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Am I opening a new chapter?

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

Hello friends,

For those of you who do not recognize me, I am 91 years old and a 26-year prostate cancer sur4vivor. I had radical prostectomy in 1991, underwent radiation treatments in 2005, and went on hormone treatment in 2008. My annual PSA readings were undetectible (<0.1) in 2009 through 2015. The undetectible symbol was removed in 2016. It read 0.1 at that time. I just now learned that it is 0.3 this year.

What now? I am scheduled to see my urologist Friday. I'll let you know this weekend what he says.

Meanwhile, I welcome your comments, questions, suggestions.

Old-timer (Jerry)

 

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3252
Joined: May 2012

Good to hear from you again Jerry, but wish the news were different.

Please do let us know what the doc thinks.

max

VascodaGama's picture
VascodaGama
Posts: 2968
Joined: Nov 2010

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

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3252
Joined: May 2012

Old,

Vasco said to you what I was thinking, except that I lack the technical expertise he possesses.  I had the thought that your PSA is still extremely low. Perhaps riding it out on A/S is an option, or playing the HT cards correctly as Vasco explained. As low as it is, I would hope and suspect that you can make it to the natural end without intervention, or without a lot of intervention.  I hope so.

I have had two friends come to the end on chemo at around 72 years of age.  Obviously, you are a long time from ever thinking chemo, if that time ever comes.  It is harsh and toxic at any age, but for them at 70 it was truly horrible, probably a mistake doing it.  

Bless you and please to let us know what the doctors say,

max

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

Thank you, Max and Vasco. I like your reponses. I anticipate that the Doc will recommend that we wait and check again in three or six months.

I believe in the Harvard School of Medicine's "Slow Medicine." No chemo for me, for sure. I am in reasonably good condition physically (and mentally). My bride of 68 years and one or both of our daughters will be with me when I visit the Doc Friday morning.

I will post a report Friday afternoon.

Old-Timer (Jerry)

GeorgeG
Posts: 127
Joined: May 2017

Perhaps a good baseline for making a decision would be to have your oncologist estimate your disease progression if you do nothing and then estimate the likely changes in projected outcomes with any suggested treatments. Although your PSA is rising past the usual threshold for biochemical failure, it has taken a long time and is still relatively low. AT this point in your life I would think that quality of life would have a strong impact on decisions. Of course I do not know you personally and you might be a real fighter and want to keep running hard at the problem. Good luck.

 

George

 

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

I am happy to announce that I am closing this new chapter. My urologist gleefully told me this morning that a PSA reading of 0.3 for a 91-year old man is not a big deal. He said let's check your PSA again in six months. I'll let you know what it is in March 2018.

Thank you Vasco, Max, and George for your good wishes messages.

I extend best wishes to you and everyone else on this Discussion Board.

I go now to my regular Friday evening bridge game.

Old-Timer (Jerry)

hopeful and opt...
Posts: 2218
Joined: Apr 2009

Glad to read your news... enjoy the game. 

Old Salt
Posts: 720
Joined: Aug 2014

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!

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

My PSA is now (2018) 0.5. That isn't high, but it's moving up. 0.3 a year ago, 0.1 two years ago, <0.1 eight consecutive years prior to that. I have an appointment with my urologist later this month. I am unafraid. I expect him to say "let's keep on eye on it." I'll let you know what happens.

 Old-timer (Jerry)

Josephg
Posts: 151
Joined: Jan 2013

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

Georges Calvez
Posts: 228
Joined: Sep 2018

Hi there,

It is not good, not bad, in my opinion.
The doubling time is very long and you are 91.
Let us say you reach 10 by the time you are 95, maybe 20 by the time you are a 100, if you are lucky enough, not a big problem?
Congratulations on fighting it off for so long, you really are a great survivor, I hope that I have the same luck as you!

Best wishes,

Georges

VascodaGama's picture
VascodaGama
Posts: 2968
Joined: Nov 2010

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

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

Hi Joseph, George, and Vasco. My appointment with my urologist is two weeks away. Vasco, I will talk with him about the points you mention.  I do not anticipate that we will begin any new treatment. Even though my quality of life is still good, I recognize that I am 92 years old. My primary goal now is to continue to live a peaceful life and to, eventually, have it end with little or no pain and discomfort. I have long believed in what Harvard Medical doctors call Slow Medicine. As I understand it, do not accept surgery or treatment that might extend life an additional six months if you are likely to be in pain and discomfort during that six months. I will give viewers of this thread a report after my urologist appointment. 

Vasco, you asked about my wife's melonoma. The surgey was easy and successful. Minor pain and little interferewnce with daily routines. The surgeon wants to look at her after three months. Meanwhile, we continue to lead an active life here in our retirement commmunity.. For example, we show an opera in the auditorium once a month. Our next one is Metropolitan Opera's 2014 producton's of Marriage of Figaro. It's delightful. Wish yoiu could be here to see it.

Old-timer (Jerry)

VascodaGama's picture
VascodaGama
Posts: 2968
Joined: Nov 2010

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

 

Old-timer's picture
Old-timer
Posts: 196
Joined: Apr 2011

Wondering about me? I am still here, and my PSA is OK, at .5, the same as it was 6 months ago.

Some other news about me and my wife. I'll be 93 in August. My wife is 94. Both of us had a stint in the hospital, with the flu, in March. After the hospital stay, we became room mates in rehab! We are happy to be at home again! Next up for us? Our 70th anniversary comes around in June.

We continue to show operas in our retirement community. Last Sunday we showed the Australian production of Cinderella. We are condidering The Magic Flute for showing in May. 

It's good to be in touch with you again.

 Best wishes, keep smiling!

Old-timer (Jerry)

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3252
Joined: May 2012

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

 

max

Georges Calvez
Posts: 228
Joined: Sep 2018

Hi Jerry,

0.5 and holding steady at close to 93 is good, even if it goes up a bit you really have nothing to worry about!

Best wishes,

Georges

Josephg
Posts: 151
Joined: Jan 2013

Great news, Jerry!!

I wish you and your wife all the best.

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