High Gleason Prostate Cancer after Androgel Application for Low Testosterone

At age 67, and after a long history of low PSA levels (0.8 to 1.2), at age 66, I was diagnosed with low testosterone levels (150 ng/ml vs a normal range of 250-1000). I was prescribed a testosterone cream (Androgel) to increase my T-level. My PSA rose fairly quickly from 1.2 to 3.5 and 10.1 over an 8 month period. After failing to lower the PSA with anti-biotics, a prostate biopsy was performed on 9/18/12 at the VA. The results were given to me on 10/1/12.....11/12 biopsies were (+) with most being Gleason 9 (5+4) and involving 90% of the cores. One core noted "perineural" involvement. I recieved an LHRH-agonist (6 month depot) and daily Casodex. Working in the medical field, I was familiar with the options for aggressive prostate cancer and chose Triple Therapy (ADT/IMRT/Implant). My regimen starts with "up-front" androgen deprivation therapy (ADT) for 3-months to be followed by 45 Gy to the prostate/SV/nodes via external beam IMRT with a final dose of 90 Gy delivered via a Palladium-103 prostate implant.

My CT and bone scans were negative except for multiple sites of osteoarthritis based on a 30-year history of contact sports (football, skiing, rugby). I currently recieve a 70% disability from the VA based on injuries from Vietnam and a cardiac event in 2010. Based on the "Agent Orange VA Registry", my disability will probably be raised to 100%. A recent ultrasound measured my prostate gland at 20 cc (small) with a "well-defined" capsule and seminal vesicles. I am scheduled for the placement of prostate fiducial markers in December and a "treatment planning" CT prior to my external beam treatments in January. No MRI or PET/CT has been scheduled with the assumption that any disease in the nodes is microscopic. A fairly recent NCI study indicates a "significant" benefit to including the nodes in pelvic irradiation if the probability of nodal disease exceeds 15%. There is also an "added" effect of the ADT therapy which reduces tumor cell activity through programmed cell death (apoptosis). A PSA taken on 10/18/12 revealed a drop in PSA from 10.1 to 1.2 over the first few weeks of ADT.

I investigated the NCI study utilizing the anti-MUC-1 vaccine in addition to Triple Therapy. Unfortunately, because I had already recieved my first LHRH-agonist shot, I was deemed ineligible. I did, however, schedule an appointment with the Prostate Group at NCI to "get my name on the list" for any new studies for which I would be deemed eligible.

Even with my heart and prostate problems, I feel "pretty good" under ADT therapy and manage to get to the gym 3-4 times/week. I started this story line to reach other individuals (and Vietnam vets) who might be in the "same boat". I didn't put much belief in Agent Orange, but I've had too many of my Marine Corps friends from I-Corps diagnosed with "odd cancers" over the years. Maybe there is some truth in the research concerning Agent Orange as well as the contaminated water at Camp Lejeune?