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Moving Forward

Posts: 2
Joined: Dec 2020


I just joined and this will be my first post.

In the summer of 2015 I had a PSA of 19, a Gleason score of 5 + 4 and staging T-1b I believe

I had short term HT along with EBRT, This went from Dec of 2015 thru March of 2016. 

I had a NADIR that was fine until the summer of 2019 when my PSA started creeping up.

In September of 2019 I started HT, Zoladex, with shots every three month. Still receiving shots, next shot due beginning Jan 2021

When I started HT back in Sept of 2019 I was asymptomatic.

In Oct of 2020 I started getting pain in my hips, leg, chest and shoulder that would come and go and also change locations. Had to start taking motrin to fight the pain. 

I just had some lab work and my PSA IS 8.5  and my Bone Scan is showing more bone activity.

My next appointment is on the 19th of Dec where they will go over the lates lab results and bone and ct scan. 

I imagine they will recommend to put me on Zytiga with Prednisone.

I would appreciate any thoughts on what I have to look forward to or what I should do, Also pain management. These last few month have not been very enjoyable.

Thank you for reading. 



Posts: 702
Joined: Jun 2015


I would think after you talk with your doctors they would reccomend the next steps you should take.  Might not hurt to get a second opinion if you feel you need to.  The best doctors +the best facilities = the best results.

Dave 3+4

Posts: 2
Joined: Dec 2020

Thank you Clevendguy

Saw the Doctor today and they want to start me on Xtandi in conjunction with my Zoladex shots I get every 3 months. 

Seems like this is the protocol.

I am very thankful to the VA for the great care they give me. 


VascodaGama's picture
Posts: 3392
Joined: Nov 2010

Hi C4

It seems to me that your doctor is following NCCN guidelines for systemic cases by recommending the typical two blockades protocol. The Zoladex (LHRH agonist) will cause castration (stop the production of testosterone by the testis) while the Xtandi (antiandrogen) will avoid absorption of testosterone by the cancer. There is an extra blockade used by some oncologists that uses drugs like finasteride or avodart, to stop the production of dihydrotestosterone (a tenfold more powerful androgen). When this protocol stops working, doctors substitute the last two blockades with Zytiga. I wonder if he is seeing you as a systemic patient.

In any case, HT is palliative and eventually will fail and be replaced by chemotherapy or a combination of both; chemo plus HT. The main goal is to extend the time under treatment. Cure in systemic cases is illusive. One must try controlling the advancement of the bandit and at the same time keeping quality of living, the best one can do. Doing things in sequential and intermittently is the way I am caring of my systemic case.

Your Gleason rates 5 and 4 are aggressive and may lead to refractory fast. I recommend you to test the testosterone (total) together with the PSA to certify that the Zoladex is working. High PSA in a low Testosterone environment signifies progression in risk of becoming refractory. That condition requires giving up with the antiandrogen as the bandit may be feeding on the drug.  The best in HT is to have low PSA in high Testosterone levels signifying dormancy or remission.

I wonder what have been the PSA levels along this year. did it advanced with constant increases or has it demonstrated a seesaw curve?

Best wishes and luck in your journey.


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