Am I opening a new chapter?

Jerry,

I am very glad for reading another post of yours but never expected it to be about your own case. Always wondering how things are going in your place.

Many here will like to know more about your story so that I want to add to the above that your Gleason score at diagnosis was 7 (3+4) and that the PSA before HT was a massive 20.4 ng/ml (2008) decreasing to undetectable levels, signifying that your type of cancer is hormone-sensitive. I do not know the HT protocol but you have informed before that you are in a continuous administration, meaning 9 years on the drug(s). The last PSA of 0.3, an increase in twelve months from 0.1 is still very low but it may represent a wakening of the bandit.

I am not aware of other health issue you may have or how your oncologist will judge your situation but he will surely take into consideration your age. You do understand not many 91 folks get involved in treatments for PCa. In any case, if the awakening is confirmed then you could look into a substitute drug of those you are taking now. At least you already know about their side effects and what to expect to occur.

An important aspect that you should care and discuss with your oncologist regards the type of refractory. If your present HT protocol involves an antiandrogen daily pill like Casodex (bicalutamide) then you should stop taking it. Very often this sort of HT refractory (increase of PSA while on HT drugs) is a cause of the antiandrogen that started being absorbed by the cancer. If one stops taking the pill then one will presence a decrease of the PSA. This is what is called antiandrogen withdrawal syndrome. You can read details in these links;

https://link.springer.com/article/10.2165/00002018-200023050-00003

https://deepblue.lib.umich.edu/bitstream/handle/2027.42/58635/23473_ftp.pdf?sequence=1

The fact all resumes to the biostructure of the antiandrogen that is similar to the real stuff (testosterone) so that it assures a better affinity for gluing it to the cancer receptors (AR). This manages to stop the feeding of the cancer, keeping it indolent during many years until the bandit finds ways for surviving or starts feeding on the antiandrogen itself. The occurrence is more common in guys with hormone-sensitive tumours (your case).

I do not think that a radical treatment is advisable. My opinion is that you should reconfirm this upward trend of the PSA with another test in three months and then act as recommended by your oncologist, taking into account your other health issues. Probably it would be wise to get a Testosterone test, a DEXA scan and a check up of heart health and full lipids count now, even before the next PSA. Your oncologist will want a bone scan but it may not shown evidence of PCa. Chemotherapy may be recommended but it is palliative and may prejudice your present quality of living.

I hope that the increase is sustained and that you can resolve it with a weapon from the HT arsenal.

Best wishes,

VGama

Old-timer is one of a kind!

Fourteen years between radical prostatectomy and subsequent radiation. Then nine years of hormone therapy. Signs of becoming refractory after seven years or so. After that, PSA rising, but slowly.

Congratulations!

Thank you for your update, Jerry.  One day at a time.

Jerry,

I recall reading about your treatment that is based on a solo Casodex 50mg daily pill during a long period on ADT. If this is correct, then the constant increases along the past two years could relate to refractory of the antiandrogen. As I comment in my above post, the situation should be verified carefully as Casodex is linked to unsatisfied refractories. The fact is that the cancer that was subjected to antiandrogens during long periods, at sometime mutates their AR (androgen receptor) and start feeding on the antiandrogen pill itself. One can check this phenomenon by stopping the Casodex and verifying the PSA. It would decrease and stay low for several months.

I hope you discuss the matter with your doctor in your next consultation. In any case, when confronting refractory, oncologists usually increase the dose (eg; 50 mg to 150 mg /daily), or change drugs (eg; Casodex to Nilandron or Eulexin) or start taking a more refined antiandrogen such as the famous Xtandi. In my lay suggestion, I would start by increasing the dose, because you have done well with Casodex. However, you should be attentive to any further increase in the PSA; stopping the Casodex immediately if that increases further.

You are our dearest companion in this fight with the bandit. I hope things get into your favor and you get relaxed.

I also hope that your wife is doing well post her treatment of the skin melanoma.

Best wishes,

VGama

I would love to be there and see your performance. Which part do you play? Is it the Figaro's?

Amadeus Mozart, my favorite.

Enjoy

VG

Great to hear all of that good news, Jerry.  Thanks for writing.

max

Great news, Jerry!!

I wish you and your wife all the best.