PSA CONCERN

Kongo said:

Cure?
Hopeful,

Forgive me if I have misremembered but I seem to recall that you were initially diagnosed with a Gleason 9 with no evidence of metastasis and your medical team launched you on a course of hormone therapy coupled with IMRT. Wasn't your original PSA reading in the 50s? Now, about 18 months later, your PSA is down to 0.28 and still dropping. I am assuming you are still receiving the Firmagon shots.

Setting aside the apparent bluntness of this particular PA it seems to me the gist of your question is whether or not a "cure" is in the offing. There have been many discussions in this forum on whether or not there is truly a cure for prostate cancer or any cancer that is inherently metastatic for that matter. It seems that a "cure" is in the eye of the beholder.

From what I have read in many cases that an early stage prostate cancer completely contained within the prostate gland and treated with either surgery or radiation that there is an excellent chance that the cancer will not manifest itself again. Historically, both surgery and radiation show about a 30-35% chance of biochemical recurrence characterized by rising PSA scores some time after treatment. While some of the more modern forms of radiation (such as what you received) seem to have a much lower recurrence rate in the near term, we won't know for several years whether this trend will continue at the 10 and 15 year points.

Prostate cancers diagnosed in the intermediate and advanced stages have higher rates of recurrence. A Gleason 9, as you well know, is a dangerous cancer. Although there may not be any immediate evidence of metastasis there is a high likelihood that a Gleason 9 patient will see tumors that have spread outside the prostate via the blood or lymph systems even though they might be microscopic and otherwise undetectable. Your treatment course, which i personally think was very wise on your part, went after the cancer in an aggressive way. The radiation attacked the prostate cancer cells within the target area of the IMRT and the Firmagon works to curb cell growth in those areas that were not radiated.

The fact that your PSA continues to drop is a good sign in my lay opinion. It suggests to me that your treatment is working as intended. What i suspect that the PA was trying to say is that the Firmagon (or any hormone therapy drug) should knock the PSA levels down to near zero levels regardless of whether or not any other treatment has occurred. I'm certainly no expert on hormone therapy and I don't know what the normal range of expected PSA scores should be given your Gleason 9 starting point. I would request an email exchange or arrange for a telephone chat with your lead physician and ask him what his opinion of a PSA = 0.28 after being on Firmagon for a year really means for a Gleason 9 patient and whether this is within a normal range or not.

You really won't get a feel for the effectiveness of the radiation treatment until you have stopped hormone therapy and your testosterone leeks return to normal. This could take several months after you stop taking shots.

Men who retain their prostates will never see a zero PSA score. (Although HT skews this data) Their PSA will decline until a nadir, or low point, is reached, and then stays at that level. If PSA results raise more than 2.0 ng/ml above the nadir it is usually considered a recurrence.

One phenomena associated with radiation treatment is the PSA bounce effect where the PSA declines after treatment then inexplicably increases and then continues a decline toward nadir. Perhaps your reading was somewhere during the bounce phase? I would also query your doctor about his thoughts on PSA bounce.

In any event your PSA continues to decline and that is a very good thing from my perspective. Whether or not there is a "cure" seems off point to me. What I think you should be asking is: Is this cancer going to progress to a terminal late stage that kills you? I think its way, way to early to draw that conclusion on that and the PA should have made that clear to you. I wish your PA had taken the time to put all of these numbers and nuances in perspective for you and I hope you seek further clarification with the doctor in person.

Best to you.

K

VascodaGama said:

What a relief !!!
RadHope

Those are wonderful news. You may be thrilled and very happy for the doctor’s comments.
I am also happy to know about the DRE results and that you finally will start having PSA tests at longer intervals.

I hope the DEXA scan is negative for osteoporosis but if it is found that you got osteopenia you may start a preventive approach taking on/off bisphosphonate pills (such as Fosamax). If you got advanced osteoporosis (bone loss) then you should consider taking a bisphosphonate continuously or take a denosumab drug (human monoclonal antibody). Prolia and Xgeva are famous denosumab drugs for treating bone loss due to cancer or in patients at high risk for bone fracture.
You may dislike the Prolia recommended by your doctor for what you know about its side effects but not all patients experience the same occurrences or intensity. You may inquire with your doctor about the possibility of changing it with Xgeva.
In any case, both drugs require a series of “standards” before taking them which you must follow strictly. Both “deliver” similar side effects, being hypocalcemia (low levels of calcium in the blood) the one most reported.

Regarding low count of RBC, you may check if your body got enough vitamin B12. This is required for the “production” of RBC. Inquire with your doctor particularly to check for Anemia.
I also recommend you to get tested for vitamin D. This is important in the osteoblast effect (build up of bone). http://www.medterms.com/script/main/art.asp?articlekey=24502

You do not need to worry about low levels of Testosterone for the moment. You can expect it to increase once you stop the Firmagon.

Have a good time.
VGama