are often ignorant of the impact of diet and nutrition on cancer but abandoning recognized and approved treatment protocols in favor of something else seems to me to be a way to justify other behaviors (such as the steroid and testosterone additions) instead of any serious attempt to address cancer.

I believe your doctor is giving you good advice. I think your use of testosterone supplements is reckless given your advanced, recurring prostate cancer. But you seem to have your eyes wide open on these matters and have a clear view of your priorities which is a far sight better than many men facing similar decisions that have not figured out what is important to them. I may not agree with your priorities, they are certainly not mine, but I do respect your choices and your willingness to accept the consequences.

All of us will eventually die of something and many of us will go never knowing what was important. It’s great that you have a passion like bodybuilding that you want to pursue even though it may kill you early.

Best of luck to you.

K

mrspjd
Posts: 693
Joined: Apr 2010

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musclenz
Posts: 7
Joined: Jul 2012

Thank You Kongo for your lengthy & informative post.

Firstly let me say that my surgeon said my biopsy - fatty tissue & lymph nodes showed no sign of malignancy & that the surgical margins on excision appeared complete. This seemed to back up the subsequent 2 yrs of PSA at 0.1. Because of the grade he was surprised that this was the case. So this is all new territory right now.

My decision to choose to take AAS supplementation & to continue on with this after surgery, might seem caviler to most on this board. I come from the opposite direction to what conventional medicine might suggest. You might say I'm biased but all things in my philosophy must be challenged until the Truth is found. So in that I challenge you to find me a recent clinical study that proves that testosterone is responsible for causing prostate enlargement or cancer. If anything & IMO it is far more likely to be high levels of estrogen that has a causative effect on prostate issues in men. I have asked the same question of my Endo & he does not have an answer either. It always begs the question as to why do hypogonadal men still suffer with prostate cancer.

I hear your thoughts on radiation vs surgery. I was lucky with the incontinence thing. I have strong pelvic floor muscles as well LOL however the nerve sparing was a last minute call from my surgeon. In fact he decided to go much more aggressively one day out from surgery & informed me I would be impotent. This news was more devastating than the news I had cancer. Anyway I'm coping with the help of a lot of technology. So I'm a little reluctant to going down the diminishing path of no return & the HT is so far away from my thinking I cannot even begin to comprehend this . I know what it feels like to be totally out of whack in the testosterone/estrogen ratio & I feel death would be a better option. Don't get me wrong ...I Love Life & everything in this World, but I do not fear Death either. What I do fear is a severely diminished quality of Life.

hopeful and opt...
Posts: 1313
Joined: Apr 2009

There is a site pubmed.gov that lists medical studies; I placed the above in the search and came up with

http://www.ncbi.nlm.nih.gov/pubmed?term=does%20testosterone%20influence%20aggressive%20prostate%20cancer

that lists some studies that do not exactly answer the question but tend to give an indication; there may other statements that can be placed into the search that will give more definitive answers.

muscle man, I wonder did you consult with a medical oncologist who hopefully specializes in prostate cancer?

By the way, Dr. Charles "Stuffy" Myers a highly regarded medical oncologist does not advocate testerone for intermediate and advanced cancer, while he does advocate, contrary to many in the medical community supplement to those with low level cancer.........he puts out a video blog each week.

.................................
You wrote,

"I feel death would be a better option. Don't get me wrong ...I Love Life & everything in this World, but I do not fear Death either. What I do fear is a severely diminished quality of Life."

A consequence that you might face, if you do not treat, and continue with "activity that many experts would advise that this activity will increase your chance of progressing your cancer" you can face a horrible death, your quality of life before dying would be horrible.

musclenz
Posts: 7
Joined: Jul 2012

thanks for the link. On a quick check I cannot find anything there that satisfies my criteria that testosterone is causative in the onset or progression of PC. In fact one study says _
Overall, prostate cancer risks were unrelated to serum T, estimated free and bioavailable T, and SHBG; however, risks increased with increasing T:SHBG ratio (p(trend) = 0.01), mostly related to risk in older men (>/=65 years, p(trend) = 0.001), particularly for aggressive disease [highest versus lowest quartile: odds ratio (OR) 2.76, 95% confidence interval (CI) 1.50-5.09]. No clear patterns were noted for Delta4-A and 3alpha-diolG. In summary, our large prospective study did not show convincing evidence of a relationship between serum sex hormones and prostate cancer. T:SHBG ratio was related to risk in this older population of men, but the significance of this ratio in steroidal biology is unclear.

hopeful and opt...
Posts: 1313
Joined: Apr 2009

http://askdrmyers.wordpress.com/category/adt-prostate/

There is one, active surveillance and testosterone that may be of interest to you

If you scroll through his site, I believe that you and others will find other videos of interest.

musclenz
Posts: 7
Joined: Jul 2012

Appreciate that link, h & o. I watched the PCa Growth Arrest vid with great interest. Will check out some more of Dr Myers blogs etc. :):):)

hopeful and opt...
Posts: 1313
Joined: Apr 2009

50 medical oncologists that specialize in prostate cancer. Dr. Myer's is one of them, located in VA. Some consider him the best in the world. There are other top ones as well. You may wish to travel to see him, or find one in your area.

Here is my 2 cent opinion; these medical oncologists are the experts in this, you are biased since you want to continue with your body building activity on a high level, additionally you are not a medical profession and qualified to make this decision......I think that it's good that you are developing information about the subject for discussion, but you need to consult with a true expert in this matter. The consequences of making a wrong decision are too strong.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Mnz,

While I didn't suggest that testosterone causes prostate cancer I do assert that it is a key element in fueling the growth of prostate cells, both cancerous and non-cancerous. The prostate uses the testosterone generated by the testes along with dehydroepiandrosterone from the adrenal glands to create the male sex hormone dihydrotestosterone (DHT) which is directly linked to the growth of prostate cells including prostate cells that are identified as early stage prostate cancers. Charles Higgins demonstrated nearly a century ago that by removing testosterone through castration or by blocking it with certain estrogens that the prostate shrank significantly (including the cancerous cells). This led to his award of the Nobel Prize in 1941 for his development of "chemical castration." With the testosterone gone, the ability of the prostate to produce DHT is significantly compromised and prostate cancer cell shrinks or stops growing.

This discovery led to many new hormonal treatments for cancers of the reproductive system such as prostate cancer, breast cancer, and ovarian cancer.

In prostate cancer removal of testosterone through orchiectomy or hormone therapy almost always results in a significant slow down in the progression of prostate cancer that is evidenced by PSA levels dropping to nil. Frequently the PSA levels remain undetectable for many years but eventually prostate cancer becomes more advanced, the cells become less differentiated, and the tumor no longer needs DHT to grow. In fact, studies have shown that as PCa becomes more advanced the cells actually generate their own testosterone. Some newer drugs such as Zytigia have been found to be moderately effective in slowing the cancer when it reaches this stage.

I agree with you that estrogen may indeed play a contributing role in prostate (and other cancer) growth particularly since it plays a role in the production of DHT.

The pursuit of truth is a noble goal but it has been my experience that in this arena truth is an illusive and imperfect thing. Frankly, truth changes based on additional knowledge and there are new and often conflicting discoveries nearly every day. There is much controversy about testosterone replacement therapy (fueled in part I suspect by manufactures of these drugs), estrogen, and how all of these and other impacts affect prostate cancer at the molecular level. While I am certainly no expert in this field, I do recognize that there are many conflicting expert opinions and that our understanding of all the chemical triggers that cause or accelerate the growth of cancers will likely be much different five years from now than it is today. All that notwithstanding, the contribution of DHT to the growth of prostate cancer is well established and adding artificial levels of testosterone to our body seems to me to be a questionable practice and most prostate cancer specialists agree with this.

It's important to keep in mind that prostate cancer is not static. It evolves and changes over time. Atypical cells progress to something a pathologist recognizes as cancerous but still is very much like a normal prostate cell but over time these cells continue to evolve toward less and less differentiation as seen in the pictures of cancer cells and their Gleason classification. Treatments that may be effective at destroying early stage cancers may not be effective at all in more advanced cancer stages and this is particularly true with hormone therapy. But since there are different stages of cancer cells co-existing at the same time, various treatments can still be somewhat effective on at least some of the cancer cells.

I share your views about hormone therapy. If my low risk cancer were to recur (I was treated with SBRT radiation) I don't know whether I would go forward with HT. I know that it is not curative and I too am unsure if I would be willing to endure the likely decline in quality of life for a questionable extension of months or even a few years. If I am faced with such a decision I am sure other factors will influence my decision (the truth changes) but it is something I hope I never have to deal with.

While I too agree that much of what the doctors tell us should be challenged I don't subscribe to the notion that we can or should steer a path that is the opposite of sound medical wisdom even though I recognize that conventional wisdom is often proven wrong. In your case, it seems to me that you quest toward "truth" is a convenient crutch to justify doing something your doctors are strongly advising you not to do.

Regarding studies. In my two years of studying prostate cancer I’ve learned that you can pretty much find a study that justifies almost any treatment method and a conflicting study that asserts the opposite view. Rather than pinning a position on a single research paper I think it is more useful to consider the body of literature on a given subject, understand the prevailing opinions, and try to sort out the controls, methods, and other aspects of the study that determine its outcome. The work done by Higgins, for example, conclusively showed the relationship between DHT and prostate cell (both cancerous and benign) growth and he was awarded the Nobel Prize for this discovery and these fundamental principles have led to other significant discoveries that aid in the battle against cancer. Other studies since then have found that there are many things that can promote prostate cancer growth besides testosterone, including estrogen, Insulin Growth Factors (IGF) found in dairy and meat products, smoking, lack of exercise, hereditary factors, obesity, sugar, and so forth. Just because our body of knowledge has grown (and become more complicated and difficult to understand) doesn’t mean that certain fundamental relationships affecting prostate cancer are no longer relevant.

Every prostate cancer patient is different. Given your initial diagnosis of advanced prostate cancer (Gleason 8 that was not contained) I suspect that your prostate cancer would have recurred whether or not you continued taking steroids to enhance your bodybuilding program. The question now is whether or not you take every prudent step to try to delay the impact of this cancer long enough that something else gets you, like a heart attack or getting run over by a bus. That’s a deeply personal choice that only you can make but as Hopeful and Optimistic points out, death by prostate cancer is an agonizing and awful way to die. I hope you avoid it either by luck or design.

K

musclenz
Posts: 7
Joined: Jul 2012

Kongo, indeed your replies are well constructed & meaningful & I can feel your heart is in the right place through your words. I am aware of Charles Higgins work some 60 years ago. It astounds me that most of the Hormone work with PC is based still on that finding. I'm not saying that there is no relationship between sex hormones & cancer. What I'm saying is I find it hard to believe that this radical & invasive treatment is continued today based solely on a study that was done so long ago & that does not appear to have been questioned by the medical profession since then. We are not talking about a compound that is artificial. We are talking about an essential hormone that is required by both men & women to enable brain function, muscle & bone repair, protein synthesis, sexual function & general well being.
You mention again that my PC was not contained. This was not the case as described by my Urologist. The fact that it appeared to be contained & excised with the prostate led me to believe that all was well in my world. Its only now after nearly 3 yrs that it appears it was not fully contained. The point I'm trying to make is, I took the decision to continue with using AAS on the basis that I was healed. Also, I my LH is so depressed that it will not restart the HPTA, so I needed to continue with TRT in any event to function properly not only as a Bodybuilder, but as a male.
I appreciate your observations. I know I challenge the norm & I may be biased in my opinions, but that's just how I work.

Kongo's picture
Kongo
Posts: 1167
Joined: Mar 2010

Mnz,

Perhaps I misunderstood your original post but you wrote in the second paragraph "...after being diagnosed with cancer - Gleason 3+5=8 Adenocarcinoma - acinar type, capsular invasion - level 3,non confined" I took it to mean that the cancer you were diagnosed with was not contained within the prostate.

The following is quoted in part from online literature from the McIver Clinic in Jacksonville, FL about capsular invasion:

"The prostate has a “margin” which is a thin membrane (capsule of the prostate). Just outside the capsule are the small nerves which look like a network of spider webs that go to the penis. A pathologist examines the capsule after surgery to make sure the cancer is confined to the prostate. If the prostate can be removed with a clear margin before a metastasis, the patient has an excellent chance of cure. A patient with High Risk prostate cancer (Gleason 8 - 10) has a high chance of cancer in the capsule. Capsule invasion by cancer increases the chance of a recurrence of the cancer after surgery."

The staging of level 3 is the classification assigned when there is capsular invasion as you had and the words "non confined" indicate to me that the cancer was outside that capsule -- hence my use of the term "not contained."

If I have mischaracterized your diagnosis I apologize.

I agree with your statements about the importance of testosterone for men (and women too). But sometimes body functions that are necessary for healthy life go awry. Diabetes is a good example of what happens when the pancreas quits producing insulin in the body of a Type II diabetic, or the pituitary gland misfires and produces too much or not enough of a chemical regulating growth and we see dwarfism or giants, or parts of our immune system fail and actually attack our own body. If things didn't go wrong with our bodies we wouldn't need the Affordable Care Act that is so controversial here in the United States and we would all live as long as Methuselah.

I certainly don't subscribe to the notion that testosterone causes prostate cancer like say cigarette smoking causes lung cancer. If that war the case all men would eventually get prostate cancer after testosterone levels moved in to the normal range for an adult male and that is certainly not the case. What I am saying is that prostate cells need testosterone to grow. Both healthy prostate cells and cancerous ones need testosterone. Adding artificially high levels of testosterone when you have prostate cancer does not seem to be a prudent course of action and most prostate cancer specialists will tell you the same thing.

I don't believe modern prostate cancer research only relies on work done by Higgins so long ago. They have built upon that work, continued to validate it, and this is how they were able to develop the modern hormone therapy cocktails we have today that are somewhat effective on many types of cancer that behave similar to prostate cancer.

Thanks for the interesting discussion.

Swingshiftworker
Posts: 634
Joined: Mar 2010

Musclenz:

I have developed a renewed interest in bodybuilding having lost 30 lbs from 190 to 160 and reduced my body fat from 25.8% to 15.45% (measured hydrostatically) in the past 3 months. I only gained 1 lb of muscle in that time but my muscle definition (particularly in my legs, arms & shoulders) has dramatically improved w/the fat loss.

I'm not "huge" by any means but am looking pretty good IMHO for a 62 (this Oct) old fart. Current basic stats are 41/33/38. I want to burn off more fat (goal 12%) in order to lose another inch off the waist (goal 32) BUT also want to gain just a little more mass -- mainly in my arms (goal 16 from 14.5) and chest (goal 42). However, I have no interest in using AAS to do so.

For those who don't know, AAS are controlled substances which require a prescription for legal possession and use. AAS also have well documented negative psychological and physical side effects -- "roid rage" and impotence being the most notable. AAS are also banned for use in competition by most (if not all) major amateur and professional sports organizations, with the exception of body building organizations which are split on the issue and has led to the development of the "natural" body building movement.

Kongo has more than adequately addressed the testosterone question and its possible connection to PCa. So, I don't need to reply about that BUT I was just curious: Why do you find it necessary to use AAS to enhance your muscle mass in the face of the obvious negative side effects and the movement against its use in sports generally?

Are you a competitive body builder and think you need to get "huge" in order to remain competitive or, if you don't compete, do you just like the size that comes w/the use of AAS?

Hope you'll take the time to answer but will understand if you don't want to get into it here.

Ciao!

musclenz
Posts: 7
Joined: Jul 2012

M8 I'm not here to get into a debate on the rights & wrongs of using AAS. It is a decision I took many years ago & I have no regrets in having taken that decision. It has enhanced my body & my life greatly. It would appear that you do not use them & are against the use of them. That is your call & I respect you for it. In the end there are many prescription drugs on the market that can do far more damage to your body than PEDs. You would also be amazed how many men & women use them in all sports & from all walks of life, so I think it is best a topic left alone given the sensitivity & illegality of it. Good luck with your training & body re composition.
Regards,
mnz

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