PSA doubling every six weeks
On July 3rd 2012 I had a radical prostatectomy. Found to be Gleason 9. Had escaped through back of prostate. Adjunct external radiation during October/November 2012. PSA end Feb 2013 < 0.01 but started growing as from June 2013 and is now 0.42 (at 5th December 2013), amounting to a doubling every six weeks. Bone, CT and PET scans have so far turned up nothing.
My onchologist proposes another blood test in mid-February 2014 and if PSA still growing, he will start me on Androgen Deprivation (AD) for six months. If scans still OK then to give me a holiday from AD for a while but resume when PSA growth resumes significantly.
Any thoughts? Grateful for any advice. David
VascodaGama Member Posts: 3,594 MemberSequentials
The rising PSA seems to be indicative of recurrence (again); in any case I think you should follow the advice of your doctor to get more tests before starting the ADT (hormonal treatment). Different doctors got different thresholds to diagnose the progress of the cancer, and still different protocols for the treatment.
Somehow we are following the same "path", I also was recommended the "traditional" sequential of therapies, similar to that of yours, with RP then RT and now on ADT. A big difference between us is that you are a diagnosed Gs9 and I am a Gs6. Such may be the reason for me having a longer period of PSA doubling (PSADT) after radiation with 9.5 months against yours of six weeks. I am also younger now at 64 y/o against yours 78 y/o. My descriptions are just informative. We may have similar paths but different cases requiring different treatments.
My doctor used a threshold of PSA=1 (ng/ml) to trigger the start of ADT. The protocol was also for intermittent (IADT) administration of single blockade with an LHRH agonist shot Eligard-6 months, to prevent the production of testosterone (chemical castration). According to your description, in yours the doctor may be using a similar trigger threshold of PSA=1, which is expected to be reached in February 2014 (in 9 weeks). He is also thinking in an intermittent modality IADT. The important now is to decide on the details of a protocol that may be favourable and beneficial to you.
The protocols used in Gs9 patients by famous prostate cancer oncologists differ according to their other health status. They focus on aggressive protocols in aggressive cases of Gleason 9. This means that they typically recommend double or triple blockade instead of the single (my case). Double (ADT2) is done with a combination of an agonist (or antagonist) like Eligard or Lupron shots plus an antiandrogen like Bicalutamide. For triple blockade (ADT3) doctors add a 5-alfa reductase inhibitor like Avodart or Finasteride that prevents the formation of dihydrotestosterone. The period on remission (PSA lower than 0.05) before stopping the drugs also varies, but the typical is to administer drugs continuously during a period of 12 months, before starting a vacation on the drugs.
Hormonal therapies in PCa consist in blocking the pathways of androgens to prevent these from being absorbed by the cancerous cells (they starve on androgens). Without androgens cancer dies of starvation or become sort of indolent but in aggressive Gs9 this may be short lived. Once these fail, a second-line of hormonal drugs are used before one needs to advance with the "sequential" of chemo therapy.
I would recommend you to read about the side effects of ADT so that you can discuss in your next meeting with your doctor about what you would not like to occur so that he may adapt the initial protocol. You can search the net typing; "ADT side effects prostate cancer". You can also get the book “Beating Prostate Cancer: Hormonal Therapy & Diet” by Dr. Charles “Snuffy” Myers; which informs in "patient's language" this treatment for systemic cases.
Diet and a change in live tactics become important to counter the treatment effects. UCSF got a publication on Nutrition & Prostate Cancer, which copy I highly recommend you to get. Here is the link;
Other health issues must be considered along the periods of ADT. Apart from the typical PSA test and scans, I highly recommend you to get a Testosterone test before starting ADT because it will be a mark to compare and verify the drugs’ effectiveness in the treatment. Also you should have a DEXA scan to verify for existing osteopenia/osteoporosis, and a ECG and Lipids to check your heart health and diabetes. These may become related to the hormonal drugs and for the hypogonadism status caused by the treatment.
I hope your cancer responds well and is affected to ADT.
Best wishes for continuing control on the bandit.
B-DIM supplement and Degarelix
My post-prostatectomy PSA was doubling every 6 months and hit 0.2. I emailed Dr. Steven Strum (my Dads oncologist and author of "A Primer on Prostate Cancer") and he suggested B-DIM, 6 150mg capsules per day. I have been taking one 3x per day since March 9 and my PSA went down to .17, .19 and now back at 0.2 8 months later in November. A lot better than the way it was going! Available at www.bioresponse.com.
I also started drinking more fresh organic coffee (about 8 tablespoons of beans per day making about 4 cups) from Costco "High Desert Roasters".
If I start ADT, I will request Degarelix. Their study comparing 1-mo shots of Lupron showed more men lived longer on Degarelix. The manufacturer Ferring Pharma will have one of their nurses show your Dr & Nurse how to mix and inject to prevent the injection site pain issue. http://www.firmagon.us/
Ferring won't tell me if Avodart is still needed for DHT (they want my Dr to call them), and so far have seen no mention of DHT in their study.0
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