To treat or not to treat

Leamon

I am very pleased to read the news. Unfortunately the PSA continues to rise but fortunately it continues moving up in a very slow pace, as in the past. Surely it may be due to the type of cancer (Gs6) diagnosed in 2011. The numbers are causing you anxiety and you want to create an idea on what to think and how to proceed.

PCa treatments for 83 years old are not easy to define and the choices depend much on other issues that one may have at present or may expect to occur in the future. We age and many health situations will show up (even if we do nothing to cause them) requiring medication or treatments that may interact with the medications/treatments for PCa. All choices therefore interweave and must be judged to attain balance. At JH they have suggested such by recommending a palliative form of control with hormonal manipulations and a late attack with radiation (on spots) if they become nasty.
Surely if you are fit and confident on RT (radiation) as a means of cure then you should chose a type that fits better your situation. In any case you should try firstly to locate the tumours to decide on the proper RT protocol and field of attack. Radiation cannot be done twice at the same area.

At this stage of your journey, even if you decide in no treatment, I would recommend you to have an exam that would look for cancer in tissue and bone. These can be done with a C11 PET/CT or F18 FCH PET/CT exam. The results would provide you peace of mind in your continuing Watchful Waiting.

Hormonal treatments are in fact very good in means of controlling (not cure), achieving such during long periods of life, but they also cause side effects that could be mild or harmful but uneasy. The worse seems to be the effects of menopause due to hypogonadism. Fatigue and hot flashes are common in some guys. Irritability and a constant sense of discomfort (indisposition) may become a temporary symptom that many see it difficult to sustain. Hormonal therapy (HT) in long periods exceeding 24 months has the risk for heart failure.
The good of the therapy is that one can stop it at any moment and the body returns to normalcy status (in about 4 months) losing its effects and taking away with it the “baddy” symptoms. HT can also be done mono or with a combination of drugs. You could choose taking a solo daily pill of an antiandrogen (like Bicalotamide) or a solo LHRH agonist shot (like Lupron) or take both in combination. Google the names to get details on their side effects.

I am following HT intermediately, since 2010. It has been successful in controlling cancer advancement but I have experienced numerous symptoms, however, mild. My aim is only control so that I take the medication for a period to lower cancer activity (lower PSA) and then I continue the treatment with a period of no medication allowing the PSA to increase freely. The timing of the “switches” (On/Off) is the PSA. When it reaches the level of 2.5 ng/ml I restart again another cycle On medication. I am now on the Off period since 2012 and the PSA has increased from 0.05 (while on drugs till May 2012) to 1.24 (December 2014). It is still far from the 2.5 threshold but I already managed control on the cancer for 53 months in this modality of HT. I am also a Gs6 guy.

The best we can do is to conduct a healthy way of living, being careful with diets and being active physically (fitness). Positive thinking and engaged in something we like (our best hobby), travelling and meeting friends to avoid stressful situations.

I hope you understand my opinion. Please note that I am not a doctor so that you should follow your instincts.

Best wishes.

VGama

leamon said:

Thanks fellows for the replies

Hopeful, I haven't found any AS around here.  The story about the 85 year old seems to re-inforce the do nothing approach for us 'over the hill guys'.  So far thats pretty much what I've done--stay active and eat what I want as always.

VGama, thanks for the info on HT.  Unless there is a big jump in PSA, I'm inclined to sit on it--no pun intended.  I think an exam to see the involvement would be a good idea.  Did the HT take your PSA that low or did you have some treatment?

Thanks again,

leamon

Leamon,

Don't just do nothing: you want a doctor who is qualified to handle your case....for example, I think that it is a good idea to have a T3 MRI to give an idea if the cancer is one lobe or two, how many suspicious lesions, potential extracapsular extension, etc. You want to proactive. So you want to have a doctor, probably a urologist to  manage your case with  Active Surveillance .

If you do not have confidence that your doctor can do this, try to attend a local support group in your area USTOO.org has many local chapters that you can access by going to their site.  

Even if you have to make a trip for treatment it is worthwhile.....

Diet , my viewpoint is different than yours; I have made changes to my diet.....Heart Healthy is Prostate Healthy

leamon said:

PSA update and a question

Hello all,  Psa 6 or 7 months ago was 14.  Early this year it was 12. It's nearing 5 Yrs. since a biospy.  Dr. suggested a repeat biospy.  I had no trouble the 1st one but I read where some have a lot of trouble.  He also says if the Psa gets toward 20, he would encourage treatment.  I am now 83 and in good health except for PCa.  Any comments or suggestions?

leamon

 

I have something to say but rather than bury your initial post and any comments within this stale thread, I suggest that you start a new one that everyone can see and respond to.