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Chemo + hormone treatment after a positive post-surgery PSA?

pinot
Posts: 12
Joined: Nov 2009

I've posted on here before about my Dad. He is 66, had the DaVinci surgery, but he still has a positive PSA ranging from 1.3-7.0 in the last 3 months.

His oncologist wants to start him on hormone therapy.

His oncologist says that chemo is more for the "end stages" of cancer. Yet, my Dad's family doctor says that chemo would be the better option. My Dad is leaning towards pushing for chemo combined with hormone therapy.

So - is there any reason NOT to do chemo AND hormone therapy early on in post-surgery treatment?

The oncologist also did not want to do a CellSearch or Prostascint scan, saying that those were inaccurate. Yet, the bone scans and MRIs have come back clean with the exception of some slightly enlarge lymph nodes. My Dad would also like to do the CellSearch or CTC scan just to see if the free-floating cancer cells show up.

Thoughts?

JohnK11
Posts: 23
Joined: Nov 2009

HI --I was the one that raise the issue of the prostascint scan (which I took a month ago--it came out negative). I was told (and also found on the web) that both bone scan
(which I also took--negative also) and prostascint scan almost always do not find any cancerous region, UNLESS your PSA at least 40+ (some say 20+) since lower PSA usually imply that the metastatic cancerous cells that have spread outside of the prostate are not big enough to be seen. Furthermore, if you see one or two patches, it does not mean that there are no other areas of cancerous growth. I'm not sure that treatment would be different if one does see some cancerous regiou.
In my case, my PSA was 7/9.2 when I took both scans. I would probably be better off just
to take Lupron (or Trelstar) earlier, instead of waiting 1 month when my PSA increased by 30%.

2ndBase's picture
2ndBase
Posts: 220
Joined: Mar 2004

There are too many reasons to list here to not take these treatments. Try to find any evidence that hormone therapy has extended someone's life by more than a couple months and let me know when you find it, because I've been searching this for 6 years and have had no luck. The side effects of Lupron are worse than the side effects of cancer and in the end we die either way.

pinot
Posts: 12
Joined: Nov 2009

Both my mom and I have been doing research on Lupron, and we're both very concerned about its side effects. I guess that's why I'm not convinced that the hormone therapy alone is the right answer.

tarhoosier
Posts: 195
Joined: Aug 2006

Pinot:

Your father, who may post and read here if he is able, has decisions to make and they are his alone. Even the top prostate surgeon, Peter Scardino has said that in breast cancer chemo is done early in many, many cases and in prostate cancer, a very similar disease, it is left until other treatments fail. These two approaches cannot both be right. Generally speaking, any treatment will work better when the tumor burden is less. This does not mean that either one recommended will work well. Each patient is different and each has his own disease. The side effects of chemo for an otherwise healthy patient are usually tolerable, particularly if following a once a week, rather than once every three week schedule as is generally used. Hair loss, loss of taste, some weight loss and other SE's, most reversible after treatment ends. This is also true for hormone therapy as many enlightened oncologists now use intermittent therapy with off periods allowing SE's of treatment to resolve.
Prostascint and circulating tumor cell tests are not relevant now as they have no meaningful impact on treatment decisions. Prostascint is inaccurate, yes, and with microscopic cells no current scan can determine location. They may be anywhere and everywhere.
Hormone therapy now and a consultation with another oncologist soon who may be open to taxotere treatment early on will provide another option.

pinot
Posts: 12
Joined: Nov 2009

Thanks, Tarhoosier, you've given me some things to think about. I think taxotere is one of the things that is on the table; but my Dad is concerned about neuropathy.

So many choices. Such hard decisions.

I don't encourage my Dad to post here, because reading about cancer drives up his blood pressure to extremely high levels. It also keeps him from sleeping at night. He does go to support groups, though, and I think that helps.

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