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Hormone therapy may boost prostate cancer growth

SPT
Posts: 40
Joined: Aug 2017

Hormone Depletion Activates Tumor Survival Process in Prostate Cancer, Study Shows

 

The article linked above begins:

 

"Prostate cancer hormone depletion treatments might, in fact, be boosting cancer growth and making a tumor more aggressive, researchers at England’s University of Surrey found."

Jpsweld
Posts: 6
Joined: Sep 2017

What is this for real? 

SPT
Posts: 40
Joined: Aug 2017

The study included both tests in a lab petri dish and tests on men with prostate cancer.

"But a finding in a lab dish does not necessarily translate into human reality. So to verify their observations, the team set up a prospective study with prostate cancer patients. Participants were split into two groups — one had anti-hormone therapy before radiation treatment, while the other started radiotherapy before hormone depletion. Those who received hormone depletion before radiation therapy had fewer cells dying from the radiation.

"Looking at tumor biopsies, the study showed that hormone deprivation impacted DNA repair, which was linked to higher PARP activity in the cells. To further verify this, the team compared PARP levels in patients before and after hormone therapy, and saw that PARP levels increased as a result of the androgen-depleting treatment."

PARP is an enzyme that participates in DNA repair. It also renders cancer treatments less effective. That's why the paper's authors, and many other groups, are studying PARP inhibitors as potential new drugs.

hewhositsoncushions
Posts: 267
Joined: Mar 2017

The OP title is misleading and disingenous. The  article suggest that there MIGHT be a correlation in some instances and that HT in conjunction with something called PARP might reduce / resolve the problem. Further research required. All papers are speculation until they become accepted practice and even then, things change.

I'm really annoyed now.

On one hand, Vascodagama is getting grief from the mods for posting well researched and well thought medically sound posts giving solid advice that may save lives. On the other hand we have people who are openly hostile to proper medicine promoting pseudo-science and presenting misleading information.

I beleive the mods need to take a stand on this and that that stand ought to be - science first. last and always.

Post reported.

SPT
Posts: 40
Joined: Aug 2017

I'll match my scientific education, credentials, and publication list against yours or anyone else. I have 3 degrees from MIT and make my living in science.

Science first last and always must tolerate dissent and criticism, and doesn't shy away from unwelcome facts and observations. Singing the praises of doctors and uncritical acceptance of everything they do is not science. Most doctors are not scientists - they are technicians. Well trained technicians for the most part. You really don't want a scientist experimenting on your body. Trust me on this one.

In this case, it wasn't even criticism, just some news that could be unwelcome to many men here. I used the word "may" in the title of the original post.

Report away, if the mods won't tolerate dissent this place is worthless.

Will Doran
Posts: 207
Joined: Sep 2015

Since I have been through all the surgery, Radiation and yes, two years of HT, I can't say that I want to hear this argument.  I'm 4 + years post diagnosis and started with a PSA of 69, and as of two weeks ago my PSA is still < 0.5, and my testosterone is back to full levels. And, yes, the beast could rear it's ugly head again at any time.  My Doctor keeps it real and reminds me of that every time I go in.  I, like "Cushions", "Vasco", and many more have had good results, and, yes, maybe "luck", and success with the use of surgery, radiation and HT.  Many of us want to only share what we have been through and the results we have had.  So, others may learn and make their own decisions.  

Please don't turn this web site, which means so much to all of us, into a battle ground like we now have in the USA with all the fighting and separation. It's as bad as it was in the 60's when I was in college.   We have too much else on our minds to have to take opposing sides.  We are worried enough about our situations to have to come on here and see disagreement going on.

Sincerely,

Love, Peace and God Bless to all

Will

hopeful and opt...
Posts: 2218
Joined: Apr 2009

Well said hewhositsoncusions...

GeorgeG
Posts: 127
Joined: May 2017

Are there any other studies that agree with this conclusion/hypothethis?

George

 

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

I believe in the main argument in this thread regarding the consequences in hormonal treatments/manipulations as an initiator in the so called refractory status. I have commented in my past threads about the danger involving continuous HT administration which may be behind the bandit’s wish in looking for survival at its own means. Oncologist researchers like Myers have studied the problem and by experience in treating his/their patients, they have confirmed that intermittent administration done with an appropriate protocol can extend the period of IADT for several years before refractory sets in. Refractory is a status given to the treatment when the bandit mutates its AR (androgen receptors) or when it starts manufacturing androgens for own survival.

In one of my threads of 2011, I had a similar discussion on the above with some of the comrades of this forum, in regards to the “behavioral adaptation” of cancer cells in surviving on low levels of testosterone. Cancer behavioral is triggered and reacts to survive by mutation. In this “adaptation process” the beneficial mutations are preserved because they aid survival. This is a process known as "natural selection" from Darwin’s theory. We all got it at all levels including the cancer. It is in our genes.

In my opinion, researchers of the above study (presented by SPT) reached further and found the genes involved in such survival principles. In any case, I think that linking HT treatment to the cause of “boosting cancer growth and making a tumor more aggressive” is over stating because we know that hormonal manipulations involve many weapons working solo (IADT) or in combination (IADT3) and aiming at several means of hormonal blockades. Another aspect to consider is the same principle in survivorship that can be expected to occur if cell’s DNA stability are threaten by bursts of radiation or chemo induced damage. Cells could be damaged and initiated to a status of cancer. That could be imagined as boosting cancer.

This finding in genes is now the subject for newer means of treatment of prostate cancer. We have been expecting this to happen and without doubts this will be the way for future interventions. It will be a more tailored way to treat each individual case that deals in fact with the cancer itself. Not as the present approaches that aim in dissecting/burning the whole flesh where the cancer is expected to hide. It makes me think that we are closer to the “Silver Bullet”.

Some of my inputs on the matter;

https://csn.cancer.org/comment/1013947#comment-1013947

https://csn.cancer.org/comment/1300510#comment-1300510

https://csn.cancer.org/node/241249

https://csn.cancer.org/node/267154

Thanks for starting this thread.

 

Best wishes,

VGama 

SPT
Posts: 40
Joined: Aug 2017

It really isn't a very surprising result.  We know that ADT invariably fails, with a mean time to failure of about 2 years.  ("Invariably fails" is a direct quote from several medical journal papers on ADT, not my opinion.)

That strongly suggests that the cancer somehow adapts to the low-T environment.  This paper, as you correctly note, has identified and investigated some of the specific pathways.

We know that castration-resistant prostate cancer cells grossly overexpress androgen receptors (AR), so much so that 2 clinical trials are investigating killing resistant cancer with supraphysiological doses of testosterone.  Google the BATMAN study.

I strongly agree with your statement that "Another aspect to consider is the same principle in survivorship that can be expected to occur if cell’s DNA stability are threaten by bursts of radiation or chemo induced damage. Cells could be damaged and initiated to a status of cancer. That could be imagined as boosting cancer."

My own investigations and background in nuclear physics leads me to believe that the risks of radiation, especially nuclear medicine like the PET/CT scans, are grossly underestimated for cancer patients.  That's being polite, as far as I can tell no one has ever looked carefully.

Essentially all radition safety studies are done on healthy patients.  PET/CT gives a very large dose, but not enough to kill cancer cells like IMRT, EBRT, or protons.  In an hour or so the patient gets as much radiation as they get in 8 years or more from natural background.  The RATE of radiation (which is well known to matter) is over 20,000 times background.  Since the whole point of PET is to concentrate the radioactive isotope on tumors, their rate is much higher still.

Yet doctors hand out these scans like candy, to patients at high risk of metastasis.  Just a few cells in the tumor bed who have their already-scrambled DNA hit in the right places could turn an indolent Gleason 6 into something far more dangerous.

The first rule of radiation safety is that you never accept a dose unless it is medically necessary.  Whole-body MRI has been shown to have better sensitivity, better specificity, and vastly superior spatial resolution than PET.  That's why they add a CT insult to PET radiation injury, to improve the image quality.

Whole body MRI is better and far safer than PET/CT for investigating suspicion of bone metastases.  The only reason the US still exposes patients to such high radiation risks is money.  The machines that make the isotopes and the PET scanners are already paid for, even though MRI has made them all but obsolete. 

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RobLee
Posts: 259
Joined: Feb 2017

Yesterday I had my final meeting with my RO and now have only four more ART treatments using the RapidArc.  We discussed how long I should remain on Lupron and between the two of us concluded 18 months total.  I asked if 2 years would be preferable and he said no for the reasons stated earlier, in that it could reduce the efficacy of HT in the event of a future recurrence.  He also said we could stop at one year if I was not tolerating it well, and I said I can do another six months okay.  Note this is just Lupron, no Casodex. My only other meds are Venlafaxine and Gabapentin for the hot flashes and mood swings.

Additionally he informed me that the radiation will continue to kill cancer cells for about nine more months after RT ends, so another nine months of HT (when my next shot will wear off) will nicely cross over with the curve of the RT's effectiveness.  It seems like a good plan.  Also he said that my testosterone should return around nine months after the Lupron wears off. Also we will not know for sure whether or not all this has worked until after three consecutive PSA tests after everything has ended, worn off, and stabilized... so we're looking at 2019 (yes, 2019) before we know for sure.

As for the sentiments expressed in this thread, I feel that HeWhoSits stated it perfectly.  I for one read just about everything that Vasco writes. It is always good information, even if it does not specifically pertain mto my own situation. And I never bother reading anything posted by the other guy anymore.  I just skip over them.  My day just goes much better and my heartrate stays lower if I do no expose myself to such contentiousness, especially early in the day.  It's just my own means of self preservation. Call it Darwinism.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

Rob, HeWho, and all others,

I have had two dear friends booted from CSN over the years. Both were stellar men writing at Lymphoma, both were highly liked, both were insufficiently PC to survive.  I am completely unfamiliar with what the controversy with VG pertains to, but he has been absolutely the best writer at PCa ever, at least over the years that I have been reading here.  He has never submitted anything even remotely objectionable that I have seen, but I do not read everything here.

I have myself been "warned" more than once over trivia that would cause no issue with any rational adult.

I have no issue with the report that SPT submitted, except that it is wholly outside any form of context.  HT has been providing thousands of suvivorship years to PCa patients for decades, and will continue to do so; in clinical terms, the report will change nothing: not now, maybe never. 

This site is mostly about clinical and practical advice for men who are not biochemical researchers.  Me, I'll read anything, and am interested in both practical as well as theoretical advances.  Most men probably are not.   Fairly often, a news areticle is shared here about some "revolutionary" new practice.  Usually these relate to diagnosis.  And always, they are not at all "revolutionary."  Frequently they are feeds from public relations organizations.   And that too is ok: it just has no context around it for people who don't know what the context is.

Men will read here what they want, when they want.  There are a couple of guys whose stuff I just skip, but others may enjoy their commentary.  I wouldnopt want them to depart. Good.  The freer the flow, the better.  Undoubtedly a few never read my posts, not liking the way I wag my chops.  That is good also. As Thoreau (paraprasing) said to potential readers in the beginning of his classic work Walden:  "Don't stretch you jacket reading this, read something else if it is not to your taste."

If I needed HT, and I'd go get started today, and have no qualms whatsoever.

Blessings to all (but especially to Vasco),

max

.

 

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

RobLee,

In my opinion your RO has chosen the best plan. Unfortunately it will take time before you really get the final conclusion and deserved peace of mind. The long period on HT with its side effects is never a wanted situation but you can trust on its influence in the overall treatment. I am glad for knowing that the RO has given you the freedom to stop HT if such becomes an inconvenience in your quality of living.

The nine months of RT effect regards the period cells take to duplicate and die. Prostatic cells life cycle (cell-division cycle) goes from two to six months and it is during this period that the damage of the DNA will take action and provide results. The survival-ship (Darwinism) enters into action trying to save the situation forcing duplication of cells which, due to the impared strands, cannot duplicate anymore. You can imagine the havoc going on in a cell, caused by the lack of testosterone in one side and the tentative in forcing repair on the other side, creating a total confusion in the system that ends in our favor. This is when we win and later celebrate.

The process involves risks too. Cells that were not much affected because of the timing of the RT administration (those at the interphase period that missed the burst) may continue duplication and living. Some can also survive with a damaged DNA that may later become cancerous. However these are minimal probabilities as RT is administered along side the period of cell'slife cycle (8 weeks in daily administration), or burst with a stronger dose in a period of one week to assure the best killing. Those that survived would take years for showing prejudice in our life span.

How about trying to extend that "self preservation" to see man on Mars by 2034?

2019 is just around the corner. You can do it

Out of the context; I wonder how you can keep reading my posts. English is not my mother tongue and grammar is not respected as it should be. When reading back past posts I am puzzled for the numerous spell errors I have committed. Sometimes I cannot even understand the main meaning of my sentences. It must be boring for the English speaking community.

Best,

VG

RobLee's picture
RobLee
Posts: 259
Joined: Feb 2017

Vasco, thank you for your reply.  You and a few other regulars here make this forum what it is, a valuable source of information. I do frequent several other forums and each has it's own flavor. This one, on CSN requires the most effort and patience to navigate, but is well worth it.

Brilliance is apparent no matter what language. Diligence in constructing meaningful sentences and paragraphs shows through dispite awkward grammer and perhaps unfamiliar terminology. I too have some difficulty both composing and interpreting these posts as I am mildly dyslexic, even though English is my primary tongue it is sometimes awkward and difficult to comprehend. Plus we all make even the simplest (and sometime humorous) spelling errors... 'typos'.

Of course, once this particular battle of prostate cancer ends for me, as it hopefully will eventually, I may tire of reading these forums and hopefully move on to another phase of my life. I will remember the people who were a tremendous influence during this period, which if it extends into 2019 will be five years long. And with great hopes that it will never be necessary for me to return to these forums to resolve a future recurrence.

Thank you once again for all that you do for everyone here, VascodaGama, and may good fortune be with you in your own struggle.

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

VG,

Like Rob, I must say that your writing is excellent.  You write English better than most American high school students, for what that is worth.

English is among the hardest of all languages to spell, even for native speakers.  My only other language is German, which is fully phonetic in spelling, easy even for a non-native of German.  One of my German professors noted the fact about how hard spelling English is.

I have never had the least bit of trouble reading a post from you,

max

GeorgeG
Posts: 127
Joined: May 2017

VG

Don't worry about it. I worked with hundereds of Engineers during my career and the better the Engineer the worse the grammar, spelling and speaking skills. Knowledgable is knowledgable.

 

George 

Grinder
Posts: 438
Joined: Mar 2017

Someone just called me "f*cktarded" on Facebook.

Why? Because I quoted verbatim an FBI terrorism expert that disagreed with something he said.

This forum is like an Hawiian vacation for the brain after dealing with the insults, pejorarives, aspersions and character assassination on Facebook, Twitter, and other social media.

Probably because everyone here shares a common misfortune that tends to make one sober minded and less concerned about pretenses.

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

I find Facebook filthy in much of its members and overtly biased in its administration. Most of the Friends suggestions I get appear to be prostitutes from Third World countries; most are nude or semi-nude, and provocative.  What "algorithm" tells Facebook that these people might somehow be my "friend"?  None that I can comprehend.  NONE of my settings, other friends, or preferences would indicate this.

A friend and I, due to its addictive nature, refer to it as Facecrack. Bored people with nothng else to do.  Social media really provide nothing of worth to the world; a diversin for the easily diverted.

I noted an axiom years ago, from my years teaching logic: People with no ability at reasoning resort to volume and the outrageous to make points, lacking any other mental devices.  If you can't outreason someone, shout them down.  And make up some farcical gingles; something easy for a mob to remember.

max

hopeful and opt...
Posts: 2218
Joined: Apr 2009

There were many immigrants that I had contact with when I was growing up.....they were mainly survivors from Europe and really experienced the challenges of life. Many of these people, who I respected a lot were a lot smarter than me. At a young age, I learned to value what a person said, not how it was presented. 

.............................

 Also, I doubt if Luís Vaz de Camões, Eça de Queirós or Fernando Pessoa can write  technical English better than you.

.................

PS. Max, the friend suggestions that I get from facebook are young body building males from third world countries. 

 

 

Grinder
Posts: 438
Joined: Mar 2017

"I noted an axiom years ago, from my years teaching logic: People with no ability at reasoning resort to volume and the outrageous to make points, lacking any other mental devices.  If you can't outreason someone, shout them down.  And make up some farcical gingles; something easy for a mob to remember. "

Nail on the head, Max.

I was a Philosophy minor as an undergrad, so I can appreciate your analysis of debate on social media.

And yes, emotional outrage and righteous indignation are the stock and trade of social media today.

My own Logic professor would patiently let us wander off the reservation, then gently reel us back into the basic building blocks of reasoning. He's long passed away now but he was a good guy and everyone liked him.

Like I said, the relaxed atmosphere here, even when we have a disagreement, is an intellectual haven compared to other social media.

Grinder
Posts: 438
Joined: Mar 2017

PS I get the body builder ads that have these immensely inflated massive muscles as well, as if I would ever want to look like that and take whatever poison they are selling that will more likely end in cardiac arrest than massive musculature.

And I also get unknown friend "requests" from mysterious women. Someone is falling for this.

I heard Glen Beck say that every one of those little clickbait ads represents over $200,000 in annual income. 

redbelly7
Posts: 34
Joined: Jul 2017

Lupron starves the PCa from getting testosterone and Zytiga stops the PCa from eating the testosterone or other forms of growing.  So..., wouldn't it be best to have Lupron and Zytiga before and during radiation?  this is what I am doing.  I had prostatectomy on 05/30/17 and soon will be starting radiation.  Waiting on continence, but ready to put a clamp on it and radiate away.

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

Redbelly,

Just for the record, the effects of the hormonal blockades in the context of the radiation treatment are not well known. Researchers found it to improve survival rates (by approximately 30%) but have no definite conclusion on the reason behind the improvement. The combined therapy is recommended solo based on trial results done at many clinics around the world. It does not assure cure or avoid definite progression of the disease, but it extends life. The cost to pay are added risks and side effects.

One knows that the hormonal component does sensitize the cells to absorb better the ionizing radiation. This is what destroys the DNA killing a cell. Though, the best combination in hormonal blockade is not defined, however, the typical protocol involved in the trials was Lupron plus an antiandrogen (such as Casodex, Eulexin or Androcur). Zytiga is relatively new in the hormonal arsenal and may have not been present in the trials. This drug acts at the same time as an antagonist of cell's AR - androgen receptors (similar to Casodex) and agonist of ER- estrogen receptors. I wonder if it makes it a better weapon in the combi therapy.

Best,

VG

redbelly7
Posts: 34
Joined: Jul 2017

thanks Vasco, I'm thinking and hoping it will be a better weapon.  I thought I was ready for radiation, and tried on a couple of clamps this morning, due to incontinence.  Neither seems to hold on to me.  I guess the Lupron has shrunk me so much that I can't put one on.......  Not sure what i'm going to do now

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3256
Joined: May 2012

Zytiga and Jevtana were both initially approved by the US FDA as drugs for "metastatic, castration-resistant, post-Taxane drugs."  Both have been in clinical trials since for use earlier in treatment, some with dramatically improved results. I posted the results of a study on this some time ago, but have not found it again yet.  I will continue to look.

I got interested in this in 2011 when my friend Gary was dying of PCa (he passed in 2013).   I took him to most of his appointements, and met with his NP and doc. His oncologist was Clinical Trials Director for the teaching hospital Gary was using.  But Gary himself was not in any clinical trials, and his use of the two drugs was in the only pattern then available: Taxotere, then them. Both probably gave him 6 months of life each.  After RP failure 12 years before, he had received massive IMRT.  This caused him horrible bleeding a few years later, which had to all be surgically cauterized in his colon and rectal area.

My only point is that Jevtana and Zytiga are indeed being tested in new ways, and it would be advisable to try to get into any of the trials that are underway. As commedians and song producers note, "timing is everything."

Jevtana is itself technically a "chemo" (a cytotoxic chemical), whereas Zytiga is technically a form of HT.

http://chemocare.com/chemotherapy/drug-info/Jevtana.aspx

http://chemocare.com/chemotherapy/drug-info/zytiga.aspx

 

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

Redbelly,

I do not recall your story and this forum's searching engines do not lead me to it. Is your incontinence a permanent issue or just a cause from the surgery of last May?

In my lay opinion (hope the administration doesn't delete this thread), if the case relates to the surgery and the improvement is not set yet then you should try postponing the RT (radiation) while continuing HT to pin down the bandit. The RT portion in the combi treatment will later take its stand in the fight with no prejudice to the overall outcome. Discuss the matter with your doctor.

I think your case being classified low or intermediate risk at the initial diagnosis, thought it be a contained case for the choice on surgery, but your treatment could belong to those aiming in attacking the bandit from all fronts (the mother of all treatments as I call it). However, only highly risky cases are doomed to the need of earlier attacks. Emergency does not make part in prostate cancer affairs but doctors prefer to keep the protocols of certain treatments which could be your situation.

I wonder if the choice was for a combination therapy starting with neoadjuvant RP (surgery) to be followed with adjuvant RT + HT. This sort of protocols usually require earlier radiation to assure better outcomes (you can read about the excellent outcome of above Will Doran's story). On the other end, if your RT is suggested as a salvage treatment then you can do it latter once the incontinence issue has improved. This is what I would do if in your shoes.

To add to the above and with regards to Max's comments, I question the reason for the inclusion of Zytiga. As Max says this drug is typically recommended in advanced metastatic cases that are moved to powerful attacks. Surely it should work in low risk treatments but surely it is also connected to an increased number of side effects over the more traditional HT drugs.

Within the HT weaponry, Zytiga has three functions acting at the same time; it acts as an antiandrogen, it acts as a 5-ARI (five alpha reductase inhibitor) and it promotes the increase of estrogens to replace the testosterone in needed systems. Together with Lupron (LHRH agonist) it covers the total blockade typically called ADT3 or MAB by physicians. 5-ARI drugs aim to avoid the metabolism of testosterone into dihydrotestosterone, a tenfold refined and powerful androgen most wanted by the bandit. The increase of estrogens in circulation will make us fatter but it will help in the good functionality of several systems/organs dependent on the testosterone.

A note to SPT above;

We have previously discussed here on the differences between endogenous and exogenous testosterone. PCa seems not to recognize exogenous stuff (TRT) so that its influence in prostate cancer treatment seems minimal. In fact this controversy started more than 20 years ago by the time Dr. "Bob" Leibowitz (a famous PCa oncologist) started using TRT in prostate cancer patients (http://www.compassionateoncology.org/). The controversy was increased when Dr. Abraham Morgentaler (an expert on sexuallity issues) alerted for the risks of low levels of endogenous testosterone in men. He applauded TRT and related its influences in prostate cancer development. Unfortunately I cannot find my own posts on the issue but you may be interested in this link;

https://pure.strath.ac.uk/portal/files/51681205/Boyle_etal_BJUI_2016_Endogenous_and_exogenous_
testosterone_and_the_risk_of_prostate.pdf

https://csn.cancer.org/node/212885

Regarding the radiation absorbed by tissues, you may know that these differ depending on the grade of the delivered energy when in traditional tests or in RT therapies. CT uses X-ray type so that its influence is minimal but the contrast agents injected in the patient are very armful for the kidneys. PET and other gamma machines deliver higher energy more armful in certain tissues, which tests should only be done when necessary, not as a frequent typical test. RT therapies use higher concentrated energy to destroy the DNA strands and that can cause irreparable damages where delivered (at the field of attack).

https://www.quora.com/Whats-difference-between-PET-scan-CT-scan-X-Ray-and-MRI

RT, therefore, should be a choice when it assures high probabilities of success. Defined targets should exist in advance of an attack and that is why proper image studies become indispensable in the diagnosis. I think you say it correctly, to avoid scans that one knows to be unfeasible for the purposes. MRI is without doubts the safest and best to be used when uncertainty exists but it cannot separate the "wheat from the chaff". It cannot distinguish malignant cancer from benign tissues. PET on the other hand with a due isotope (like PSMA in PCa cases) manages to provide results highly appropriate in a diagnosis done to define a therapy.
My case follows that principle as an example. I could have done a PET scan already but I have been waiting in the past five years for higher level of PSA (close to 2.0 ng/ml) before engaging in a PET F18-fluorocholine so that it assures me a more reliable result. A PET Ga68-PSMA could be done much earlier at a PSA level of >0.70 ng/ml but it was not at my reach.

Best,

Vgama

SPT
Posts: 40
Joined: Aug 2017

Vgama

Thanks for the response.  I agree with everything you wrote except this one point:

"MRI is without doubts the safest and best to be used when uncertainty exists but it cannot separate the "wheat from the chaff". It cannot distinguish malignant cancer from benign tissues. PET on the other hand with a due isotope (like PSMA in PCa cases) manages to provide results highly appropriate in a diagnosis done to define a therapy."

For bone metastatses MRI can distinguish cancer from benign tissues.  It's quite a bit better than PET, which is subject to false positives because the isotopes go wherever bone is growing.  MRI detects the morphological changes in the bone associated with mets.

"Whole-body MRI is more sensitive than scintigraphy in the detection of bone metastases. This is partly due to the lower spatial resolution of scintigraphic images but also reflects that scintigraphy detects bone remodeling, whereas MRI detects structural alterations in bone marrow. Several small studies have reported sensitivities and specificities of the different imaging techniques. Reports of sensitivity of whole body MRI range from 97.5-100%, compared to 26-71% for 99mTc scintigraphy. Although CT has a high sensitivity for soft-tissue metastases, the sensitivity for the detection of bone metastases has been reported to be 10%."  Massachusttes General Hospital Radiology Rounds, Whole-Body MRI

In the quote, "scintigraphy" is PET.  That article was written in 2010, like all else there has been a lot of progress in 7 years.  Whole-body MRI is much better and more widely available.  I get whole-body MRIs annually to check for distant metastases.

Localized MRI is pretty good at detecting malignancies.  My multi-parametric prostate MRI had no trouble detecting the tumor and enlarged lymph nodes, and these days they can even tell high-grade tumors from lower grade.  It's not as deterministic as a Gleason score from a biopsy, but you can get a pretty good idea without a biopsy and without exposure to ionizing radiation.

If, and only if, my medical team convinced me that the results of an MRI strongly suggested using CT or even PET/CT to investigate further, I might consent.  But I would always insist on the MRI first, and then I would ask hard questions about what would be learned in an additional test that would change my treatment. 

If they can't answer that question, don't take the test.  That last part is not my advice, but of urologist Dr. Cooperberg.

redbelly7
Posts: 34
Joined: Jul 2017

My info is age 54, biopsy in Feb, Gleason 9, Thought contained, RALP on May 30th.  Was in margins and seminal vesicles and micros in bed, I guess.  They are planning on radiating the bed, next to the bladder.  I think they classify me as high risk. But my PSA's are .01 at Emory and .04 in Albany.  Anyhow, I'm battling the tiger best I can.  As far as weight gain, I've actually lost 6 lbs from the last visit and been on Zytiga 6 weeks.

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

Redbelly,

Your reply tells me that your case groups with what we call “Adverse post-surgery Pathology” patients. These are cases with advanced stages of T3/T4, high Gleason score and positive margins. The PSA seems low if we judge it against the findings but it could be that your type of cancer produces less amounts of the stuff (typical in aggressive type of cancers). I do understand now the reason for Zytiga. Even without RT you cannot avoid this fast start of HT involving as many blockades as possible. Many guys with similar pathological stage (that also includes spread of seminal vesicles) are moved into combination therapies of Chemo plus hormonal (recall Max comments above), before attacking with radiation. I would think that the image studies done at your initial diagnosis were negative and probably the biopsy did not detect PIN or cancer closer to the shell, leading to judge it as contained.

Your doctor wants now to try cure with salvage radiation. The hormonal component will render the PSA improper for any judgment. The radiologist will define the field of attack comparing past images with the ones he will do when defining the isodoseplan. Most probably he will radiate the typical areas targeted in SRT approaches that include localized lymph nodes, the bed and tissues surrounding the bladder. I would recommend you to meet the radiologist and express your worries regarding the incontinence issue. SRT can also cause stool incontinence and it is prohibitive if you have/had any ulcerative colitis case (get a colonoscopy in advance). He can always avoid some spots or attack them with lesser doses.

Unfortunately, newer genetic tests are still immature to predict the best or worse type of salvage therapy for a case like yours. There have been incredible advancements in the genetic researches and they have found already a gene in PCa indicating if the bandit would disregard any radiation attack. In fact it is known that cancer with such a gene may develop further if radiation or chemo is administered. In any case, you could do and rely on a genetic test to verify the benefit of certain drugs in your future attacks, if any.

Best wishes and luck in your newer treatment.

VG

VascodaGama's picture
VascodaGama
Posts: 2969
Joined: Nov 2010

SPT,

I do not know if you are correct in regards to the higher capability of MRI detecting PCa bone metastases against PET but I disagree that MRI is better in detecting PCa when this refers to a small sized tumor. CT and MRI cannot detect small tumors that lay within their planes. In fact, all scanning machines/equipments have limitations in their detection capability. If one refers to the average; CT requires sizes over 1.2 cm, MRI over 0.7 cm and PET over 0.3 cm, to assure a reliable result. The image produced by the computer stretches the lines make it unreal to the view. When using the PSA as a reference for reliability, the average stands in; BS (PSA>20), CT (PSA>10), MRI (PSA>2) and PET (PSA>0.5).

The dye used in MRI machines is friendly but limited to deformation which may not be useful without a previous image used for comparison. Experienced radiologists manage to get excellent results out of a primer scan (first MRI test) when fusing various data from other tests that could originate from ultrasounds, Doppler and CT (commonly referred as mpMRI). Unfortunately to us patients, the best results are obtained using radioactive-tracers armful to the body that together with an isotope specific to the type of cancer, such as the Prostatic Specific Membrane Antigen, manages to identify and locate those tiny cells involved with such a protein. The choice of the isotope is important and probably a choline based will not be so reliable in bone metastases. One must gamble in the judgment.

I disagree with the quote that "Scintigraphy is PET”. PET uses gamma rays capabilities (similar to scintigraphy scans like the traditional Technetium-99m BS scans) to identify/locate the various radiotracers but the cancer will be detected where the attached protein is found. Technetium-99m is not used as the transporter/carrier of such protein in PCa PET exams. Surely these also fail as it accumulates more at certain areas in the body. For instance, in the typical Ga 68–PSMA PET one finds an higher accumulation in the kidneys and mouth which by experience is taken as a false positive due to the low probability of existing PCa in those places. This is in fact one of the limitations in PET exams making it still not 100% reliable, but close to a better result.

Another aspect to take into consideration is that Full Body MRI machines are rare and not available everywhere. You are fortunate for having that machine close to you.

Best,

VG 

redbelly7
Posts: 34
Joined: Jul 2017

well, i met w/ the radiologist yesterday and told him about incontinence.  he wants to start anyway, so I'm getting a clamp....  really thinking about taking Family leave act and moving up to Atlanta for treatment

hewhositsoncushions
Posts: 267
Joined: Mar 2017

"I respect their choices, but I fear that most of those choices are made because doctors lie and conceal the truth about their "treatments."

The alternative medicines nearly always make you feel better, improve your health, and many of them can be used with conventional treatment to make it work better and reduce some of the worst effects. It is your life and your choice."

 

My issue is not with the science (or not) with the referenced document. It is with OPs agenda. This post was preceded with a post that was openly and unfoundedly hostile and critical of hard peer reviewed and clinically evidenced science (that saved my life and has saved the lives of hundreds of millions of people) and promoting what Prof. Brian Cox calls (rightly so) "woo woo". At the same time, OP suggests that science should welcome dissent. It does, through the medium of debate, research and peer review all based on evidence and fact. I repeat my statement in that thread - if an alternative medicine works it becomes mainstream, period. Herbal medicine preceded modern medicine, was suppressed (witchcraft etc.) and has again become mainstream and monetized as big pharma begins to exploit the rainforest. Meditation is proven of benefit for mental and physical wellbeing. Surgery has been performed under acupuncture and hypnosis. I have seen and experienced interesting phenonena doing martial arts and tai chi. On the other hand, Steve Jobs and many others (often celebrities) died by rejecting conventional medicine and choosing unproven I'm not even sure what to call them as the word is not treatments.

At the same time, Vasco (who is being far more of a gentleman that me in this thread) gets penalised for giving well researched and scientifically founded advice.

I don't care what people believe and I won't try and shut them up down the pub or on the street corner but I damn well will take a stand in a forum like this where desparate people will grab at anything for a chance of life. I've lost (and currently losing) too many people to cancer to sit idly by.

C

 

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