Joining the Club with high initial PSA

Old Salt

amdenver said:

Brachytherapy

Hi VGama:

Your additional information on Brachytherapy experiences is helpful and appreciated.

Thank You for the valuable other input as well from your deep knowledge on the subject.

I've started reading Bob Marckini's book "How to beat Prostate Cancer". As you probably know, he's a big proponent of Proton Therapy, which unfortunately my HMO does not provide or cover. In his staging of his reasonings for his decision against RP, he draws a rather gut wrenching pitcure and says that he was asked to bank 4 pints of his blood for RP.

I've no prior experience with any surgery, or such prep. I'm reading that our body can replenish the plasma for a pint of blood removed in 24 hours, but can take 4 weeks, or more, to replenish all the red cells. I'm on the lightweight side, at 140 lbs. So, banking 4 pints would be a challenge for me

Is Mr. Marckini dramatizing, or closer to the truth?

Don't cry over proton therapy

There are numerous papers showing that proton therapy is not more effective than other current radiation therapies. Just more expensive!

ASAdvocate

VascodaGama said:

Have you received a clinical stage?

AMdenver,

I think that you are doing well in researching before deciding on a treatment. Apart from cure, you need to include in your decisions the factor regarding the side effects that you will endure after therapy. Two friends of mine have chosen Brachytherapy (seeds) as their initial and main treatment because they were diagnosed with supposedly contained cases. One is doing well but the other experienced recurrence and had gone through SRT, managing remission since 2010. Both recovered well from the side effects.

Brachytherapy is an option for contained cases that, like surgery, can be copped with additional EBRT if the cases are considered advanced. Recurrences from Brachy and Surgery are typically treated with SRT or a combination adding ADT (hormonal treatment). Brachy plus Boost and HDR are also recommended in contained cases. The Boost is done with the intent in widening the targeted field of attack but it is done with lower Gy doses in total. CK alone could be a substitute in contained cases. EBRT alone (IMRT or PB) can do the whole job radiating the whole gland in addition to the surrounding areas of the prostate that includes localized Lymph nodes. It is an option for those with identified metastasis or for those cases where containment is not assured.

In your case the high PSA may indicate that you have localized spread. In your shoes I would add the results of an MRI to the existing data to be more certain about the case. The size of the gland also matters If your preferences include Brachytherapy. The MRI can provide those details. You can discuss further on the matter in your next consultation.

Best wishes and luck in this journey.

VGama

Regarding brachytherapy and prostate size, i have read that size limits apply only to low dose (seeds), and not to high dose (momentary inserts) BT.

Georges Calvez

Surgical notes and blood loss

Hi there,

I had a look at the surgical notes from my laparoscopic RP and the estimated blood loss is 100 ml or less than half a cupful.
I reckon I lost more than that when I cut my foot on a piece of broken glass on the kitchen floor, I managed to soak a couple of pieces of kitchen towel before I got the bleeding under control and stuck on a dressing.
On a lighter note, last night was Burns Night, so we had a haggis that arrived in a tin and had to be fished out and simmered lightly before eating.
We are having some Breton sunshine at the moment, the sky is leaden grey, and it is pouring it down, but the snowdrops are out!

Best wishes,

Georges

amdenver

Surgical and Radiation Options

Folks: Hope everyone is doing well !

(For new readers summary of my situation: No PSA test in prior 15 years, until I had some issues w/passing urine last Dec., then PSA was found to be 25 (22 10 days later), biopsy showed Gs 3+3=6 on one side and 3+4=7 on the other. Graded at T2c)

Had met with the Uro/Surgeon last week. Just came back from my meeting with the RO. Between them my initial options:

Surgical:  RP (overnight stay) + 2 years of Lupron. Surgery recovery: 3-4 weeks. Said radiation too would probably be needed after 6-10 years. Post Op aftereffects mitigation period: 6-12 months. Up to 10% patients have permanent incontinence.  Uro did not mention long term PSA control %

Non-(Semi)Surgical:  Casodex for 2 weeks, then 1st Lupron shot at end of 1st week. Two months later HDR Brachy followed by EBRT Boost starting a week later (20 daily M-F sessions) Total two 6-Mo Lupron shots. Brachy will be single 16-needle session with lower half anesthesia. In at 7:30, discharged at 2 PM. Post Op aftereffects mitigation period: 3 months. Brachy+Boost long term PSA control chances: 83%

The RO is 15+ year at his craft and specializes in HDR Brachytherapy. Is among the top rated ROs in CO.

Uro says has done about 500 RPs and said he's adept at saving nerve bundle whenever he can.

Between the two specialists my comfort factor is greater with the RO. Same for Brachy Boost between the procedure options, so leaning towards it.

Thoughts from my comrades?

Anyone see any major issue(s) with the Brachy Boost plan?

Thanks

 

Yank31

Surgery Will Not Be an Option After Radiation

Hi, Denver

Remember that surgery will probably not be an option after radiation. After radiation the "cooked" prostate will fuse with surrounding tissue, making it very difficult, if not impossible to remove later on. I hope your surgeon mentioned this to you.

Also, ask them about the size of your prostate. I was told that because mine was very large (120 g) I was NOT a good candidate for radiation. It seems there is a general rule: The larger the gland the less effective radiation may be.

Good luck with your decision. Take your time and consider second opinions.

amdenver

Yank31 said:

Surgery Will Not Be an Option After Radiation

Hi, Denver

Remember that surgery will probably not be an option after radiation. After radiation the "cooked" prostate will fuse with surrounding tissue, making it very difficult, if not impossible to remove later on. I hope your surgeon mentioned this to you.

Also, ask them about the size of your prostate. I was told that because mine was very large (120 g) I was NOT a good candidate for radiation. It seems there is a general rule: The larger the gland the less effective radiation may be.

Good luck with your decision. Take your time and consider second opinions.

Biochemical Failure Factor

Hi Yank:

Appreciate your feedback.

Actually, before meeting my Uro and the RO, I had already learned that Urologists don't like to do salvage surgery after radiation. And the Uro mentioned that too.

IMO, whichever way we cut it, the choice between treatments comes down to a gamble to stay alive. As you know at all times there are different studies in progress, which are comparing treatment methods, and combination of treatment methods, to see which has the lowest rate of recurrence at 5 years, 10 years, etc. There is no one method which stands out on its own.

The Uro/RP surgeon could not give me any specific numbers for non-recurrence after RP but the RO said that they are following the latest ASCENDE-RT studies which have reported a lowest long term recurrence from a combination of Short HT+EBRT+HDR Brachy. So, in this bet, that I have no option but to make, I'm putting my chips on the long term retreatment numbers.

Another factor, that I have formulated on my own, is that even with this combo method's recurrence probability at 17% -for my numbers-, I assume that I won't be that lucky and will face re-treatment at 5+ years. Re-treatment is always radiation+ HT, so it may have a sliver of better 'protection' for adjoining organs to have some prostate mass than for a void. There doesn't look to be eventual escape from radiation, or from HT, so it comes down to with or without the prostate. Just my own thoughts.

With this reasoning I've decided to go with this trifecta combinaton and hope that I'll be in that 83-84%. Here is one of the links to the ASCENDE-RT study:

https://pubmed.ncbi.nlm.nih.gov/28262473/

Wish you the best with your management of PCa.

 

Clevelandguy

Good choice

Hi,

You should feel assured that you are going down the proper path for your situation because you did your research and made a choice.  Hope the best outcome for you and glad that you have decided and rationalized it in your mind to be the proper course of treatment. Hope for many more years and a quick recovery.

Dave 3+4

VascodaGama

One sept forward to success

I agree with Dave's opinion above. The decision you have reached seems proper to me too for the circumstances you describe above. After all you consulted the experts and are now satisfied with an option. Being comfortable with a decision and trusting the doctor caring for us is a big step forward for a successful outcome.

I wonder the radiation grays (absorbed Gy) planned is each modality. Also important will be the timing for EBRT as that may affect the sphincter area.

I  recommend you to discuss with your radiotherapist on the details of the isotope planning taking special attention with regards to the side effects. Low doses do not kill the bandit but high doses in unnecessary areas produce no successes. 

Best wishes for the best outcome. 

VG 

Old Salt

Agreed

that your treatment plan is based on the best evidence currently available.

Maybe it will be of some comfort to you that I am still kicking seven years after 'triple play' therapy (SBRT + EBRT + 18 months of ADT) for localized (Gleason 9) prostate 'disturbances'.

 

Best wishes for a successful outcome.

amdenver

Thank You Gentlemen:

for your feedback and your kind thoughts.

I pray for you to have and keep the winning hand against this monster !

Best Regards

Arnoldpig

My prayers are with you amdenver

 I had my RP last Aug 12th 2020 and it went well. Iwas in and out in 5 hours and went home the same day.. Before surgery my PSA was 20 and gleason was 9... I Played golf Oct. 28th 2020 after sugery...I Have some small urinary leakage when I strain but getting better..  I have to do some follow up radiation and ADT because my PSA was detectable with 0.14 after surgery..but looking forward to many more years on the golf course and I am 78..

AP

amdenver

Arnoldpig said:

My prayers are with you amdenver

 I had my RP last Aug 12th 2020 and it went well. Iwas in and out in 5 hours and went home the same day.. Before surgery my PSA was 20 and gleason was 9... I Played golf Oct. 28th 2020 after sugery...I Have some small urinary leakage when I strain but getting better..  I have to do some follow up radiation and ADT because my PSA was detectable with 0.14 after surgery..but looking forward to many more years on the golf course and I am 78..

AP

Nice recovery !

Thank You for your kind thoughts. Wish you well too Arnold. All the best for things to stay on track for you.

You and I can be treatment buddies, almost. To compare our treatments. I am about finishing two weeks of Casodex and had my 6-month Lupron injection last Friday.

Next stage will be the fiducials (gold markers) and 20-session EBRT in 2 months from the Lupron. Then a 3-4 hour HDR Brachy procedure, with needles.

I'm D+4 from my Lupron intake and waiting -with my seat belt fastened-  for the side affects to come Hopefully, they'll be not too severe.

Best wishes to you for your treatment to be successful !

AM

Gs 7 (3+4), T2c, PSA=25 at Dx (down to 17.9 at start of HT), Bone & CT scans clear, MRI: PI-RAD=5

Old Salt

Those side effects

If at all possible, exercise one way or other to counter the side effects of ADT. You may well feel tired because of the hormone and radiation treatments, but try to be active anyway. 

Unfortunateley, the hot flashes, which are likely to come, will be worse once it warms up (unless you are living in an area that is already warm in the winter).

 

PS: The next time you get tested, ask for a testosterone test as well to make sure the ADT is 'working'. 

jeffsch

Need to learn more

I was just diagnosed with prostate cancer today.My PSA was 6.5 and my Gleason score was 9.I'm scheduled to do an MRI and a bone scan.I don't know much more.Not  a good news day today.Not sure where to begin.Anybody have any thing postive about this?Or can you share your experiences?I nwant to learn more about this.thank you

amdenver

jeffsch said:

Need to learn more

I was just diagnosed with prostate cancer today.My PSA was 6.5 and my Gleason score was 9.I'm scheduled to do an MRI and a bone scan.I don't know much more.Not  a good news day today.Not sure where to begin.Anybody have any thing postive about this?Or can you share your experiences?I nwant to learn more about this.thank you

Assessment of spread

Hi Jeff:

My own experience with PCa is just about two months old. I was in your shoes on Jan 13th-2021. Have come a long way since.

With the bone scan and MRI your physicians would be looking to assess if the PCa is still within the Prostate capsule, or has gone beyond. Treatment plans will be different accordingly.

You've gotten the bad news but the good part is that like other manageable conditions, like Diabetes and BP, etc. PCa too is manageable, with variety of and different levels of treatments.

May I, respectfully, suggest that you post your query as a new topic?

Chances are that more folks will see it as a new topic.

Wish you the best on your PCa journey.

amdenver

PSA Update at D+30 since Lupron intake

Team:

Hope everyone is in good spirits and doing well.

As I wait through my countdown towards the beginning of my 20-session EBRT after getting the Lupron shot, my RO wanted to do the next PSA test not before August. But not knowing the PSA is a part of the anxiety I'm living with, so I decided to go around him and am planning to test it every 30 days. Atleast through my treatment, which'll be until June end. So, got this test done by an independent lab, outside my HMO.

I also was interested to know the PSA status because since my Dx I've been conducting a 1-person study on myself with medicinal mushrooms. Wanted to see if there's any truth that some mushrooms and their supplements help against PCa.

At the time when I was waiting for my biopsy, I could see at minumum 4-6 weeks before ANY actual treatment would begin, so I immediately began the mushroom diet and supplement regimen. There was some encouragement with the initial results so I have continued with them even after the Lupron shot, as an adjunct therapy.

With that said, here is my PSA tracking, timeline and results so far:

12/26/20: Initial PSA test: 25.02

12/30/20: Began my mushroom supplements

1/6/21: Follow up PSA test by Uro: 22

1/12/21: Biopsy (Gs 7 (3+4) T2c

2/15/21: PSA 17.9 (Began 2 weeks of Casodex)

2/19/21: 1st Lupron 6-month shot

3/19/21: (D+30): PSA= 1.7

Just got the result. What I do not know is how much of PSA reduction is expected at D+30 after the Lupron intake, but looks like there may be something with the medicinal mushrooms.

Thoughts ?

 

Old Salt

Lupron is working

as it's supposed to. Good news!

Your musthroom 'experiment' can't be evaluated; too many variables because you are also doing androgen deprivation therapy (Lupron).

Personally, I would discontinue the 'medicinal' mushrooms and stick with the diet that the rad oncologist recommends. 

 

VascodaGama

Let's focus in treating the malady

From your update calendar, at 2/15/21, the reduction of the PSA from 25.02 to 17.9 could be attributed to the effects of the supplements. After that any further reduction of the PSA would be considered a cause from the ADT (casodex and lupron). The last PSA+30 is therefore masked and only served to confirm the effectiveness of ADT in the combination treatment (HT+RT).

This value will continue its descent till a nadir, maintaining a plateau while the effects from the lupron shot is active, but it will gain significance only mush later once the effects of the ADT vanishes, approximately 4 months post the end of the effectiveness of lupron (6+4=10 month from the date of lupron's injection). In my opinion your doctor's recommendation in doing the test in August was correct but it also would be used solo as a threshold at a particular timing of the treatment, usually fixed to a certain date after RT.

In clinical trials some supplements have shown reduction of the PSA but none up to day have shown to be effective in combating the bandit. Some supplements incorporate substances used in the ADT drugs which by itself is known to influence the PSA. I also took supplements after my diagnosis thinking them to be good but they only treated the PSA not the malady. Cancer was always there, dormant-like for some periods but alive and kinking.

The RT is the one aiming cure. It destroys the DNA of the cancerous cells prohibiting duplication along its life cycle. This may take a period between four and six months which is the life period of a prostatic cell.

I agree with Old Salt comment above. You should inform your doctor on any "adjunct therapy" you do while under his treatment.

Best wishes for success.

VGama