PCa update

leamon
leamon Member Posts: 39

Swingshift, thanks for the suggestion to start a new thread.  I'll re-post some info from the other thread;

 

Hello all,  Psa 6 or 7 months ago was 14.  Early this year it was 12. It's nearing 5 Yrs. since a biospy.  Dr. suggested a repeat biospy altho he was against it a year ago.  I had no trouble the 1st one but I read where some have a lot of trouble.  He also says if the Psa gets toward 20, he would encourage treatment.  I am now 83 and in good health except for PCa.  Any comments or suggestions?

 

Following is my PSA history;

 

4/2004 3.2, 5/2005 3.0    6/2007 4.4    8/2008 5.9    4/2009 6.8    5/2011 7.0    11/2011 4.6    2/2012 6.16   free 1.24 % free 20.13    5/2012 7.2    8/2012 6.93    11/2012 6.53    3/2013 6.23    8/2013 7.18    9/2014 9.6    2/2015 9.99, mid 2015 14, early 2016 12.

An admission;  Altho I have researched the different treatments for PCa, I have not spent a lot of time on the ins and outs of different options.  I may be 'wistling past the cemetery' but I don't spend much time or energy worring about it nor did I when scheduled for bypass surgery.  I guess I'm stupid and may have some regrets when I face an open caket.  Don't take this to mean I don't covet and appreiciate your opinions and advise.  I have learned a good bit here and a lot of it has encourged me to not worry about it and has strengthened my resolve to be very slow about something that might greatly alter my enjoyable life style.  I weigh the +s and -s and ask 'how much added time do I get for doing this', the unanswerable question.  Sorry if this seems inappropriate and thanks for reading and thanks much for the time and effort many spend writing and giving good info.

leamon

 



 

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Comments

  • VascodaGama
    VascodaGama Member Posts: 3,513 Member
    Downed PSA

    Leamon,

    I am pleased to know about the decrease of the PSA. Again my advice would be to try in locating the bandit's hideaways with a PET scan. A biopsy may not be needed unless you want to know if cancer has changed its Gleason (aggressivity) or "expanded" to an higher number of cores (previously it was 3 out of 12). Though, the procedure is simple but may lead to unwanted infections, and its results would not alter the choice in treatment at your age. In such respect, the best is to do something that allows peace of mind, free of side effects and no lost of quality living.

    Your story since 2012 is here; https://csn.cancer.org/node/234627

    Against Swing suggestion, I would prefer to read your post in your previous thread. Does it matter?

    Congratulations in your "downed" PSA.

    Best wishes.

    VGama

     

  • leamon
    leamon Member Posts: 39

    Downed PSA

    Leamon,

    I am pleased to know about the decrease of the PSA. Again my advice would be to try in locating the bandit's hideaways with a PET scan. A biopsy may not be needed unless you want to know if cancer has changed its Gleason (aggressivity) or "expanded" to an higher number of cores (previously it was 3 out of 12). Though, the procedure is simple but may lead to unwanted infections, and its results would not alter the choice in treatment at your age. In such respect, the best is to do something that allows peace of mind, free of side effects and no lost of quality living.

    Your story since 2012 is here; https://csn.cancer.org/node/234627

    Against Swing suggestion, I would prefer to read your post in your previous thread. Does it matter?

    Congratulations in your "downed" PSA.

    Best wishes.

    VGama

     

    PSA, etc.

    VGama, thanks for the reply  I want to thank you for all the time and effort you and others expend to share your expertize.  It saves me a lot of time finding the info myself.  And someone else's opinion is of value even if we don't agree. It doesn't matter to me about which thread.  Your link to the other thread is probably best.  I think the Dr. just thought it was time to see what has happened.  I thought about getting it done now so if I had problems it would be during the winter but I may just wait 'til May's appointment and see the psa then.  In re-reading the old posts, someone had said that statins may increase psa.  At the time of the last test I wasn't taking statin so that might explain the drop. My Dr. does not order a lot of tests, PSA and DRE is all since the 1st biopsy.  Some are likely to say that is not acceptable but there is no known active surveliance program in my area that I have found.  'Hopeful' related the story of a Dr. son telling his 85 year old Dad, with 45 PSA to just enjoy life.  That kind of re-inforces my attitude toward this.  Maybe doctors would rather not reccommend a lot of treatment at this age but feel compelled to offer it. Whatever we choose may turn out to be wrong.  I'm thankful that God has given me 83 good years and am carful about decisions that might ruin what's left  If 10 or 20 yrs younger, my thinking would probably be mush different.

    leamon

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    .

    I must report that during the last few months,  there was a significant PSA increase for the 85 year old man that I referrenced....I think that it went to the 70ties.  He had a biopsy that indicated that there were cores of high intermediate, treatment was necessary. His treatment was first a couple of months of  Lupron, followed by SBRT (using the Novalis machine). He is still on Lupron. His PSA reading after SBRT is  1.7.

     

  • VascodaGama
    VascodaGama Member Posts: 3,513 Member
    If 10 or 20 yrs younger…

    Leamon

    You are right, if younger even doctors would highly recommend treatment. Older guys with no apparent aggressive cancer are put on hold because the majority of them die of other causes.
    In any case, one should not give up in trying controlling the bandit’s advancement. Treating prostate cancer with intent of cure is ambiguous and nobody can assure 100% success. Only contained cases may have such probability secured.
    In a case of uncertainty, the risks and side effects attached to the treatment must be carefully weighed in.

    Surgery is very much linked to incontinence. Radiotherapies are linked to colitis, prostatitis and weakness of the immune system. Hormonal therapies are linked to menopause like symptoms (lost of concentration, mood changes, anxiety, fatigue, depression, etc). None of the above therapies are recommended in guys with heart problems.
    In other words, if treatment becomes inevitable, one should try balancing the choices against one’s preferences, giving credit to present and future health occurrences (not linked to PCa).

    Many old men try controlling the cancer via the reduction of the testosterone. This simple procedure can be accomplished in “phases”, eliminating the level of the stuff in circulation (orchiectomy), or in an intermittent modality (LHRH agonists). Both are good choices if the type of cancer is androgen dependent. Soft drugs substituting the means involving lowering the testosterone are the antiandrogens, pills taken daily but which may interact with other medications for other illnesses.
    HT efficacy can be tested with one shot of Firmagon. If the PSA goes down it would mean that the cancer is hormone dependent. Such could then be continued if you manage the symptoms or substituted with orchiectomy of one testicle to diminish a part of the testosterone in circulation, but avoiding menopause. The PSA would serve as the marker of control.

    I never heard of statins increasing the PSA. I believe that statins decrease the activity of the cancer, therefore lowering the PSA. Testosterone is produced from cholesterol so that lower cholesterol may relate to lower T. You could request a Testosterone test together with your next PSA test to have a base-line value before starting any treatment. Here is a video of Dr. Myers talking about statins influence in PCa;

    http://www.prostatepedia.net/blogs/ask-dr-myers/61783427-statins-and-prostate-cancer

    I am sorry for this difficult and stressful moment in your life.  I believe that PCa will not “kill” you. You may try living with it, try controlling its advancement or try eradicating it. Your choice will be the best for sure.

    Sincerely,

    VGama

     

  • leamon
    leamon Member Posts: 39

    .

    I must report that during the last few months,  there was a significant PSA increase for the 85 year old man that I referrenced....I think that it went to the 70ties.  He had a biopsy that indicated that there were cores of high intermediate, treatment was necessary. His treatment was first a couple of months of  Lupron, followed by SBRT (using the Novalis machine). He is still on Lupron. His PSA reading after SBRT is  1.7.

     

    Dr.s Dad

    Thanks for the reply and info.  I don't think his having treatment changes my view.  It is almost certain that the cancer will increase if we live long enough.  If so, then we make a decision on what to do or not do.  I have leaned toward cyberknife if treatment became desirable but wonder if the small doses of IMRT would be less likely to do real damage.  The old saying, "you pays your money and takes your choice".

    Thanks, and keep up the good work.

    leamon

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,736 Member
    Admirable

    Leamon,

    I very much admire your healthy and balanced attitude toward all of this.

    Like Vasco, I have never heard of statins, which I have taken for 20 years, increasing PSA.   Except in early 2015, your PSA  "doubling-rate" has been very low, which usually in indicative of a non-aggressive disease.  I am NOT deeply read regarding A.S., but I believe that PSA above 10.0 is usually a point at which other treatments are recommended.

    Personally, I feel that surgical removal for a man 83 would be a very bad choice, almost absurd.  I think your idea regarding IMRT is very sound, and likely much less traumatic to deal with, and it also avoids the nasty side-effects described regarding hormonal therapy.

    I have a friend with PCa, now 73.  He had a mildly positive biopsy about seven years ago. His next biopsy was totally negative, undoubtedly what is termed a "false negative," but it proved his cancer is small, limited.  His PSA has remained below 3.0 for the last three years, and the urologist only checks him once a year now.  it is remotely possible that in three or six months your PSA would be at, or below its current level.  Not probable, but possible. Ask your doctor.

    Your calm is the perfect response in your case, I suspect.

    max

  • leamon
    leamon Member Posts: 39

    Admirable

    Leamon,

    I very much admire your healthy and balanced attitude toward all of this.

    Like Vasco, I have never heard of statins, which I have taken for 20 years, increasing PSA.   Except in early 2015, your PSA  "doubling-rate" has been very low, which usually in indicative of a non-aggressive disease.  I am NOT deeply read regarding A.S., but I believe that PSA above 10.0 is usually a point at which other treatments are recommended.

    Personally, I feel that surgical removal for a man 83 would be a very bad choice, almost absurd.  I think your idea regarding IMRT is very sound, and likely much less traumatic to deal with, and it also avoids the nasty side-effects described regarding hormonal therapy.

    I have a friend with PCa, now 73.  He had a mildly positive biopsy about seven years ago. His next biopsy was totally negative, undoubtedly what is termed a "false negative," but it proved his cancer is small, limited.  His PSA has remained below 3.0 for the last three years, and the urologist only checks him once a year now.  it is remotely possible that in three or six months your PSA would be at, or below its current level.  Not probable, but possible. Ask your doctor.

    Your calm is the perfect response in your case, I suspect.

    max

    biopsy

    Thanks fellows.  I'll probably wait a while for the biopsy.  A daughter is planning back surgery in a month or so.  I don't want any "complication" at that time.

    Thanks again for all the info.

    leamon

  • leamon
    leamon Member Posts: 39
    edited October 2016 #9
    New biospy

     

    Hello all, I have been Watchful Waiting for 5+ yrs. A recent biopsy calls for an update. I had an MRI guided biopsy which showed major involvement and a Gleason of 8 or 9(per John's Hopkins). I've seen 2 oncologist. One recommended 2 to 3 yrs. of hormone therapy and 45 external beam radiation treatments. The other suggested 3 to 6 months of hormone ( to reduce the size) followed by High Dose brackytherapy followed by 25 treatments with external beam IGRT/IMRT. Urologist says bracky is more likely to have uninary problems. Unless I change my mind before 11/11, I will start the hormone treatment (Firmagon followed with Elagar) and decide what radiation to take after the 3 months. Latest scans show no spread of the cancer outside the prostate. Any comments appreciated. It seems not many on this board have had Bracky. Psa in May was 14.8> If you want to read the earlier posts, type 'leamon' in the search.  Thanks in advance. 

    leamon

     

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,736 Member
    edited October 2016 #10
    leamon said:

    New biospy

     

    Hello all, I have been Watchful Waiting for 5+ yrs. A recent biopsy calls for an update. I had an MRI guided biopsy which showed major involvement and a Gleason of 8 or 9(per John's Hopkins). I've seen 2 oncologist. One recommended 2 to 3 yrs. of hormone therapy and 45 external beam radiation treatments. The other suggested 3 to 6 months of hormone ( to reduce the size) followed by High Dose brackytherapy followed by 25 treatments with external beam IGRT/IMRT. Urologist says bracky is more likely to have uninary problems. Unless I change my mind before 11/11, I will start the hormone treatment (Firmagon followed with Elagar) and decide what radiation to take after the 3 months. Latest scans show no spread of the cancer outside the prostate. Any comments appreciated. It seems not many on this board have had Bracky. Psa in May was 14.8> If you want to read the earlier posts, type 'leamon' in the search.  Thanks in advance. 

    leamon

     

    sorry

    Sorry about the bio results.

    Using brach for neoadjuvant therapy is sometimes mentioned, but from what I have read, in a case as aggressive as yours, I would not go that route.  The most common employment of brach is for mild, incipient disease, with PSAs below 10.

    Undoubtedly you will get some combination of aggressive IGRT and HT.  I wish you well, and hope total elimination of the disease is possible and occurs. What is potentially CURATIVE in your case is the radiation, while the HT in effect assists the radiation in beating back the disease.

    max

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    leamon said:

    New biospy

     

    Hello all, I have been Watchful Waiting for 5+ yrs. A recent biopsy calls for an update. I had an MRI guided biopsy which showed major involvement and a Gleason of 8 or 9(per John's Hopkins). I've seen 2 oncologist. One recommended 2 to 3 yrs. of hormone therapy and 45 external beam radiation treatments. The other suggested 3 to 6 months of hormone ( to reduce the size) followed by High Dose brackytherapy followed by 25 treatments with external beam IGRT/IMRT. Urologist says bracky is more likely to have uninary problems. Unless I change my mind before 11/11, I will start the hormone treatment (Firmagon followed with Elagar) and decide what radiation to take after the 3 months. Latest scans show no spread of the cancer outside the prostate. Any comments appreciated. It seems not many on this board have had Bracky. Psa in May was 14.8> If you want to read the earlier posts, type 'leamon' in the search.  Thanks in advance. 

    leamon

     

    .

    Bracky is not effective for men with large prostates, thus the recommendation to reduce your prostate size so you might receive this treatment.

    Suggest that you speak with a radiation oncologist that does SBRT. This radiation type is  very precise. The radiation can be directed to encompass the prostate and some surrounding tissue. There are four or five treatments.............a combination of hormone and radiation in my laymans opinion will be very effective.

  • leamon
    leamon Member Posts: 39
    edited October 2016 #12
    Thanks Max and Hopeful.  The

    Thanks Max and Hopeful.  The bracky oncologist was ok with the Gleason score but the size would have to be reduced.  This Dr. says she has done about 1000.  Some things I read indicate less sever side effects but my Urologist doesn't agree. I can't find much up to date experience postings about bracky. Maybe few on these boards have had it. As for the SBRT, some do not take anyone with Gleason higher than 7. The IGRT oncoligist says he does about 40 a week and has been with this place 3 yrs. Don't know about his prior experience.

    leamon

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    edited October 2016 #13
    .

    A study

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4227393/

    gleason 8 results from above study

     76.2% for GS ≥ 8,

    You may wish to compare a combination of GS 8 with hormone versus other treatment choice.

     

  • leamon
    leamon Member Posts: 39
    edited October 2016 #14
    Hopeful, thanks forthe link. 

    Hopeful, thanks forthe link.  Do you know of a similar study for IGRT/IMRT?

    leamon

  • Max Former Hodgkins Stage 3
    Max Former Hodgkins Stage 3 Member Posts: 3,736 Member
    edited October 2016 #15
    View

    Leamon,

    All books and articles (or very nearly all) on the subject of comparing SBRT to fractionated (conventional) RTs (i.e., IMRT-IGRT) show them to be statistically identical in cure rates for PCa. I do not have any studies at hand, but could look for them. I do have comments in book form that I could share, but no one here that I can recall debates this.

    IGRT would take about five or more weeks of treatment to deliver around 76-80 Gray ("Gray" is a measure of radiation dose), SBRT about five days for approximately the same amount of Gray.  Think of IGRT as drinking from a shot glass, while SBRT is drinking a Slurpie Big Gulp at 7-11. 

    Convenience is a major selling point for SBRT.  There are cases in which SBRT is less ideal, and radiation oncologists revert to fractionated, but there is no reason to get into that here....debate over how to cover the prostate bed to kill micrometastatic cells, etc.  With good imaging and results, a radiation oncologist will know pretty clearly if SBRT is suitable.  In America SBRT consists of essentially two machines: the Cyberknife, and products made by Varian.  Some centers buy one, some the other (and some smaller facilities have neither).

    max

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    .

    another platform for sbrt

     https://www.novalis-radiosurgery.com/patient-center/faqs/

    ................................................................

    brahytherapy outcome for high risk patients 63 %  , in a dated 2010 study

    "The biochemical outcomes with brachytherapy are also durable with longer term follow-up. Taira et al.reported 12-year bpfs rates of 97.4% and 96.4% respectively for low- and intermediate-risk patients (n = 463) treated with prostate brachytherapy monotherapy 7. Results from the BC Cancer Agency for 1006 patients with low- and “favourable” intermediate-risk disease, of whom 65% received neoadjuvant androgen deprivation therapy (adt), demonstrated 5- and 7-year bpfs rates of 95.6% and 94% 8. For 1449 patients, 27% of whom received adt and 20% supplemental ebrt, Potters et al. reported 12-year bpfs rates of 89%, 78%, and 63% for low-, intermediate-, and high-risk patients 9."

    external beam

    "External-beam rt may also be combined with high-dose-rate (hdr) prostate brachytherapy. As with the combination of ldr brachytherapy and ebrt, the combination of hdr brachytherapy and ebrt has produced biochemical outcomes of 96%, 88%, 69% at 5 years for modified low-, intermediate-, and high-risk groups 13."

    Total study....worth reading total study

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2935704/

    Best

    "

     

  • leamon
    leamon Member Posts: 39
    Thanks Max and Hopeful.

    Thanks Max and Hopeful.

  • leamon
    leamon Member Posts: 39
    Update

     

    After my recent biopsy, it seemed advisable to start treatment. I was told by my Urologist that treatment would be IGRT/IMRT and 2 to 3 years of HT. I consulted with his associate, a radiation Oncologist, and he said the same with no other options mentioned. I consulted a brackeytherpist. Because of the danger of heart damage, she suggested HT for only 3 to 6 mo. to reduce the size of the prostate. First time heart damage was mentioned so I talked to my cardiologist. He was not in favor of HT unless it became necessary. I then consulted with a radiation Oncologist at a major hospital. He laid out 3 options, do nothing, radiation or radiation plus HT. The last was not his choice but he would accept my choice. I was not a candidate for SBRT, so it would be IGRT/IMRT. He laid out the chances of a cure with or with out HT. If I wanted HT, he suggested a 1 mo. shot as a trial, the first to suggest the smaller dose. He also would bring in a medical Oncologist. He also showed me the graph that estimates the chances of dying with Pca with no treatment. For my age (83) and Gleason (8 or 9), 6 out of 100 would die from Pca. Radiation is my choice.

     

    The point of all this is; don't accept the first opinion and be aware of the heart damage possibility with HT.

     

    I started radiation Nov. 3. After the 2nd treatment, I had to go to the Emergency room and get my “radiator” drained. Looks like a “fun” 2 months.

     

    I thought about posting details of the significant issues that occure (maybe in my 'profile'?) altho it's doubtful if that will add to what others have akready posted.

     

     

     

     

     

  • hopeful and optimistic
    hopeful and optimistic Member Posts: 2,333 Member
    .

    Thanks for the update

    Wishing that the rest of your treatment is  non eventful ,  and a speedy recovery.

    h

  • VascodaGama
    VascodaGama Member Posts: 3,513 Member
    Great report

    Great report. There are many reading your posts and benefiting from your updates (even if they do not participate in the discussions). Please continue reporting on the issues.

    I couldn't understand the full protocol of your treatment. Have you started Firmagon?
    How many Gy (RT dose) and number of RT sections have been planned?
    Did they check the PSA before starting HT?, RT?

    What do you mean by saying: "I had to go to the Emergency room and get my “radiator” drained"?

    I wonder what has been decided in regards to the above comment/occurrence. There have been cases that patients had to suspend radiation for a number of days without problems. The radiation would continue and the dose would be rescheduled with no loss in the benefits of the treatment. Some busy clinics do not like delays because of machine's fixed schedule for other patients, but you should only continue once the problem is solved.

    I hope all is "fixed" and that the treatment is successful.

    Best wishes,

    VG

  • leamon
    leamon Member Posts: 39
    Added info

    Thanks Hopeful and VG for the replies and best wishes. The 'radiator' (a country boy expression) is the bladder . I had to go to the Emergency room late night after the 2nd treatment. A lot of pain for a few hours and finally decided I had to go. For anyone that has that almost constant pain and can't urinate, you might as well go to the ER. It won't go away.

    My cardioligist, the oncoligist I chose and myself all agreed to take HT only if it became necessary. The HT would increase the cure rate by abount 15% but with only a 6% chance of dieing from Pca, is it worth all the problems that are a part of HT especially at this age?  VG, the total radiation was 39 sessions for a total of 78 or 79 Gy. VG “I wonder what has been decided in regards to the above comment/occurrence.” If I understand you correctly, they thought the early occurance of this might have been because of a large prostate. They left the cath in until Monday and didn't do the Friday session. Monday they removed the cath and resumed. For the treatment we have to drink 24 oz. of water 30 minutes before. I had trouble holding that Monday but not today. I had to get up several times last night. Probably because of the cath and FloMax. I seem about normal today. The last PSA I had was in May. It was, I think 14.8.

    Thanks again for the wealth of info.

     

    leamon