PCa update

Leamon

You are right, if younger even doctors would highly recommend treatment. Older guys with no apparent aggressive cancer are put on hold because the majority of them die of other causes.
In any case, one should not give up in trying controlling the bandit’s advancement. Treating prostate cancer with intent of cure is ambiguous and nobody can assure 100% success. Only contained cases may have such probability secured.
In a case of uncertainty, the risks and side effects attached to the treatment must be carefully weighed in.

Surgery is very much linked to incontinence. Radiotherapies are linked to colitis, prostatitis and weakness of the immune system. Hormonal therapies are linked to menopause like symptoms (lost of concentration, mood changes, anxiety, fatigue, depression, etc). None of the above therapies are recommended in guys with heart problems.
In other words, if treatment becomes inevitable, one should try balancing the choices against one’s preferences, giving credit to present and future health occurrences (not linked to PCa).

Many old men try controlling the cancer via the reduction of the testosterone. This simple procedure can be accomplished in “phases”, eliminating the level of the stuff in circulation (orchiectomy), or in an intermittent modality (LHRH agonists). Both are good choices if the type of cancer is androgen dependent. Soft drugs substituting the means involving lowering the testosterone are the antiandrogens, pills taken daily but which may interact with other medications for other illnesses.
HT efficacy can be tested with one shot of Firmagon. If the PSA goes down it would mean that the cancer is hormone dependent. Such could then be continued if you manage the symptoms or substituted with orchiectomy of one testicle to diminish a part of the testosterone in circulation, but avoiding menopause. The PSA would serve as the marker of control.

I never heard of statins increasing the PSA. I believe that statins decrease the activity of the cancer, therefore lowering the PSA. Testosterone is produced from cholesterol so that lower cholesterol may relate to lower T. You could request a Testosterone test together with your next PSA test to have a base-line value before starting any treatment. Here is a video of Dr. Myers talking about statins influence in PCa;

http://www.prostatepedia.net/blogs/ask-dr-myers/61783427-statins-and-prostate-cancer

I am sorry for this difficult and stressful moment in your life.  I believe that PCa will not “kill” you. You may try living with it, try controlling its advancement or try eradicating it. Your choice will be the best for sure.

Sincerely,

VGama

Leamon,

I very much admire your healthy and balanced attitude toward all of this.

Like Vasco, I have never heard of statins, which I have taken for 20 years, increasing PSA.   Except in early 2015, your PSA  "doubling-rate" has been very low, which usually in indicative of a non-aggressive disease.  I am NOT deeply read regarding A.S., but I believe that PSA above 10.0 is usually a point at which other treatments are recommended.

Personally, I feel that surgical removal for a man 83 would be a very bad choice, almost absurd.  I think your idea regarding IMRT is very sound, and likely much less traumatic to deal with, and it also avoids the nasty side-effects described regarding hormonal therapy.

I have a friend with PCa, now 73.  He had a mildly positive biopsy about seven years ago. His next biopsy was totally negative, undoubtedly what is termed a "false negative," but it proved his cancer is small, limited.  His PSA has remained below 3.0 for the last three years, and the urologist only checks him once a year now.  it is remotely possible that in three or six months your PSA would be at, or below its current level.  Not probable, but possible. Ask your doctor.

Your calm is the perfect response in your case, I suspect.

max

leamon said:

New biospy

 

Hello all, I have been Watchful Waiting for 5+ yrs. A recent biopsy calls for an update. I had an MRI guided biopsy which showed major involvement and a Gleason of 8 or 9(per John's Hopkins). I've seen 2 oncologist. One recommended 2 to 3 yrs. of hormone therapy and 45 external beam radiation treatments. The other suggested 3 to 6 months of hormone ( to reduce the size) followed by High Dose brackytherapy followed by 25 treatments with external beam IGRT/IMRT. Urologist says bracky is more likely to have uninary problems. Unless I change my mind before 11/11, I will start the hormone treatment (Firmagon followed with Elagar) and decide what radiation to take after the 3 months. Latest scans show no spread of the cancer outside the prostate. Any comments appreciated. It seems not many on this board have had Bracky. Psa in May was 14.8> If you want to read the earlier posts, type 'leamon' in the search.  Thanks in advance. 

leamon

 

Bracky is not effective for men with large prostates, thus the recommendation to reduce your prostate size so you might receive this treatment.

Suggest that you speak with a radiation oncologist that does SBRT. This radiation type is  very precise. The radiation can be directed to encompass the prostate and some surrounding tissue. There are four or five treatments.............a combination of hormone and radiation in my laymans opinion will be very effective.

A study

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227393/

gleason 8 results from above study

 76.2% for GS ≥ 8,

You may wish to compare a combination of GS 8 with hormone versus other treatment choice.

Leamon,

All books and articles (or very nearly all) on the subject of comparing SBRT to fractionated (conventional) RTs (i.e., IMRT-IGRT) show them to be statistically identical in cure rates for PCa. I do not have any studies at hand, but could look for them. I do have comments in book form that I could share, but no one here that I can recall debates this.

IGRT would take about five or more weeks of treatment to deliver around 76-80 Gray ("Gray" is a measure of radiation dose), SBRT about five days for approximately the same amount of Gray.  Think of IGRT as drinking from a shot glass, while SBRT is drinking a Slurpie Big Gulp at 7-11. 

Convenience is a major selling point for SBRT.  There are cases in which SBRT is less ideal, and radiation oncologists revert to fractionated, but there is no reason to get into that here....debate over how to cover the prostate bed to kill micrometastatic cells, etc.  With good imaging and results, a radiation oncologist will know pretty clearly if SBRT is suitable.  In America SBRT consists of essentially two machines: the Cyberknife, and products made by Varian.  Some centers buy one, some the other (and some smaller facilities have neither).

max

Thanks for the update

Wishing that the rest of your treatment is  non eventful ,  and a speedy recovery.

h