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Recent results of prostatectomy, with detectable PSA

Arnoldpig
Posts: 13
Joined: Jan 2021

 4 months after my prostate surgery, i had a PSA of 0.14.. My gleason score was 9...They now want me to do hormone and radiation and stay on the hormone trt. for 18 months to 3 years.. I am very woried about the side effects of hormone trt... I just turned 78 yrs. old..

Thanks Arnold

Clevelandguy
Posts: 646
Joined: Jun 2015

Hi,

If it was me I would wait for a couple more PSA tests to see if they trend up or down or flatline.  If your PSA does continue to climb it sounds like your doctors have charted the traditional course of treatment.  I would want a PET scan to show where the cancer has spread to for the radiation treatment targeting.  From what I know I would think the hormone treatment might actual make the cancer harder to find by shrinking the tumor prior to the PET scan.  Maybe wait til after the scan to start hormone therapy?  Proton & Cyberknife radiation are two popular options for treatment.  If you need to go down that route now is a good time to research the various treament protocols.

Just my thoughts as a learn as you go Pca survivor.................

Dave 3+4 

Arnoldpig
Posts: 13
Joined: Jan 2021

I am leaning that way to wait and watch PSA and see what it does.. I am also trying to schedule a second opinion with another oncologist..

Thanks for info..

Arnoldpig

VascodaGama's picture
VascodaGama
Posts: 3296
Joined: Nov 2010

Arnold 

Welcome to the board. I wonder what you mean with the “hormone trt" you write above. The term  “trt" stands for testosterone replacement therapy,  which is not traditionally applied in PCa recurrence cases.

The typical treatment for recurrences from surgeries (RP) is the dual Hormonal plus Radiation therapy which combines chemical castration (androgen depletion) to weaken the bandit and then followed with a period of radiation sections (two months depending on the type of RT) to kill the bandit. The hormonal portion starts two months in advance of the radiation and continues being administrated during a period that can last 6 to 18 months. Surely this hormonal treatment period can be extended by the doctor depending on the status of the patient but it can also be shorten at the request of the patient.

Can you provide more details about your case. What was the PSA before  surgery? Do you have the results from previous image studies, what has been found? Do you have any other health issues?

A 0.14 PSA 4-months post RP signifies biochemical failure. Recurrence is typically attributed to higher levels above 0.2 ng/ml. RT is typical but patient’s age and other health issues are also considered when deciding on an option. Radiation is not usually recommended in symptomatic cases. Instead doctors prefer to recommend palliative hormonal therapy alone or a combination of hormonal plus chemotherapy. In any case, the PSA is still low and you got time to think on what to do. Recurrence treatments work as well if the PSA is higher at the 1.0 mark.

Dave above is giving you good advice.  I recommend that you get a PSMA-PET scan before starting the hormonal treatment for locating the bandit’s hideaways, otherwise the radiation may be delivered in the dark missing the bullseye (the bandit). 

Treating is a must do thing but in your age you need to consider the quality of life as priority. Palliative approaches could be an option too.

Best wishes and luck in your continuing journey. 

VGama

 

 

Arnoldpig
Posts: 13
Joined: Jan 2021

 Thanks VGama, The trt. abbreviation I used was ment for treatment i dont understand all these terms..

My PSA before before surgery was 20.. i had a whole body scan.. In the left calvarium is a small focus of nonspecific uptake.Otherwise no definite suspicious uptake to suggest osseous metastic disease. No abnormal uptake at T10 and L1 at the small scierotic lesion seen on CT. Prostate is mildly enlarged. Had a 17mm simple cyst posterior right kidney. and kidney stones..

Pathology report afterRobot- assisted laparosopic radical prostatectomy with bilateral incremental surgey - Gleason 9, T3a disease occupying 45% of the gland by volume with involved left apical margin and negative lymph nodes.. They removed 9 lymph nodes.. sugery date 8/12/20..

I am 78 years old..I have no other health problems and I am pretty active.. I play a lot of golf during summer..

Thanks Arnoldpig..

VascodaGama's picture
VascodaGama
Posts: 3296
Joined: Nov 2010

Hi Arnold 

I now understand better your situation. You may have confused “trt" with  “srt".

The results of previous image studies (bone scan and CT) you describe above did not find significant lesions that could relate to cancer at far places which led to the initial choice of surgery. This time your doctor may be thinking therefore on a localized recurrence (at the prostate bed and surrounding tissues). They typically treat these cases with SRT (salvage radiotherapy) zipping the whole area with low Gy doses,  doing it earlier in the dark when the PSA is still low (at the biochemical failure stage), disregarding the recommended recurrence threshold PSA level of 0.2 ng/ml.

You can accept this modality or wait till the PSA reaches an higher level indicating recurrence.  Some doctors prefer to allow a longer period for tissues recovery after surgery before starting radiation to prevent damage to the tiny muscles (sphincter) controlling continence. 

In your shoes I would discuss the matter with your doctor to be more informed on the options and related quality of life. You can inquire on the possibility in having a PET scan to confirm the results of previous scans too. After all he wants to eliminate the bandit but you will endure the side effects, if any.

Best wishes. 

VG

(Has your acronym something to do with the "Green Acres" TV show?)

 

 

Arnoldpig
Posts: 13
Joined: Jan 2021

Thanks VG

Arnoldpig
Posts: 13
Joined: Jan 2021

 Does anyone know about a new drug, orgovyx for prostate ?

Old Salt
Posts: 771
Joined: Aug 2014

Very expensive ($2300/month), unless you have some sort of discount. 

Although it looks like taking this drug orally is an advantage over getting 'stuck' once every three or six months, it also means that 'forgetting' to take your daily dose is a disadvantage that can't happen with the deposit type drugs like Lupron, Degarelix, etc.

amdenver
Posts: 15
Joined: Dec 2020

https://www.fda.gov/drugs/drug-approvals-and-databases/drug-trial-snapshot-orgovyx

 Edit:

Also more info and free trial offer at:

https://www.orgovyx.com

 

Arnoldpig
Posts: 13
Joined: Jan 2021

Thanks amdever and VG.

VascodaGama's picture
VascodaGama
Posts: 3296
Joined: Nov 2010

It was on trials in 2017, to verify safety and efficacy.  The results were similar to the more familiar drug degarelix (Firmagon). This is a LHRH antagonist doing the same job as the LHRH agonists (Lupron, Eligard, Zoladex, etc) used in hormonal treatments to cause chemical castration. 

The main difference between Orgovix and Degarelix is that it is taken in pills which avoids the discomfort of the injection used to administer firmagon.  The side effects are reported to be equal, therefore friendlier to those with cardiovascular issues. The pharmaceutical is giving the drug free of charge for a short period. Here is a link to more information on the drug's efficacy;

https://www.urotoday.com/conference-highlights/asco-2020/asco-2020-prostate-cancer/121804-asco-2020-hero-phase-iii-trial-results-comparing-relugolix-an-oral-gnrh-receptor-antagonist-versus-leuprolide-acetate-for-advanced-prostate-cancer.html

Best 

VG

Arnoldpig
Posts: 13
Joined: Jan 2021

Thanks VG.. Are you a doctor?

VascodaGama's picture
VascodaGama
Posts: 3296
Joined: Nov 2010

No. I am not a doctor.  I have been curious about all things related to prostate cancer since my diagnosis in 2000. Along these years I have studied and read many clinical papers and have followed developments in researchers works; on drugs, treatments and their results. I have followed the stories of patients of all ages.
My lay opinions do not substitute those presented by your doctor or care provider. I believe that doctors prefer educated patients. They understand the facts and get to a final decision faster.
I recommend you to research more on the matter, prepare a list of questions and discuss them with your doctor.
Best
VG

Arnoldpig
Posts: 13
Joined: Jan 2021

 Thank you Vg, your views are appreciated...

A.P.

Georges Calvez
Posts: 491
Joined: Sep 2018

Hi there,

You have to remember that these drugs work indirectly affecting the ability of the pituitary to produce FSH and LH, the latter stimulates the testicles to produce testosterone.
When you stop taking the drug it takes several weeks or months for things to return to normal, if you have taken them for long enough then you will never return to normal you are castrate for life.
If you have taken Orgovyx for a few months I reckon you can miss a day and nothing will happen.
It takes four days to induce chemical castration, < 50ng/L of testosterone, I reckon it takes a while to climb back up again.
They were experimenting with Degarelix for sex offenders and they were giving them the standard 80mg dose every three months and that was keeping them satisfactorily castrate.
https://pubchem.ncbi.nlm.nih.gov/compound/Relugolix#section=Pharmacology

Best wishes,

Georges

Arnoldpig
Posts: 13
Joined: Jan 2021

I 1st hormone treatment 2/12/21 with a injection of Eligard, Lupron Depot and a daily pill of bicalutamide 50mg for 30days then start radiation on 3/30/21... The injection is supposed to be a 3 month injection.. Another one is scheduled May the 7th and July 30th.. I am worried about side effects and dont know what to expect..

Thanks

Max Former Hodgkins Stage 3's picture
Max Former Hodg...
Posts: 3577
Joined: May 2012

Arnold,

As others have mentioned, your doctors are proceeding exactly according to best practices for refactory PCa following prostectomy.   "Refractory" simply means a cancer that was not 'cured' by initial (first-line) therapy. Clinically, you are not in relapse, since you were never clinically at a point that would be called 'cured.'    Experts argue over whether the word cure should ever be used in the context of cancer.   What it does mean when used s simply that there is no evidence of disease, long term  (N.E.D.).   This is also called complete remission (C.R.).

HT for a few months, followed by IMRT radiation:  this is the best option that exists.   Some few doctors would also throw in some chemo, but Taxotere is harsh, and most would not introduce it at this point (Taxotere and Prednisone is the most common chemo for PCa).    The exact drugs combined for HT also varies some between doctors. 

Every case is different, but HT alone ordinarily gives men several more years, and a few here have gained DECADES of good quality of life.  The radiation is potentially curative, but it will take a long time for that to be verified.  Bottom line: at 78 years of age, you very likely will be here writing to friends for a long time, and will likely also live to whatever age you would have reached without ever having had PCa.  These are generalities, but you have much cause for hope.

Old Salt
Posts: 771
Joined: Aug 2014

Side effects are mostly due to the lowering of your testosterone.

The most common side effects of LUPRON DEPOT include hot flashes/sweats, headache/migraine, decreased libido (interest in sex), depression/emotional lability (changes in mood), dizziness, nausea/vomiting, pain, and weight gain.

Side effects are likely to show up some time after the Lupron shot and vary a lot among individuals.They can be counteracted by staying active and lowering your intake of calories.

VascodaGama's picture
VascodaGama
Posts: 3296
Joined: Nov 2010

Hi Arnold, 

It seems that the protocol of your treatment is the common combination many guys have gone through. The hormonal component will cause hypogonadism and you will experience sort of menopause symptoms. These are mild in some guys but some report nasty experiences. For me fatigue was the worst. I  experienced many symptoms but many just come and go in a short period of two months and some were there but unnoticed. 

At the end period of my hormonal treatment I experienced kind of arthritis in my feet and knees. Yes, it was ugly but when the last shots effectiveness ended, the testosterone increased and the symptoms disappeared. 

In any case,  you can request your doctor to stop the hormonal  shots earlier if the symptoms become unbearable. In my lay opinion 6 months of Lupron (2×3-months) is enough to  accomplish its purpose in the combination therapy.  The radiation is what kills the bandit. 

Best of lucks. 

VG 

Josephg
Posts: 256
Joined: Jan 2013

Arnold,

I went through a combination Hormone/Radiation treatment a number of years ago, and in fact, I am again embarking upon a combination Hormone/Radiation treatment now.  If you would like to review my previous experiences, I have listed some links below, where I talked about my experiences with both the Hormone and Radiation treatments.  Please note that my previous Radiation treatments used a different therapeutic approach, IMRT (many visits with small radiation dosages per visit).  My current Radiation treatment is the same therapeutic approach that you are now embarking upon, SBRT (few visits with large radiation dosages per visit).

Hormone and Radiation Salvage Treatment Experiences

http://csn.cancer.org/comment/1414101#comment-1414101

http://csn.cancer.org/comment/1414282#comment-1414282

http://csn.cancer.org/node/299431

I wish you the best of outcomes on your PCa journey.

Arnoldpig
Posts: 13
Joined: Jan 2021

Thanks Max, Old Salt, VG, and Josephg for the info this forum is great..

Arnold P

Arnoldpig
Posts: 13
Joined: Jan 2021

I was prescribed to take this pill Bicalutamide 50mg once a day for 30 days along with my 3 month shot of Eligard before I start radiation march 30th. Anyone know what the pill is for or what it will do..

Thanks Arnold P

 

 

VascodaGama's picture
VascodaGama
Posts: 3296
Joined: Nov 2010

Bicalutamide is an antiandrogen. It works at cells' androgen receptors preventing these from absorbing testosterone (the bandit 's food).

Typically it starts being taken one or two weeks before the initial Lupron shot to avoid "flare". Flare represents a sudden surge/increase of the testosterone. It is a condition caused by Lupron during the initial one to two weeks post shot.

The side effects of bicalutamide are usually mild but it can lower the libido (or cause ED) and influence periods of hot flashes. Guys with acute cardiovascular issues should inform their doctor.

Best wishes for a successful outcome. 

VG 

Arnoldpig
Posts: 13
Joined: Jan 2021

Thanks again VG

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