PCa update

Glad for the news. Let's celebrate the Radiator's improvement.

A bottle of red is already reserved aside to celebrate the final RT outcome.

Best,

VG

Yes, these are good news. I enjoy reading it allover again. The lower PSA is consistent with a successful RT outcome. One must recall that HT is not part of your protocol so that the PSA of 2.6 ng/ml is unmasked. The lowering from 14.8 (+α) to 2.6 in 6 months in a Gleason grade of 4 signifies that the RT gave a big blow to the bandit. You will need more time to confirm cure.

Congratulations.

VG

Miao,

Get the biopsy, it' doesn't hurt that much. They gave me a Xanax which really helped.

Then when you get your results, have the slides sent for a 2nd opinion to the famous Dr. Epstein at John Hopkins. My understanding is that if you have a Gleason Score of 7, and it is made up of 4+3, that puts you in Group 3, called  Intermediate, also known as agressive. That is what I am so I am now looking at surgery or radiation. If you get a lower score you can do Active Surveillance, basically waiting, it depends on your age and longevity plans. But do the biopsy.

Nick

Old Salt said:

Aggressive cancer

Does not have high PSA. In fact, the opposite may be true. In other words, high Gleason score cancers appear to be generating less PSA. But these thoughts are all highly premature. Just relax for the time being and get the biopsy over with. Choose someone who has done many. 

And PLEASE start your own thread. so that we can focus on YOUR situation. Look for the tag Add new Forum topic

Old Salt, thank you. i am 68yrs old. psa was 4.3 on  nov, 2016, 4.08 on 3/31/17. no any symptom. it really scared me. i will have my biopsy next week

Leamon,

This last increase is not good news. Could there be a lab error? You can always repeat the blood test before advancing with any decision. But you inform here for the first time since 2012 the result of an image study (without details) on which makes me difficult to opinion.

I understand that the rise and high number in PSA is worrying you and probably affecting your reasoning. After rereading your story (since your initial thread) I think that you did very well and even got the guts to use a radical at your age, to eliminate the unwanted guest. Your choice was the best. For me, there was a missing truthful image exam in the planning (field of attack) of the radiation that most probably did not cover the affected bone areas.

I wonder what have you discussed with your present oncologist/urologist, but it makes sense the comment from the urologist’s office in starting ADT (Firmagon and Xgeva) if apparent metastases have been detected in bone. Firmagon is an LHRH antagonist that will drive you to chemical castration providing control on cancer advancement, and Xgeva/Prolia will try preventing the breakdown of bone that is infested with cancer (it is used in osteopenia/osteoporosis situations or to prevent it). When guys got extensive metastases in bone, joints may be affected so that Eligard (another LHRH agonist) should only be administered after two weeks of antiandrogens like Casodex. LHRH antagonists (Firmagon) do not cause flare so that it is the best choice for starting the hormonal therapy.

Firmagon is also friendlier to heart issues and some guys continue this med all along their ADT. The protocol requires two initial injections of 120mg (2x120=240) that will accumulate in the body, which dose is then maintained with monthly shots of 80 mg. Please read my comments on Firmagon to another poster in here;

https://csn.cancer.org/node/314251

Eligard/Lupron (leuprolide) is typically injected every three months (lesser times at the doctor and lesser injection pain). I was on Eligard 6-month shots three times (covering 18 months) back in 2011. I did not have bone metastases but slight osteopenia. In your shoes I would do two important tests (urologists never request) before starting ADT that will help you in continuous control. Firstly the Testosterone (can be requested with the same blood sample for the PSA) and secondly, a DEXA scan (densitometry) to verify present bone health. If osteoporosis is already evident, then you should do any needed dental repair before starting Xgeva. Osteonecrosis of the jaw may occur.

At your age, I would try keeping a medical oncologist to follow your situation (every six months), in particular regarding drugs use and interactions with other illnesses. Urologists typically only follow the cancer issue and the treatment. Heart health is not their specialty and would not provide you with counseling on matters away from their urinary/prostate field.

Please post here any image study report you may have since 2012.

Best wishes and luck in your continuing journey.

VGama

Leamon,

I do not want to lower your esteem and positiveness you done in confronting your case. However, I am astonished with the contents of the bone scan report; in particular I am astonished for the fact that doctors had access to the scan findings before starting the radiation therapy and advanced in doing it. The report comments on vast spread of metastases which surely could not have been covered in the radiation planning. Patients on such a status are never moved into radiation therapies of the prostate for the risks it entails and the problem in future possibilities of controlling pain due to bone metastases.

The decision of the doctor(s) assisting you in 9/28/2016 was solo to diminish the burden of the cancer not to aim at cure. The progression of your illness was expected and that reflects in the last PSA increase. I am not a doctor but in view of your later information I think now that RT was not the best choice. You should have been moved into a protocol of chemotherapy with hormonal manipulations, reserving spot radiation to future needs as pain becomes unbearable. Surely your age and other health issues were taken into consideration and probably lead to avoid chemo and ADT, but RT for palliative administration purposes would not incur such vast field to administer 78 Gy, unless the planning included radiation in the whole skeleton.

Please let me know what has been discussed in your next consultation. Do not forget to request the above tests before starting ADT.

Best wishes,

VGama