Hello. New here and cancer is back

derekmlacey
derekmlacey Member Posts: 2 Member
in Prostate Cancer #1

Hello,

New here and looking for knowledge from others on this board who might have similar circumstances.

Original diagnosis 2014 - Prostate biopsy - Radical prostatectomy with Gleason of 4/3.

2016 rising PSA - MRI confirmed tumor on bladder - Scope of bladder confirms no perforation - 40 courses of radiation at MSK - Addition of 3 months of Lupron and Cassodex.

2023 PSA at almost 10 then two weeks later almost 13 - Barium CAT scan showed lymph node involvement - Biopsy thereafter confirmed prostate cancer - Had PSMA CAT scan which showed lymph nodes in lower and upper abdomen as well as left side of my neck - Began with loading dose of digarelex then followed up 28 days later with Lupron (3 month dosing) - Plan is to add abiraterone and prednisone, however I have treatment resistant major depression, general anxiety disorder and CPTSD.

The androgen deprivation therapy has obviously made the MDD much worse, however I am confused as to why MSK Psychiatry is using an either or approach to the depression and debilitating insomnia. Been on a great many SSRI/SNRI combinations that included antipsychotics used off-label etc.

I guess with all of the above I am wondering if anyone else here has similar issues and how, if at all, you have been able to get some relief from the psychological black pit that the androgen deprivation has caused.

I am afraid to take the abiraterone for fear it might worsen the depression in addition to the long list of common, and worrisome, side effects from this medication.

Anyway, apologies for the long message and thank you,

Derek

Comments

  • Josephg
    Josephg Member Posts: 443 Member
    #2

    I have a similar history to yours, Derek. I completed a 2 year stint of Lupron, Abiraterone, and Prednisone in this past January. I did not find it any more debilitating than my previous 6 month stint of Lupron and Casodex several years ago. That is not to say that it was without side effects or was fun, but the alternative of doing little or nothing in our cases is quite ugly.

    Quality of life is very important, and I have been able to find more than enough quality of life even during these stints of ADT. There are medications (Venlafaxine) out there that reduce the severity of the side effects, and I suggest that you inquire about those with your doctor, if you proceed down the ADT path.

    I wish you the best outcomes on your PCa journey.

  • derekmlacey
    derekmlacey Member Posts: 2 Member
    #3
    https://csn.cancer.org/discussion/comment/1707086#Comment_1707086

    Hey Joseph,

    Appreciate your response. Already on the Lupron path and having just finished six courses of Ketamine IV infusions prior the Lupron has completely undone any of the benefits leaving me with a 5,000 dollar ketamine loan to pay off.

    Having issues finding an MDD psychiatrist who isn't already swamped with patients and also takes Medicare/Anthem and getting nowhere in that respect.

    Thinking I will just put a hold on the abiraterone/prednisone for the time being as MSK Psychiatry is part of a medical corporate culture unwilling to get creative in any attempt to help people with worsening depression etc. Have an appointment with my oncologist July 19th and will try to get a handle on survival rate/prognosis without abiraterone.

    Be well and best of luck,

    Derek

  • Old Salt
    Old Salt Member Posts: 1,467 Member
    edited July 2023 #4

    I am so sorry to read about your medical situation. Most contributors on this forum know something about prostate cancer but little about psychiatry. Having those two specialties negatively interact is so very unfortunate for you. I hope you can find a 'holistic' specialist who can help you. Although MSK is a center of excellence, perhaps you can find this person in another NYC medical facility.

    Best wishes!

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