PSA 1550

I'm so sorry to read about your husband's cancer. There's really not much that can be done at this point.  Once it has spread to the bones and organs there's really no way to get rid of it.  So you are looking at how long he can be kept alive and how comfortable he will be.  You haven't meantioned any treatments other than HT, but there are new therapies being developed all the time.  Eventually PCa becomes castrate resistant and HT no longer works, but for some that doesn't happen for a decade or even longer.  Every case is different.  Be sure to take good care of yourself, as his caregiver and loving spouse.  Ultimately this will be very hard on both of you.

Sid,

Welcome to the board. I hope he manages to get the longest life expectancy possible but with quality of life.

Can you share more details on his diagnosis and treatment protocol? What is the Gleason score?

You said that his PSA has risen from a nadir. Can you tell more about the PSA histology?

The worrisome goes to the metastases in organs, the liver in particular, but you comment these to be in the lungs. I know of several patients that have dissected the metastases in lung successfully. This is treatable if only a fewer number of spots are involved.

The hormonal treatment is palliative but in the hands of good oncologists these can hold the bandit for long periods of time. There are he so called second-line ADT to replace the ones that stop working or immune therapies to extend their effectiveness. You need to be vigilant not just with the cancer but with any deterioration of other functional organs like the heart, kidneys and liver that will be affected by ADT drugs and manipulations.

Your husband needs to set a sort of monitoring program to avoid deterioration, involving diet, physical exercises and periodical tests (testosterone, estrogens, bone densitometry, vitamin D, etc) along with the PSA to check for the functionality of other systems and to verify the effectiveness of the ADT before it becomes refractory. Intermittent approaches may be useful to prolong the period of the hormonal treatment.

Doctors typically, in stage 4 patients, treat the pain in bone with spot radiation. This cannot be done at the same area twice so that one must choose the most affected areas.

A good book for you to read is;

“Beating Prostate Cancer: Hormonal Therapy & Diet”, by Dr. Charles “Snuffy” Myers.

Tell us more and will try helping you with comments based on our own experiences.

Best wishes and luck in his/your journey.

VGama

Sid,

I am sorry to hear about the extent of the disease as you describe it. I was thinking on the possibility in debulking some spots to alleviate the burthen of the whole cancer but due to the extent of the spread at the mediastinum area (that contains some of the most vital organs of the body), I think it better for your husband to just try holding the bandit with the present treatment.

The last PSA increase could signify the start of refractory or it could be due to a moment of unbalanced hormonal biorhythm. Lupron should drive your husband into chemical castration but any movement that could massage or squeeze the prostate (or sex) the day before drawing blood for the test can influence the level of the PSA. Casodex works by interfering with the absorption of androgens at cell's receptors (AR).  It works well until mutation of AR occurs rending down this drug’s capabilities. At this time oncologists try increasing the dose from 50/daily to 100 or 150 mg. if by doing so the PSA increase continues then they call it refractory and substitute Casodex with other more refined antiandrogen, like Xtandi. I recommend your husband to do a testosterone test to check Lupron's effectiveness. It should be lower than 25 ng/dL

Famous oncologists in aggressive cases similar to your husband use other means of blockades too. For instance, they use 5-ARI like Avodart and Finasteride to avoid refinement of the androgens. They also tend to use Crestor (a statin) because cells produce their own androgens from cholesterol. Surely each drug will add more side effects so that oncologists usually add medication to improve/boost the immune system such as Leukine (taken intermittently).

This is something you will understand by reading the above book and that you can discuss with his present doctor, which can be added in your monitoring program. The book author, Dr. Myers is a retired medical oncologist that dedicated his professional life in investigations and treating prostate cancer patients. He worked as an Integrative Oncologist overseeing all aspects of the treatment and balancing life style. You can see several of his videos in this link;

http://askdrmyers.wordpress.com/2012/02/01/memory-adt-for-pca/

Fatigue was probably my worse symptom when on ADT. The wide spread of cancer may also cause fatigue but it is the hipogonadism status that drives us to a series of unpleasant symptoms. Mood-changes are also terrifying and our partners must be prepared to understand it as occasional. It has led some couples to divorce for no particular reason. Physical exercises and a change in life tactics are good to balance things. Walking seems to be the best but one will need to rest along the way. Afternoon naps and earlier dinners are also good.

Here is a comprehensive introduction on Hormonal Treatment;

http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-hormone-therapy

Here is a link on nutrition;

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

Try being positive. How about a trip to visit that place you both wanted but never did.

Best wishes,

VGama

so sorry to hear this. my wife and i was hit with the same diagnosis. my psa was 4.61, gleason score of 7. i had surgery last week to have prostate removed. two lymph nodes where sent to pathology. results came back with a gleason score of 9. so now i guess it is a wait and see. But i can tell you one thing. cancer is not going to ruel my life.my wife and i are going to enjoy every day to the fullest. Good luck on this journey

In a different forum there was a patient with a PSA value of 6700 at diagnosis. Gleason 9 and mets everywhere. He was treated with ADT plus Docetaxel (Chemo). After one year the PSA value got down to 1.1 and then started to rise again.

I would recommend to add Docetaxel to the current hormone therapy.

Sid,

I am sorry to hear about the increase. I would recommend you to discuss with his doctor next week about the need in stopping the Casodex straight, substituting it by another antiandrogen.

The matter regards what is called "Antiandrogen Withdrawal Response" or "Androgen Withdrawal Syndrome" that occurs when the cancer has mutated the AR and starts feeding on the Casodex itself. The issue is seen initially with an increase in the PSA (refractory) that starts to fall once the Casodex is stoped. Casodex is made up of a similar biostructure as the real stuff so provoke absorption by the cancerous cell, faking the real androgen. The syndrome can last 4 to 6 months with lower PSA results. After that one must start taking another antiandrogen or change to the second-line ones like Xtandi.

Here are some materials for you to read and prepare the questions for your next meeting;

https://pcri.org/-aawr-the-anti-androgen-withdrawal-response

https://jhoonline.biomedcentral.com/articles/10.1186/1756-8722-1-21

https://www.researchgate.net/publication/257461567_No_Androgen_Withdra

wal_Syndrome_for_Enzalutamide_A_Report_of_Disease_Dynamic

s_in_the_Postchemotherapy_Setting

Best of lucks.

VGama

my PSA was 550 when I was dxd,, chemo was the first treatment I had, and that got me down to PSA 50.. Then I went on zytiga, prednisone, lupron, xgeva, oxycodone, zoloft and this got me down to PSA 7.5, and i am PSA 24 now.. That all took place from Jan, 2017 to present day.. i'm 81 yrs old and looking fwd to a long cold winter and then a beautyful spring.. keep posting and enjoy all the time you and your spouse have together.. also, check out the chat-room there are some interesting folks there.. good luck and enjoy life !!

The forgetfulness is weird and it happens with Firmagon as well, I have to make a list before I go shopping even if it is only for less than a few things or I might forget completely why I am there, but I can add up the till roll easily so that bit of my brain is completely unaffected.
I can do dates, etc but it is a bit hit and miss on what I had for dinner.

Sid,

I read your other thread but I prefer to give you my opinion in this your initial post where you shared details of your husband's case. Resuming; the PSA "started at 1550 and over 6 months of tx with Casodex and Lupron came down to 22.  then went up to 24, then 26 and yestready was 96".

In my opinion, the last increase certifies the refractory status. We have discussed the matter in above post. Your husband should stop the Casodex the soonest and look for a substitute such as Xtandi. Lupron should be taken continuously with the newer antiandrogen.

Best wishes,

VG