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Hope??

Sadie marie
Posts: 63
Joined: Sep 2016

My husband is diagnosed with prostate cancer. His PSA was 87 and size of prostate was 130. His bone scan was clear and at present no organ. Doctor thinks it is in lymph nodes because of size and PSA.frozen dissection today. Won't do surgery if any in lymph node. Said he would have to throw everything at it and it is a huge mountain to climb. Gleason was 7 and 8. sounds so bleak. My husband is 64 walks 5-6 miles a day. Some urine urges and a little ED otherwise seems healthy good appetite and sleeps well. Is this hopeless.

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GeneRose1
Posts: 64
Joined: Aug 2016

Sadie, That's precisely what's happened to me. I had surgery to remove my prostate in April 2014 and then had several months of radiation treatment and hormone blocking (ADT) therapy with an injection called Firmagon. That brought my PSAs down to 0.06 which is fantastic. I highly recommend you go online and research side effects for any type of ADT (Firmagon or Lupron); especially the part about Type 2 Diabetes. I was fine for a little over two years and now the cancer is back with a vengence. Even though it's still prostate cancer, it has reestablished itself in my spine and pelvic area and is growing at a rapid clip. I start a new program a hormone blocking therapy tomorrow with a drug called Casodex followed with injections of Lupron. That should get everything under control and help start rolling the cancer back. There are treatments for prostate cancer in the bones - particularly a drug called Xofigo and another that's just coming out called Lu-177. I highly recommend you review the discussion board and research VascodeGama's and Old Salt's posts on these topics. When I go see my oncologist, I always have a bunch of questions written down to ask him and also print out VGama's and Old Salts posts for further discussion. The good news for your husband is that there are a lot of new treatments coming out. The trick is to get it under control and stay vigilent for any changes. Once there's any upticks at all, get with your oncologist to get it back under control. Also, there is a book written by Dr. Patrick Walsh called, "The Guide to Surviving Prostate Cancer". It is an encyclopedia of knowledge on EVERYTHING related to prostate cancer and can be picked up at your local bookstore. There are tons of guys who are in their 70s and 80s who have been fighting prostate cancer since the 1990s. They don't panic and just take it one challenge at a time. The guys who die two or three years after they're diagnosed are usually the ones who just curl up in a ball and give up. Don't let that happen. There's no reason for it and I'm confident your husband has got many, many years of life ahead of him. I sincerely hope this post does some good and I look forward to hearing from you in the future. Best/Gene

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VascodaGama
Posts: 2932
Joined: Nov 2010

Marie

The new finding on cancer in bone is not good news. This may restrict an option involving typical radiation treatment. In other words you have to think over again on the possibilities of each option. I am sorry for the situation.

I wonder if you have obtain a copy of the exam this time to compare with the previous. Most probably they are different exams (different machines, techniques, contrast agents, etc), if not the results are fake or the radiologist is not the same man that interpret the images. Cancer does not grow to such sizes in such short period of time (one month). From your shared information I think it to be very ambiguous.
Sincerely, in your shoes I would not trust the report and would look for a second opinion on the films from an independent radiologist, before proceeding further.

Cancer in bone sets your man in the stage 4 classification. These patients are treated differently and may be restricted in certain clinical trials. You need to discuss everything again with his physicians. Surely he can start the hormonal treatment but the intent at cure is not in jeopardy.

Get answers.

 VGama

Sadie marie
Posts: 63
Joined: Sep 2016

Thank you for responding. He has had one Lupron shot. Oncologist personally called and said it did look like something is there. He said at present still no chemo and he is now a candidate for trial of Lupron and xtandi. But he wanted to check out before anything was signed. You mentiones intent to cure not in jeopardy there is no cure right. I have read swog9308 which says one with minimal metastatic had median survival of 7 years with just hormone treatment. Did I misinterpret and what does the Xtandi help with does it add to survival? Thanks for any input I am very scared.

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VascodaGama
Posts: 2932
Joined: Nov 2010

Marie

Regarding your inquire on my comment; "You mentiones intent to cure not in jeopardy there is no cure right", it means that if your husband decides to have a radiation therapy in the future, the hormonal therapy he has started now it would not place the effectiveness of radiation into jeopardy. In other words, cure would be possible if one of the radical treatments (surgery or radiation) can be administered with success.

From the diagnosis you shared here before, we may have ruled out surgery because the cancer is not contained, but radiation was still an option. However, radiation success depends on the location of the cancer so that the last image study results become important in the final decision. In this respect I cannot trust the results provided by his doctor (your post of today) without a second opinion.

The Hormonal treatment with Lupron and Xtandi could be started at any time. These drugs will control the advancement/grow of the cancer, until the patient becomes refractory. The treatment is controlled via testosterone tests and the PSA. Once refractory is set in then the patient is moved into other set of drugs before starting chemotherapy. These are all palliative but allow the patient many years of life and enjoyment. Some guys with no other illnesses managed over 15 years.

The side effects are numerous (some mild others more accentuated) but can be controlled with a change in the life style, diets and fitness programs. He needs to be vigilant with bone health, the lipids and any heart problem along the therapy.

Best,

VG

Here is a link for nutrition that may be of help;

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

Sadie marie
Posts: 63
Joined: Sep 2016

Got info on clinical trial. They are seeing if adding Xtandi to Lupron from the start helps. As VG stated earlier one group gets a placebo while other group gets Xtand. All costs are covered and you get $44 each time. We have a couple months to decide and we can talk to radiation oncologist and if possible have that done prior to starting. Is 3 spots on left hip minimal advanced. Will radiation help? How can they tell if Xtandi helps when men react differently to Lupron some is very effective others don't last long.

Old Salt
Posts: 720
Joined: Aug 2014

How can they tell if Xtandi helps when men react differently to Lupron some is very effective others don't last long.

Let's get this straight.

Lupron is generally very effective in driving down testosterone levels. What differs among men are the side effects. Also, some men become refractory (the cancer cells have changed and don't need outside testosterone any more to thrive) earlier than others.

Regarding the clinical trial:

Whether Xtandi 'helps' will take time to figure out. That's the reason for the trial. I haven't read the protocol (you should though), but it seems likely that the group will be followed for several years.

Did you ask whether this is a blinded trial? In other words, will your husband know whether he gets just Lupron or Lupron + Xtandi?

Sorry, but I am not able to answer your question about the spot radiation.

Sadie marie
Posts: 63
Joined: Sep 2016

Yes it is a blind trial. I guess I meant if some become resistant faster will it matter if they have Xtandi with the resistance factor

Old Salt
Posts: 720
Joined: Aug 2014

Normally, Xtandi (enzalutamide) is used after Lupron (or a similar drug) has failed in patients with metastatic prostate cancer. At that point, Xtandi will still be effective since its site of attack is different (it binds to androgen receptors in the cancer cells). Unfortunately, resistance to Xtandi may develop after a certain amount of time.

The purpose of the trial is to find out if using the two drugs together from the start will extend the time to 'double resistance'. Even if resistance to both drugs develops, there are still other methods to control the cancer. And who knows, this is a very active field of research, perhaps another therapy will become available.

As an aside, Xtandi is VERY expensive, and getting the drug for free in a clinical trial is something to consider. Of course, it won't be known if your husband will actually get Xtandi, since you wrote that the trial is blinded. Suppose your husband gets just Lupron and if resistance develops, does the clinical trial offer some help?

Better info:

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

Sadie marie
Posts: 63
Joined: Sep 2016

No they won't till trial is done. What is average length of time Lupron works? Can the 3 spots on hip possible be treated with radiation?

Sadie marie
Posts: 63
Joined: Sep 2016

looking at second bone scan: Impression: increasing focus of abn tracer uptake involving the left os pubis extending into the left inferior pubic ramus, as well as a new focus along the right sacroiliac joint, likely representing progression of osseous metastatic disease. Can anyone tell how serious this is. Can radiation be used. I realize it is very serious, the whole disease is serious, but is this treatable.

Sadie marie
Posts: 63
Joined: Sep 2016

saw radiation oncologist today said he couldn't or won't do anything till there is actual pain and hope for the best with Lupron until it becomes refractory which could be 5-10 years which is different than urologist saying maybe 2 before it's over. Still trying to decide about Xtandi trial. Not knowing if you are really getting real meds is hard to decide plus it's with urologist not oncologist. So much to try to absorb.

 

Old Salt
Posts: 720
Joined: Aug 2014

If your husband will get only the Lupron in the trial, it should still drive down the cancer. At least, that's what we hope. Once he becomes resistant to it after X number of years, Xtandi will still be an option.

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VascodaGama
Posts: 2932
Joined: Nov 2010

Marie,

I am sorry for the situation. I agree with Old Salt comments. Lupron will hold the bandit. Meanwhile you can discuss with other radiologist to get an opinion on the radiation possibility.
Keep checking the PSA every three months and the lipids annually.

Best wishes,

VG

Sadie marie
Posts: 63
Joined: Sep 2016

I am very confused trying to study all the info out there. I've read the SWOG 9346 report on continuous hormone therapy in people with low volume metastatic median survival was 7 years. But other info says hormone therapy only lasts 18-24 months. Am I missing something or misreading report.

Old Salt
Posts: 720
Joined: Aug 2014

Sadie Marie,

You are comparing apples (when does hormone therapy fail?) to oranges (how long until death?). As we tried to explain earlier, once the first kind of hormone therapy (like Lupron) fails, there are other therapies that should be tried (like Xtandi etc). Hence, life can be prolonged by many years after failure of the first hormone therapy drug.

Keep the faith!

PS: did your husband enroll in the clinical trial that you wrote about?
 It's almost a month since the first Lupron shot. When will he get his PSA measured?

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VascodaGama
Posts: 2932
Joined: Nov 2010

SWOG was a trial to compare hormonal therapy effectiveness in two modalities. Administered continuously against  intermittent. They say that continuous treatment (meaning continuous chemical castration) is not inferior to intermittent in regards to biochemical survival period length. However, the effects of the treatment were not compared. The 7 years you comment may refer to the period in treatment before the patient experienced refractory. However, there is a higher percentage of refractory cases when patients go over the two years in continuous treatment.

In my opinion the period for hormonal therapies should consider efficacy with the lesser side effects and the longest survival before refractory. Intermittent protocols allow periods away from the side effects and permit recovery from hypogonadism which will benefit other body systems dependent on androgens. It is thought that it also extends survival delaying refractory. Intermittent modalities are regulated by PSA thresholds and castration levels. The typical is one year in remission levels of PSA>0.05 ng/ml with testosterone at castrate levels of lower than T=30 ng/dL; and off drugs till the PSA increases to a threshold defined by the oncologist to such particular patient. In my case this threshold is PSA =2.5 ng/ml. Some guys are higher at 5 or 10 ng/ml.
In such regard, the patient restarts the hormonal treatment with one months of antiandrogens followed by a shot of Lupron or similar (LHRH agonist).

Typically, the one year on remission can be achieved with 18 to 24 months in castration levels. Periods above such length are not recommendable because the problem with the faster refractory possibility.

Hope the above answers your question.

Best,

VG

when we

Sadie marie
Posts: 63
Joined: Sep 2016

So you are saying lurpron only last 18-24 months. The study said continuous hormone therapy was advantageous to those with low volume metastatic hormone sensitive cancer than intermittent. Intermittent was better for those with high volume. Didn't say anything about refractory. Median survival for low was 7.1 years. Just trying to grasp the effectiveness of lurpron as we go forward. We are still looking at trial with xtandi while we wait to get appointment at Washington University in St. Louis for second opinion.

Gleason Score 9...
Posts: 62
Joined: Nov 2016

Hi Sadie,

I have been reading your posts and the comments. We also live in Illinois and my husband was just diagnosed yesterday and I am really, really scared. We have Gleason scores of 9 & 10 and a bone scan and CT scan scheduled two weeks from today. His pathology report also shows perineural invasion as identified.  

I am curious what part of the state you live in? We are in east central area and are also considering a second opinion after we get all the results. In reading other posts, I have come across John Hopkins University (JHU) remote second opinion program. JHU seeminly has the number one urology program in the nation. Wash U is certainly wonderful and we may head there as well, or Chicago. One interesting thing about the JHU second opinion is they give you an opinion on the pathology, course of treatment, and suggestions for physicians/surgeons in your area to help. Please see below for the link if you want to review.

http://www.hopkinsmedicine.org/second_opinion/

My thoughts and prayers are with you!

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VascodaGama
Posts: 2932
Joined: Nov 2010

From your posts I believe that you want to know for how long your man is going to live if he takes Lupron. However, as you may understand nobody can provide you with such answer. It could be 7 years (SOWG) as 15 years or more. The end of the treatment is when your man becomes refractory to all drugs.
The above discussion refers to the drugs' efficacy in the overall treatment. To understand the matter you need to investigate more regarding the "mechanics" behind HT administration and what has been in discussion by the fellas at SOWG.

I have posted in this forum extensively several references regarding the SWOG trials on HT. Unfortunately CSN administrators never tried to improve its search engine so that I cannot provide you the links.  In any case my opinion is that the effectiveness of Lupron in the treatment is not endless. It can continuously avoid the manufacture of testosterone by the testis, depriving cancerous cells from its "food", the androgens, but the bandit manage to mutate its androgen receptors (its mouth) to live of tiny portions of the substance or even start producing testosterone by itself (as a means of survival understood via Darwin principles).
When the above occurs, the patient experiences a period of refractory to the treatment, meaning that the drug is not effective in the treatment (but it can still be working properly in maintaining our body at castration levels). Accordingly, your comment of:  lupron only last 18-24 months means efficacy in the treatment before cancer mutates and looks for means of survival (refractory). Long periods in castration may accelerate this process, so that one should exchange drugs the soonest before it occurs.

The SOWG trial's 7.1 year, refers to the length of life of a patient in continuous HT treatment. You may find this comments confusing but the trial was never clear enough and it has been controversial since its beginnings. The fact is that HT has distinct applications dependent on the patient status and type of cancerous cells.

The trial 9346 were done to compare intermittent against continuous modality involving a cohort of patients with metastatic cancer, not discriminating its extent. Where these mets located in bone alone, or in bone and tissues, or tissues alone, or........
The results were presented indicating that the modality intermittent was "inferior", however, another previous trial prove the contrary (intermittent "superior") but it was designed to patients of failed radical therapies (which is considered by these oncologists as "localized metastases", wherever they exist).

Regarding the effectiveness of Lupron in maintaining castrate levels of testosterone, the length of its period depends on the type of shot. Lupron injection/shot is available for 1 month, 3 months, 4 months and 6 months. To the above length one should add the drugs' half-life plus approximately 2 month which is the period our body (the pituitary) takes to recover and starts producing testosterone.

The SOWG Trials;

http://www.cancernetwork.com/review-article/prostate-cancer-clinical-trials-southwest-oncology-group-0

http://www.ascopost.com/issues/july-1-2012/swog-9346-conclusions-debated-in-special-post-plenary-discussion/

 

Best wishes,

VG

Sadie marie
Posts: 63
Joined: Sep 2016

Actually I have no idea how long he will live on Lupron that's why I ask questions. I have read it can last months to years. The urologist said we would be lucky with 2 years till death. So I am hoping Lupron last a long time and the urologist is wrong.

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shipjim
Posts: 137
Joined: Apr 2006

Sadie,

I think we understand your fear and confusion.  You're driving  by wanting a schedule so you know what to look forward to and what each stage means and when it will occur.

Unfortunately, cancer doesn't stick to time lines.  You seek hope and you're getting the best advice from many people who have lived this life.  Maybe try the AA slogan of one day at a time.  I don't mean litteraly one day as much as getting yourself settled to accept there are no firm answers.

There are lots of potential  out there, I'm glad you're looking around.  You don't have to be in a giant rush.  It took years to get into him, a few days more probably won't matter while you search.  You also have mentioned several types of MDs ordering different test and offering different ideas.  Do you have one person MD or experienced RN who, once you assemble the diagnosis, readings and prognosis gathered, you can sit and create some sort of chart or study guide so you can look at all options side by side and then compare, kind of like you can do when online buying things.

You've got to find  way to slow down your mind full of worries as it can't help to go from post to post with no sense of direction.

I don't know if this makes any sense to you but it's the best I can seem to come up with.  You have a lot of info, you need to sift it.

Good luck, keep us posted.jj

Sadie marie
Posts: 63
Joined: Sep 2016

As far as I know our only option is hormone therapy unless we get into clinical trial with xtand. I know no one can tell exact time line I was wondering about average and if there was survival with low volume metastatic prostate cancer. We are going for second opinion at Washington university in st Louis November 30. Not sure if it will help but I don't think it will hurt. He is in good health and positive. The hormone shot seems to have helped with urine flow so that's a good sign I believe.

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Rakendra
Posts: 198
Joined: Apr 2013

   Basically, when one is diagnosed with stage four cancer, there are two choices – faith and fear.  Faith to me means that everything that happens to me is for my benefit, even those things that I do not “like”.  In other words, I totally trust that I am taken care of on a moment to moment basis, and I will always be taken care of REGARDLESS of the outcome.  The proof is that you have always been taken care of in the past, and are being taken care of in the present moment, if you are willing to see that.  The future does not exist, it is only a thought.  No one has ever been to the future.  No one has a future.  There is only this moment and then the next and the next……

You have made the choice of fear, and that choice is causing you suffering and causing you to not be in the moment, and so you miss the blessings that are available to you.  You are always concerned about the future, and you lose the here and now of the present moment.  You are trying to take control to make things happen the way you want.  You are not in charge.  Surrender to,”Thy will be done” and abandon, “My will be done.” The alternative is to simply accept the present moment and celebrate that, even if it is stage four cancer. 

Worrying about life extension is a fool’s game with Pca.  I have had massive and extended matasteses over seventy five per cent of my body with a Psa of 300 and was given six months.  That was four years ago.  Now my Psa is under 1.5 and I am body building again at 85.  I mention this to show that positive thought and acceptance and celebration and trust will add a very healing vibration.  Fear and worry will most certainly feed the negativity of the cancer.  I suggest you read Eckhart Tolle – The Power of Now and A New World.

   I am sorry that you and your husband have to go through this.  You are only seeing the medical problems and ignoring the spiritual.  There is nothing wrong with that, but the consequences are going to be unnecessary suffering.  Love, Swami Rakendra

 

 

 

Sadie marie
Posts: 63
Joined: Sep 2016

You are absolutely correst time to quit moping and enjoy life. He has enrolled in the trial study of xtandi with Lupron. He is joining the YMCA and is very positive. A little down about the loss of libido but we will get through that. Thank you for the wake up.

Old Salt
Posts: 720
Joined: Aug 2014

Glad to read your update and the fact that your husband was accepted into the trial. I am pretty sure that his health will be closely watched.

Will Doran
Posts: 207
Joined: Sep 2015

Sadie,

Amen & Amen to what Swami Rakendra said above. Especially "Thy will be done".  It's one day at a time in this deal.  On Dec 10, I'll be a three years survivor since my surgery. I started with a PSA of 69, and the PSA has remained at undetectable levels (<0.010 --0.035) since my Surgery, Lupron and Radiation treatments.   I see every new day as a gift, and Thank the Good Lord every day for the new day, and for all the doctors, medical and therapy people who have helped and are helping me.

Love, Peace and God Bless

Will

Sadie marie
Posts: 63
Joined: Sep 2016

Ok question? My husband is starting trial and had to to blood test bone and ct scans. PSA went from 87 in August to 2.19 but bone scan showed 4 spots instead of 3. So is this good kinda good or not good?

Sadie marie
Posts: 63
Joined: Sep 2016

Actually nurse couldn't read doctors writing and still only 3 spots one possible "healing" oncologist explained was very pleased with results.

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VascodaGama
Posts: 2932
Joined: Nov 2010

So far, the decrease in the PSA demonstrates improvements. It means that your husband's type of PCa responds to hormonal treatments and that he can expect a long period of survival. The CT result has nothing to do with this improvement. The oncologist may be pleased for confirming the previous results for a fewer number of metastases. If these spots are located at convenient areas then it may be possible to radiate them for good. You could inquire if your husband's case can be considered for an oligometastatic treatment. There is in fact a clinical trial for such patients. Please read this;

https://clinicaltrials.gov/ct2/show/NCT01859221

You can find details here; https://www.verywell.com/sir-spheres-to-treat-liver-metastases-2782224

Best wishes for a good Christmas to both of you.

VG

Sadie marie
Posts: 63
Joined: Sep 2016

January PSA down to .17. In 4 months PSA has gone from 87 to .17. Is this fast enough and how much lower should it go. 

GeneRose1's picture
GeneRose1
Posts: 64
Joined: Aug 2016

Sadie, those are superb results and indicates the effectiveness of the therapy. For me, my PSAs went down to 0.06 and stayed there for a couple of years. That is absolutely wonderful news. He will probably be getting his PSA checked every three months from now on. Vasco De Gama wrote a nice post about his PSAs and the various things that could bump up the numbers from time to time and you should check it out. I'm very happy for you and hope he has many, many years with a very low PSA.

Old Salt
Posts: 720
Joined: Aug 2014

We can't answer your questions whether the lowering of the PSA is fast enough and how low the PSA will go. But to me, these results appear to be outstanding. Clearly, for now, the cancer cells are sensitive to the lowering of the testosterone and dying. You and your husband should be very pleased.

What about the side effects; I hope that they are manageable.

Sadie marie
Posts: 63
Joined: Sep 2016

We don't know if he is getting the xtandi as it is a blind trial. He has fatigue and hot flashes and no libido. Gained a little weight but has joined the YMCA and continues to walk. Sometimes he seems in a fog and a little forgetful. The libido is the worse side effect but he is positive and in good spirits.

Clevelandguy
Posts: 393
Joined: Jun 2015

Hi,

If his PSA went from 87 to .17 sounds like to me that he got the Xtandi or there was a mistake in the PSA test.  Hopefully the next test will also show a low PSA.  Good luck.............

Dave 3+4

Sadie marie
Posts: 63
Joined: Sep 2016

Can PSA go down but bone mets increase at the same time?

VascodaGama's picture
VascodaGama
Posts: 2932
Joined: Nov 2010

I wonder the reason for your inquire. In any case, I would say it to be possible.

Aggressive Gleason rates produce lesser PSA serum and if not dormant it could metastasize further. One may find additional spots in bone while seeing the PSA stable.

 

Sadie marie
Posts: 63
Joined: Sep 2016

PSA .07 bone mets 4th spot that appeared in December gone others degree of activity decreased and intensity decreased. Sounds good.

Old Salt
Posts: 720
Joined: Aug 2014

How is your husband feeling?

 

 

Sadie marie
Posts: 63
Joined: Sep 2016

Feeling pretty good. Does get fatigued so he is changing when he takes the blind trial medicine to see if that helps. His testosterone is down to.35 so he does get a little disapppointed with loss of libido. Otherwise he is very positive 

Sadie marie
Posts: 63
Joined: Sep 2016

In March PSA down to .07 and bone involvement down to 3 with less intensity. Question, I have read reaching this low of PSA in 6 months is a bad thing, is this true?

Old Salt
Posts: 720
Joined: Aug 2014

Those results look great to me (not an MD).

How could reaching such a low PSA in six months be a bad thing? 

Sadie marie
Posts: 63
Joined: Sep 2016

Not sure just was reading a report that stated before 7 months reaching .20 was not a good prognosis however if he is getting trial drug not sure if something like that was taken into account

VascodaGama's picture
VascodaGama
Posts: 2932
Joined: Nov 2010

Marie,

Taking into consideration his initial status shared by you in your first post of this thread, the present results sound good to me. Can you provide a copy of the report you talking about?

Sadie marie
Posts: 63
Joined: Sep 2016

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2931827/

Sadie marie
Posts: 63
Joined: Sep 2016

http://www.sciencedirect.com/science/article/pii/S2287888215000070

VascodaGama's picture
VascodaGama
Posts: 2932
Joined: Nov 2010

Marie,

I do not know exactly what his treatment includes but your concern regarding the study of your link (short time to nadir PSA of <9 months, reaching <0.20 ng/ml) could apply to your husband's case if the patients in the study had the same type of PCa and included the same treatment protocol.

Typically, Lupron alone drives the Testosterone down to castration levels in just two to three weeks. Once at this status the cancer becomes sort of indolent and its response to the treatment, as seen by the decrease in PSA, varies depending on the type of the cancerous cells. Some cells produce more PSA serum than others, or even produce zero PSA. In the case of your husband, his cancer has responded well to Lupron (plus something?) lowering the PSA from 87.0 to 0.07 ng/ml signifying a good result. The extent of the disease (number of metastases) may alter conclusions but it is not definite in concluding that such a patient would present treatment failure (refractory to ADT).

You do understand that ADT is palliative (do not cure) and that the patient is at risk of experiencing refractory one day. In any case, the treatment can be continued substituting the drugs with the so called second-line HT drugs that are more refined to do the job. ADT can last many years providing quality living to the patient, before he starts chemotherapy.

I hope my comment is of help to you.

VG

Sadie marie
Posts: 63
Joined: Sep 2016

You are always very helpful and informative. I read different articles as I find info on metastatic disease and wonder if they pertain. I do realize Lupron will not cure, he is in trial study and may be getting xtandi which would affect PSA I assume. I did read another article that had some promise for a cure. http://www.medpagetoday.com/hematologyoncology/prostatecancer/64834?pop=0&ba=1&xid=tmd-md&hr=trendMD He goes for his 3 month scan tomorrow. Hope the results continue to be good.

Sadie marie
Posts: 63
Joined: Sep 2016

8-9 month results PSA down to .03 bone scan mild interval improvement no new activity one appears more faint one appears smaller. Husband ask about testosterone but doctor said that fluctuates so not importan. I had him call back and ask it was .35. When they say testosterone should be below 20 or 30 do they mean .20 or 20. Actually Doctor didn't give him PSA husband had ask nurse to write down. Do these results sound good normal so so. I appreciate everyone's input.

Old Salt
Posts: 720
Joined: Aug 2014

No, the doctor was correct. Hormone therapy should knock testosterone to below 30 (or so). So it's all good.

VascodaGama's picture
VascodaGama
Posts: 2932
Joined: Nov 2010

To avoid confusion, try getting a copy of the results not just verbal information.

The testosterone is usually measured in ng/dL or nmol/L depending on the laboratory (the PSA is traditionally in ng/ml). When we talk about T levels we tend to be referring to the Total Testosterone, however, this number varies depending on the quantity of the so called Free Testosterone (the one used by the body for particular functions) circulating in the blood. In any case, in PCa matters we use T value for reference purposes to verify the drugs effectiveness. The PSA is used to judge cancer activity; progress or remission.

The normal level of T is between 250 to 800 ng/dL. Chemical castration in PCa treatments is T<30 ng/dL (<1 to 30). Any variation of T within the brackets is not important as far as T is maintained lower than 30 ng/dL. In clinical trials researchers use clinical chemical castration at T< 50.
In hormonal treatments, some oncologists use lower values of T to regulate the treatment of certain patients. For instance, in intermmitent ADT they typically require to keep the patient at a T level of less than 20 ng/dL for at least one year, before stopping the administration of HT drugs (off-drugs period). I never saw a testosterone measurement of 0.20. The smaller value is indicated in <1 ng/dL.

T values lesser than 250 ng/dL cause the majority of symptoms we read so many times in this board. When at chemical castration (T<30) one may expect many deficiencies such as: no sex drive, lean muscle building, cardiac function problems, lower brain function, bone loss, mood changes, etc. Long periods in castration risk irreversible recovery.

Congratulations on another lower level of PSA. This reflects in our previous discussions. Your husband is in remission and we should hope that this can be kept during a long period.

Best

VGama

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