cipro

Cipro Use
Califvader,

Cipro is an antibiotic. I presume your doctors are having you take this medication to see if your elevated PSA might be caused by a urinary tract infection. Since your prostate has been removed, it's unlikely prostatitis is in play here although depending on the size of the margins left behind, an inflammation of prostate tissue could also cause a PSA increase but I would be surprised if the relatively small amount of prostate tissue remaining in the prostate bed could account for that much PSA.

Cipro will not have any effect on inhibiting prostate cancer although there are some studies that suggest that prostate cancer cells treated in vitro with cipro die faster but I am not aware that there have been any sudies of this in animals or humans.

I think if your PSA decereases after this treatment your doctors will assume that the PSA was caused by something other than cancer. I'm certainly no expert on this but it seems to me that a PSA of 5.8 after RP is too high to be associated with just a urinary infection or inflamed prostate tissue. If I were you, I would assume that I was experiencing a recurrence and would begin to study likely treatments to deal with that.

Best of luck to you.

K

califvader said:

i also think it is a recurrence Kongo. i will follow my doctor's advice and take the cipro for month and get re tested. although i believe my psa will still be elevated and probably a higher reading than it is now. i have been checking into what i can do next. i have researched Lupron depot and it scares the living hell out of me. the side effects can be very severe and possibly permanent. Kongo, what do you think about radiation treatment. i know radiation kills cancer cells but it also kills good cells as well. i do not have a bad problem with incontinence now. if i have radiation done i am worried that i will constently be peeing on myself. also i heard the radiation can damage your rectum. do you have any knownledge on the radiation issue?

Radiation
I chose radiation as my primary treatment and have done a lot of study about its possible side effects and long term impact on quality of life and the potential for secondary cancers.

Radiation kills cancer by interfering with the DNA in the cancer cell causing them to die on time. Healthy cells die naturally through a process called apoptosis and is essential to maintaining a healthy body chemistry. Cancer cells somehow forget how to die naturally and continue to divide out of control. The radiation effect on cancer DNA takes care of that and because of the rate of division of cancer cells (known as the alpha/beta ratio), prostate cancer is particularly vulnerable to radiation treatment.

As you point out radiation can also kill healthy cells too and in some rare cases has been found to cause secondary cancers years later. But you have to put the whole thing together in a risk/reward perspective. Modern applications of post RP radiation are extremely accurate and minimize any radiation dosage to surrounding tissue and organs. Although the colon is near where cancer cells tend to grow, salvage radiation therapy can deliver dosages with sub-millimeter accuracy. In my own case, the bowel and rectum were never radiated with a dose significant enough to cause any damage.

Near term radiation effects are often seen as a sense of urinary urgency...a feeling like you have to evacuate your bladder frequently. It does not normally result in incontinence where you have no control. These conditions tend to pass within a few weeks to a month. Rectal toxicity is even more rare but it too usually resolves within a month or two. In my own case I never experienced any urinary or rectal issues.

Long term secondary cancers are extremely rare with salvage radiation, but if they do occur, are very treatable. Given your relatively young age, it may be a matter of concern but the alternative is much, much less attractive.

I would visit a radiologist that specializes in salvage therapy for prostate cancer and go over your concerns and fears in detail. I think after such a visit, most of your fears will be put at ease.

I share your concern about some aspects of hormone therapy although studies seem to indicate that HT in conjunction with IMRT is more effective that radiation alone. But only a doctor can really explain the nuances of increased success and whether or not that statistic is meaningful in your case.

In general, I think that radiation can be safely and accurately administered in a way that can be quite effective in treating a recurring cancer with minimum side effects. Check it out.

Best,

K

califvader said:

Kongo do i assume that you did not have a radical prostatectomy then? i have noticed you answer many posts here and that you are well educated on p/c.

No RP
No RP at all. Only had radiation (CyberKnife) as primary treatment.

tdorman said:

Cal
I had RP in 1996. In 2002 my psa started rising. When it reached .4 my urologist suggested radiation. I had 43 hits of IMRT in 2003. The radiation had no effect on incontinence or ED. PSAs have all been zero since the radiation. In 2010 I passed a small amount of blood. After an exam by my surgeon he determined the problem was caused by the radiation I had 7 years earlier. He burned a spot in my bladder and have not had any problem again. I was surprised that the radiation was still causing problems after 7 years. My Urologist told me the radiation goes on forever.

I had sporadic incontinence over the years. I would go for a year or more with no leakage and start leaking for a period of time, then dry gain. Lately the incontinence is continuous. I am told that because of the radiation I am not a candidate for many of the tools to treat incontinence; AUS 800, most of the injections, etc.

tdorman
There is another gentleman posting on this forum who has had RP, IMRT (radiation), ADT AND has the AUS 800. His name is Bob, goes by the user name ob66 and, you can search out several of his posts using the search feature on the PCa forum main page. Below is a link to a PCa thread discussing the AUS 800. ob66 has many posts on that thread, however, be sure to read his last post in that thread near the bottom dated November 24, 2010 - 6:16pm. I know each man's case is different, but I hope things work out for you.

http://csn.cancer.org/node/188931

ob66 said:

Hi tdorman
Logged on tonight and normally I would not read a thread with "Cipro" as the head, but I did and saw your post and mrspjd's posts. I am Bob (aka ob66). I did not have your specific problem, but I think I can be of some help. The short line is that I had daVinci in June of 2009, followed by PSAs of 0.05 for 10 months, then a slight elevation to 0.07. My urologist wanted me to compliment the surgery with RT at that time, however, I was undergoing physical therapy for incontinence and it was working, but not well enough. The word was that with RT it would not get any better, only worse. So, I had the artificial sphincter put in in May of 2010, after being on Lupron for 4-5 weeks. The results have been nothing but amazing. My life does not revolve around my incontinence at all anymore. I honestly think I could go into a men's room with any male and urinate without them knowing I had an AUS. I choose to use a stall, just because it is much easier and more discreet. But enough about me.

One of my neighbors in NorCal had PC that was treated in the mid 1990s with RT, and had 14 years of continuous incontinence. He was told he could not have an AUS, because of the RT. That is WRONG. It is the doctors insecurity, and lack of wanting to take a risk on a very difficult case. He found a good doctor (I think it was at UCSF, but I will find out for you if you wish) who would undertake such an operation. He had it done last fall and is in as good shape as I am. I talked to him about worrying about it lasting over ten years, for it is so good, and his response was he didn't think he had to worry, for he is 86 years old. It can be done. By the way, his doctor put in a double sleeve, for he thought the tissues (post RT) were not that great. It is working great. Please e-mail me at rforsberg1@cox.net if you need or desire more help. Bob

great timing!
Thanks Bob. Hope you are doing well.

califvader said:

R/T
it seems that r/t will develop a strong chance of incontinence. if not when it is done but futher down the road. when this happens it is permanent. is that correct?

NO
While RT as a sole tx may have side effects related to urgency and freqency due to irratation, those side effects usually resolve quickly. Proctitus and cystitus are rare but possible (usually from older forms of radiation such as unfocused, unguided EBRT). As written in other threads (please do your reading and research), incontinence is usually NOT a side effect from RT tx ALONE.

Incontinence is a very real potential side effect from RP (whether robotic or open), AND when RT is indicated after RP in the context of a rising PSA post RP, either as adjuvant or salvage and, there has been incontinence that has not fully resolved FROM THE RP, IT IS THEN, that it is very possible the incontinence may become chronic and/or severe, due to the added RT. This may have to do with the formation of scar tissue or other factors from the initial RP surgery and complicated by the addition of the RT. It might be best to discuss your concerns with your doctors, as well as obtain several 2nd opinions.

mrspjd said:

great timing!
Thanks Bob. Hope you are doing well.

To mrspjd/Kongo
Thanks for your wishes, and yes, matter of fact I am on a high right now. Just had a physical last Friday with blood tests in advance. If you remember I started the no red meat, no dairy, low sugar diet in Sept. So not only is my PSA below 0.01 for the second three months post RT (with lupron) test, but also my cholesterol is down from 220 to 148, my LDL down from 150 to the 65 range and my HDL up from 45 to 53. B12 was a little low but still in range so I am supplementing. Now I am not naive' enough to not realize that those PSA numbers are assisted big time by lupron, but they are down. I am on a virtual vacation for a short while. I also know lupron works for me for any future potential needs. And Kongo is very responsible for getting into my brain about diet back in August/September. My better half is developing some new rather good recipes and all is well. For that I give thanks, and enjoy passing on whatever successes (or failures) that I have.

ps. Maybe we can develop a thread that is tagged to stay high (without constant bumping) with good recipes on the type diet I describe. May be helpful to all to continue such. I know my wife has rejected a lot of recipes, but her turkey meatloaf is great, as well as squash and black bean chili. You would enjoy it whether you were on this diet or not, and that is our criteria of the keepers. Any ideas to share recipes for the common good?

califvader said:

mrspjd
actually mrspjd i am scared to death about all the possible side effects from treatment concerning rising psa that are associated with post r/p. i know i ask a lot of questions and to be honest with you i have read so many posts here they can get confusing. (as in pros and cons) i am seeing my urologist soon and i will ask him questions. but from reading these posts it has given me questions to ask.

Calif
Welcome to the PCa "scared to death club," which is an auxiliary to the reluctant brotherhood and, unfortunately, lists among it's members both men and women. Kidding aside, I can sense from your many questions/posts going back to August of last year that you are going through a very difficult time and struggling with your decision choices post RP in the context of a rising PSA. Knowledge is power, but do not make your choices solely on the info posted on a site such as this. Please try to read and research (if possible, from an unbiased unprejudiced point of view) the resources available to you such as PCa books, established and credible websites of well-respected research centers and teaching university hospitals, as well as pub-med clinical trials to supplement your "factual" education. Most importantly, from following your posts, you should have and be very knowledgeable about your own personal PCa stats (dr & tx reports), pre and post RP txs, etc., since only you can be your own best advocate to assist your doctors (and 2nd opinions) by providing a full and complete picture of your disease to determine the next step that would be appropriate for you, given your own criteria for the side effects that may be possible from your follow up tx.

It is worthy to note here again that no PCa tx (primary or secondary) is without some degree of long or short term side effects. Good luck.

ob66 said:

mrspjd
I think my verbage or style may have thrown you a bit. I can be somewhat flip and cynical at times, and my words may have covered my true meaning. To clear it up, when my PSA rose after 10 months a game plan was developed, as I described. My understanding is that, aside from all the hideous side effects of lupron, the drug when working properly gives you a "vacation" from the worry of your PSA rising for a while (I guess I could say for the time period you take it). That 3 month or 6 month fear that hits all of us when test day comes up again. That was the vacation to which I was referring.
Now I think I need to take Mrs. B on a vacation too, for all her hard work, love and support. Great that you mention it. And I am in a position to enjoy as well. Win, win. Thanks mrspjd.

Bob
Got it! Thanks for the clarification. I should have known If your travels ever take you through So Cal, please drop us an email. Maybe Mrs B and I can trade recipes!
All the best to you both.
mrs pjd

mrspjd said:

Bob
Got it! Thanks for the clarification. I should have known If your travels ever take you through So Cal, please drop us an email. Maybe Mrs B and I can trade recipes!
All the best to you both.
mrs pjd

mrspjd
There must be some way to send a PM on this site, but for now I will bore all the rest of the people who may waste time reading this exchange, but Mrs. B and I travel SoCal all the time. We got a great laugh over your post, as we do, in fact, live in Laguna Niguel. My medical team is at Mission Hospital, and I am lucky to have had great Tx. You can e-mail at: rforsberg1@cox.net Kind of scary when the world gets smaller and smaller all the time. And I do believe our friend Kongo is a subversive from San Diego County, if I am not mistaken. Haha...All the best.