PSA rising again after Radical Prostectomy in Nov 2009

Kongo said:

Choices
Mnz,

Welcome to the forum and I expect that the questions you pose in this thread will generate a lot of responses.

A couple of things that should not be surprising in your situation: First, since your biopsy indicated that the prostate cancer was not contained within the gland, surgery never had a chance of eliminating it completely. Prostate cancer tends to grow more quickly when it is outside the prostate gland and in your case you are now seeing a progressive rise in PSA levels, which almost surely correlates to cancer growth somewhere else in your body. This should not be a newsflash to you and your doctors should have explained that your PSA levels would eventually rise because the cancer was not contained.

As you know, a Gleason 8 cancer is serious. You threw gasoline on this fire when you made a conscious choice to continue to use testosterone boosters to enhance your bodybuilding program. The links between testosterone and prostate cancer are well known and have been understood for a long, long time. Refusing to acknowledge this may be convenient for your priorities but it doesn’t mean that increased levels of serum testosterone are not fueling cancer growth.

I do not understand your conclusion that radiation would be more apt to cause bowel or potency problems than the surgical removal of your prostate. Studies suggest exactly the opposite, particularly when treating a more advanced cancer such as yours where wider margins must be taken at surgery. While a very small percentage of men do experience bowel issues immediately after initial radiation treatment, these symptoms almost always pass within a few weeks. Surgery runs a much higher risk of near and long-term incontinence but fortunately you seem to have dodged that bullet.

I do agree with your conclusion that radiation at this point could have a detrimental effect on sexual potency. The nerve bundles necessary to achieve an erection are very fragile and yours have already been damaged from surgery. Radiation could further injure those nerves over the next few years although drugs like Viagra have been shown to be quite effective in restoring potency to men who have seen a decline in sexual ability after radiation.

The biggest question about radiation at this point is where to apply it. Since your cancer was not contained at the time of surgery, the rise in your PSA levels could be caused by cancer growing almost anywhere: liver, lungs, brain, bones, etc. Salvage radiation therapy is most often applied to the area in the pelvic region adjacent to where your prostate used to be although that’s just a good guess as to where the cancer is. Unless they can pinpoint any tumors through various imaging techniques it’s a shot in the dark but studies have shown it to be a pretty good choice when you don’t have anything else to go on.

Your urologist is applying conservative, conventional wisdom in recommending radiation treatment in conjunction with hormone therapy. The combination of these two procedures to treat recurring prostate cancer has been shown to be effective in many cases but you must keep in mind that with aggressive cancers such as yours any treatment will carry a larger risk of failure than when used against a cancer that is lower risk and less aggressive (like say, a Gleason 6 cancer).

I get that you want to avoid HT because it will significantly interfere with your bodybuilding regimen. In fact, I would hazard a guess that two years of HT at your age would probably pretty much end your bodybuilding goals permanently. We all must make choices about what is most important: quality or quantity of life and you seem to have made the decision that bodybuilding trumps conventional treatment methods.

Regarding unconventional or self-healing techniques for prostate cancer. My opinion is that they don’t work. Sure there are anecdotal stories out there but no serious studies that can confirm any of the many alternative methods for treating cancer. I understand that there’s plenty we don’t understand about our bodies and that physicians are often ignorant of the impact of diet and nutrition on cancer but abandoning recognized and approved treatment protocols in favor of something else seems to me to be a way to justify other behaviors (such as the steroid and testosterone additions) instead of any serious attempt to address cancer.

I believe your doctor is giving you good advice. I think your use of testosterone supplements is reckless given your advanced, recurring prostate cancer. But you seem to have your eyes wide open on these matters and have a clear view of your priorities which is a far sight better than many men facing similar decisions that have not figured out what is important to them. I may not agree with your priorities, they are certainly not mine, but I do respect your choices and your willingness to accept the consequences.

All of us will eventually die of something and many of us will go never knowing what was important. It’s great that you have a passion like bodybuilding that you want to pursue even though it may kill you early.

Best of luck to you.

K

Kongo said:

Testosterone Levels
Mnz,

While I didn't suggest that testosterone causes prostate cancer I do assert that it is a key element in fueling the growth of prostate cells, both cancerous and non-cancerous. The prostate uses the testosterone generated by the testes along with dehydroepiandrosterone from the adrenal glands to create the male sex hormone dihydrotestosterone (DHT) which is directly linked to the growth of prostate cells including prostate cells that are identified as early stage prostate cancers. Charles Higgins demonstrated nearly a century ago that by removing testosterone through castration or by blocking it with certain estrogens that the prostate shrank significantly (including the cancerous cells). This led to his award of the Nobel Prize in 1941 for his development of "chemical castration." With the testosterone gone, the ability of the prostate to produce DHT is significantly compromised and prostate cancer cell shrinks or stops growing.

This discovery led to many new hormonal treatments for cancers of the reproductive system such as prostate cancer, breast cancer, and ovarian cancer.

In prostate cancer removal of testosterone through orchiectomy or hormone therapy almost always results in a significant slow down in the progression of prostate cancer that is evidenced by PSA levels dropping to nil. Frequently the PSA levels remain undetectable for many years but eventually prostate cancer becomes more advanced, the cells become less differentiated, and the tumor no longer needs DHT to grow. In fact, studies have shown that as PCa becomes more advanced the cells actually generate their own testosterone. Some newer drugs such as Zytigia have been found to be moderately effective in slowing the cancer when it reaches this stage.

I agree with you that estrogen may indeed play a contributing role in prostate (and other cancer) growth particularly since it plays a role in the production of DHT.

The pursuit of truth is a noble goal but it has been my experience that in this arena truth is an illusive and imperfect thing. Frankly, truth changes based on additional knowledge and there are new and often conflicting discoveries nearly every day. There is much controversy about testosterone replacement therapy (fueled in part I suspect by manufactures of these drugs), estrogen, and how all of these and other impacts affect prostate cancer at the molecular level. While I am certainly no expert in this field, I do recognize that there are many conflicting expert opinions and that our understanding of all the chemical triggers that cause or accelerate the growth of cancers will likely be much different five years from now than it is today. All that notwithstanding, the contribution of DHT to the growth of prostate cancer is well established and adding artificial levels of testosterone to our body seems to me to be a questionable practice and most prostate cancer specialists agree with this.

It's important to keep in mind that prostate cancer is not static. It evolves and changes over time. Atypical cells progress to something a pathologist recognizes as cancerous but still is very much like a normal prostate cell but over time these cells continue to evolve toward less and less differentiation as seen in the pictures of cancer cells and their Gleason classification. Treatments that may be effective at destroying early stage cancers may not be effective at all in more advanced cancer stages and this is particularly true with hormone therapy. But since there are different stages of cancer cells co-existing at the same time, various treatments can still be somewhat effective on at least some of the cancer cells.

I share your views about hormone therapy. If my low risk cancer were to recur (I was treated with SBRT radiation) I don't know whether I would go forward with HT. I know that it is not curative and I too am unsure if I would be willing to endure the likely decline in quality of life for a questionable extension of months or even a few years. If I am faced with such a decision I am sure other factors will influence my decision (the truth changes) but it is something I hope I never have to deal with.

While I too agree that much of what the doctors tell us should be challenged I don't subscribe to the notion that we can or should steer a path that is the opposite of sound medical wisdom even though I recognize that conventional wisdom is often proven wrong. In your case, it seems to me that you quest toward "truth" is a convenient crutch to justify doing something your doctors are strongly advising you not to do.

Regarding studies. In my two years of studying prostate cancer I’ve learned that you can pretty much find a study that justifies almost any treatment method and a conflicting study that asserts the opposite view. Rather than pinning a position on a single research paper I think it is more useful to consider the body of literature on a given subject, understand the prevailing opinions, and try to sort out the controls, methods, and other aspects of the study that determine its outcome. The work done by Higgins, for example, conclusively showed the relationship between DHT and prostate cell (both cancerous and benign) growth and he was awarded the Nobel Prize for this discovery and these fundamental principles have led to other significant discoveries that aid in the battle against cancer. Other studies since then have found that there are many things that can promote prostate cancer growth besides testosterone, including estrogen, Insulin Growth Factors (IGF) found in dairy and meat products, smoking, lack of exercise, hereditary factors, obesity, sugar, and so forth. Just because our body of knowledge has grown (and become more complicated and difficult to understand) doesn’t mean that certain fundamental relationships affecting prostate cancer are no longer relevant.

Every prostate cancer patient is different. Given your initial diagnosis of advanced prostate cancer (Gleason 8 that was not contained) I suspect that your prostate cancer would have recurred whether or not you continued taking steroids to enhance your bodybuilding program. The question now is whether or not you take every prudent step to try to delay the impact of this cancer long enough that something else gets you, like a heart attack or getting run over by a bus. That’s a deeply personal choice that only you can make but as Hopeful and Optimistic points out, death by prostate cancer is an agonizing and awful way to die. I hope you avoid it either by luck or design.

K

hopeful and optimistic said:

here is the link for dr myers blogs
http://askdrmyers.wordpress.com/category/adt-prostate/

There is one, active surveillance and testosterone that may be of interest to you

If you scroll through his site, I believe that you and others will find other videos of interest.