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3 yrs 2 failed tx.What should I expect

pattyann1750
Posts: 2
Joined: May 2018

My husband was diagnosed 2016 with gleasonn 7 prostate ca (psa 11)and tx with external beam radiation and inplaqnt seeds.22

2017 bpsa up 22 and pelvic lymph nodes involved.tx increased strength radiatiom and lupron. after tc psa 1.7

2018 psa back up 3.4. we have a bone scan and CT scan ordered for next week and then see the oncologist 2 weeks.He is only 62 and we have been told with tx he should be good for 10yr or more but we are on yr 3 and it doesnt get better.He is in denial and I am his wife and a nurse who researches everything..They call the first chemical failure and do "salvage tx" so what do they can the 2nd failed tx?I am trying to see the light at the end of the tunnel and I can't.Has anyone been there and can share something positive?I sure can use it.Thanks,Trish

VascodaGama's picture
VascodaGama
Posts: 3013
Joined: Nov 2010

Trish,

Welcome to the board. I have difficulty in understanding what you wrote but will try providing you a comment on what I understood. Please correct me if I phrase it wrongly.

You say that your husband (62 years old) did brachytherapy (22 seeds) plus external beam radiation in 2016 for a Gleason score 7 (PSA=11.0 ng/ml). Later, in 2017, the PSA increased to 22.0 ng/ml and they found lymph node involvement, which was treated with spot radiation plus hormonal Lupron. That decreased the PSA to 1.7 ng/ml, but in 2018 the PSA increased again to 3.4 ng/ml so that his doctor is now requesting a bone scan and CT.

Your question regards opinions on what to do next.

I wonder what was done at the time of the initial diagnosis, before 2016. Did his doctor order any image exam? What was the result? Where there any symptoms that took your husband to consult an urologist?

In 2017, how did they find the positive lymph node? Was it via an image exam? For how long did your husband stay on hormonal therapy (Lupron)? What was the strength of the shot (1, 3 or 6 month)?

The most common salvage treatment for cases with RT (radiation treatment) failure is the hormonal therapy. In highly risk cases (with far metastases) they also use chemotherapy or a combination of chemo plus hormonal.

I wonder the real status of your husband and the effect of the Lupron (ADT). When this fails, doctors add blockades with daily pills of antiandrogens, or change medications to drugs like Zytiga. I think that you should try getting a second opinion from a specialist medical oncologist if this exists at the place you live. Where are you from?

Hope for the best,

VG

 

  

 

pattyann1750
Posts: 2
Joined: May 2018

Thanks for your response  VG.Sorry my note was confusing.

aug 2016 psa 11 and bx done.sept 16 saw urologist  and oncologist.Plan 5 weeks radiation and 68 seed inplant which was done thur dec 2016.CT and Bone scan at that time negative for anything outside  prostate.

May 2017 repeat psa 10.4.Urologist thought it was a bounce  so it was repeated  3 weeks later and up to 22.Urologist ordered Lupron but to say the least he was horrible and a big disappointment in his attn to care and we left him and saw the radiation oncologist and ask for a uro oncologist and we found a wonderful one.She had him on  casodex for a week then started lupron inj 1x month for 2 months and radiated the lymph nodes in the pelvis now involved.Bone scan still clean.Dec 2017 6mo lupron injection  given  as we spend winters in florida but live in Rochester ny.PSA in dec 1.7

May 2018 psa  back up to 3.4 .After his tx he should not have a psa >1.0.My husband has no symptoms except fatigue.Never did.During regular physical 2016 psa had gone from 4.0-11 and  that started everything.In the beginning they promised 10 yrs.No one ever talked about recurrances every year.I am so confused and look forward to more answers at his appt 6/4.I feel we are loosing hope but we pray the next tx will do it.

I hope that cleared up my muttled attempt to explain last night.

 

 

VascodaGama's picture
VascodaGama
Posts: 3013
Joined: Nov 2010

Trish,

I believe that your husband had a biopsy in September that diagnosed the cancer. I wonder if at the beginning (2016) he had an image study apart from the bone scan. I would also like to know his age, the Gleason grade of the cancer and the number of positive needles.

In my opinion the hormonal treatment (ADT) is obscuring the real status of your husband. Your info doesn't fit the dates you write and I wonder if he is still on ADT at the present. In fact, one could even consider "cured" (by the 2016 treatment) without the ADT effect. Nobody allowed time to verify such a status. The treatment of brachy plus IMRT causes PSA bounce which values can fluctuate along 2 to 3 years (increasing and decreasing) presenting a gradual decline till nadir which could occur 4 years after the treatment. In such regard, the PSA of 22.0 increasing from 10.0 post RT could be a natural effect as his initial pre-RT PSA was high at 11.0 ng/ml. After these data, all tests have be masked by the hormonal treatment and become unreliable for evaluation of outcomes.

I also wonder why did the radiologist decided to radiate the pelvic lymph nodes in 2017. This matter should have been included in the IMRT field of 2016. Was there any additional image exam showing positive results for lymph node involvement?

The last PSA (May 2018) 3.4 ng/ml which is an increase from 1.7 (Dec 2017) could be ADT refractory or due to a bad administration of the shot, if he has continued and is still on ADT. Another fact is that many patients do not respond to chemical castration when the tumor got cells not hormonal dependent. The best way to verify if refractory exists will be through a Testosterone test. T value should be lower than 20 ng/dL and the estrogens should be high. ADT could be the cause of the fatigue your husband is experiencing.

I sincerely cannot help you because of missing information. In any case, famous medical oncologists use several alternative drugs to bring and keep the PSA in remission levels. I wonder how experienced your oncologist is and what is she planning to do next.

As precautious, I would recommend your husband to get a DEXA scan to check bone health. Many guys on hormonal drugs need bisphosphanates (Prolia) to avoid further deterioration. He should also get a full panel of lipids and check all cardiovascular issues.

Best wishes and luck in his journey.

VGama

Please note that I have no medical enrolment. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.

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