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genemyers's Message Board Messages

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The psa seems to have stabilized while on Zytiga (since April 2015). Hopefully you will start seeing the psa go down. Might want to continue with the Zytiga for a while to see if it brings down the psa.  Ask your doctor how long to wait to see if Zytiga reduces the psa. Has your father been feeling better since on Zytiga (another indication it is working)?  Are there more bone/CT scans scheduled to compare current status to the last scans before Zytiga?

If the psa starts going up or future scans show progression, a change in medications is needed.

What to switch to depends on how your father is feeling. Is he active and mobile and otherwise in good shape? Or does he have a hard time getting around and appears weak? These are important questions to answer because Taxotere chemotherapy would work but it tends to beat older frail men up with each round of chemotherapy. Taxotere will reduce pain the fastest, but it is harder on the man in terms of side effects.

Xtandi would be the alternative, especially since your dad had Casodex and appeared to respond well to it. Xtandi tends to be easier on the patient than Taxotere. 

You can take Taxotere after Xtandi and Xtandi after Taxotere. Either of these treatments can be started, and then if it does not work or the side effects intolerable, the treatment can be stopped and then switched.

Another thing that can be added is that they can do spot radiation to the bone for pain. This is palliative only and not curative. 

After Taxotere there is also Jevtana (cabazitaxel) chemotherapy as an option. 

A lot depends on how your father is feeling and what are his wishes.  These drugs can be very hard for a man to tolerate and some men decide to skip the treatment  in order to avoid the side effects.  Just realize that your fathers wish might be for no further treatment.

Radium 223 (Xofigo) is not recommended in the United States because it is only for bone mets and is not indicated when there is also known visceral metastatic disease, which your father has.

Hope this helps you.

Gene

RE: Possibility of PC

by genemyers - June 22 at 2:54 AM

A lot of it depends on your overall health condition.  Are you a robust and healthy 76 years, active, with no other diseases or conditions?  Or do you have other health conditions, which likely will limit your life before any potential prostate cancer does?

The American Society of Clinical Oncology recommends that patients do not perform PSA testing for prostate cancer screening in men when they are expected to live less than 10 years.

The reason is that these men are very likely to die of something else, even if they do have prostate cancer.  A small amount of Gleason 6 cancer is common in men your age and it rarely possess a threat in the mans lifetime.

Your psa rise from 2 to 11.5 over 15 years is about a 7 years psa doubling time.  This also with your free psa is indicative of no cancer or a very small low grade tumor that is not a threat to your life.

If you are concerned about this situation you could keep getting psa tests and monitor it for the time being.  If the doubling time gets shorter (like 1-2 years), then you could consider action at that time.

A psa of 11.5 by itself is not concerning.  It partially depends on the size of your prostate since normal prostate tissue is putting out psa and a larger normal prostate will produce more psa.  That is why the doubling time is monitored instead.

There are other genetic tests and scans you could do, if your situation was very concerning to you.  There is no clear cut answer here, but I would bet that you can watch the psa for now, calcuate the doubling time, and monitor the situation without doing anything else.

Best,

Gene

RE: Should I have a biopsy?

by genemyers - June 13 at 2:46 AM

Did the nurse do the DRE? Just curious.

“DRE was enlarged and firm”. “Enlarged” is ok, as it could be anything but “firm” is ambiguous. If it came back saying they felt a “nodule” that would definitely be biopsy time (multiparametric).

Your psa’s of 4.4, 3.7 and 4.7: I consider those the same stable results. So far your psa is not increasing. The difference between 4.4 and 4.7 is within the normal variability of the test on the same man from the same lab from day to day.

You should have been getting free psa’s all along. You might call your doctor and have him send you the lab reports to see if free psa was done. That would give you another data point on what is going on, if anything.

If you do not have a free psa, I would go ahead and get another psa at this time. 

This is a hard call on getting a biopsy now. Maybe 50/50. Because your psa is low and not rising over time, my conservative inclination would be to listen to your doctor, finish the full course of the Flomax and the Bactrin, however long that is, and then get your psa and free psa again. You just might have prostatitis.

If you opt for a biopsy at some time I would not get a “blind” biopsy and instead get a multiparametric MRI with or without image guided biopsy. You might have to search for a center to do this but it will give you a better indication of what is going on in the prostate, and they will often only take 3-4 core samples in suspected areas, not the standard 12 core.

Your risk calculator sounds about right, including a risk of infection of 2-4%.

Thomas:

Are you looking for diet and lifestyle guidance and/or conventional medicine information? I know almost nothing about Apricot, Bicarb soda, Trypsin Enzymes, Paw Paw, Black Salve cream, or Bloodroot

The supplements I take to help suppress my cancer are curcumin, pomogranite, vitamin D, and resveratrol. Outside of these I am not very knowledgeable in this area. I do not believe that supplements, Diet, or lifestyle can stop a Gleason 8 cancer, although I think they may be helpful so why not do all your can do.

You say you do not want hormonal treatment, but you want to get aggressive now on treating your cancer. Please clarify and expand on this statement as to what your thinking is, or what you are looking for.

If you are looking on information on conventional medicine treatments please indicate this and indicate where you are located as this may affect your treatment options.

Gene

 

So sorry to hear about your husband, and the sudden shock of the whole thing, but there is hope. 

The change from 1000 to 181 is good news. Assuming it has only been 3 weeks that is good. Hopefully it will continue to go down. How far and how fast it goes down will give your doctor an indication of how well he is going to respond to treatment.

Well it is never better to have more mets than fewer mets, but the psa response in future tests will give you an indication of survival time; BUT everybody is different and there is really no way to predict long term outcome. Some men respond many many years to treatment and their disease becomes stable and get on with their life. 

Your husband is lucky to have you to help with his care.

 

 Gene

 

 

There is a benefit to doing chemo after Firmagon has failed, and until a couple of months ago this is what everybody did. 

But according to a trial that was just announced at the 2015 ASCO meeting it was shown that a 22 month average overall survival advantage was obtained for newly diagnosed metastatic patients given early Taxotere and Lupron/Firmagon vs. just Lupron/Firmagon alone. This is a huge development that is making medical oncologists change their treatment recommendations, and is likely why your doctor is recommending early chemo.

Gene

RE: PSA levels ?

by genemyers - May 21 at 2:55 AM

This is not an uncommon situation where a family member has cancer but does not want to talk about it or tell other family members the specifics; but the other family members are frantic for information as to how the loved one is doing. Maybe your brother in law can authorize his wife to talk to the doctors and then talk to you about his situation. Short of that, you have to wait for your brother in law to change his mind, while you are in the dark. Sorry.

It is very difficult to guess as to a prognosis, because you need more information, which it sounds like your brother in law is not sharing at this time. Specifically you would need to know the Gleason score from the pathology report, and the cancer stage from the pathology report.

With a psa doubling time of a few weeks (from 10 to 20), my guess is that your brother was put on Taxotere (Docetaxel), which is chemotherapy, which is give on a cycle of every 3 weeks; usually given over 6 cycle’s of a total of 18 weeks. This is just a guess.

If true, a psa that doubled in a few weeks would indicate an aggressive form of prostate cancer, but the pathology report would clarify this.

These psa levels are indicative of someone who had surgery, and there was some cancer left behind after the surgery. Not an uncommon event, especially if the Gleason score was high. 

I do not consider a psa of 20 to be a high number.  To me apsa of 20,000 would be a high number.

Gene

RE: Help for a newbie

by genemyers - May 20 at 3:11 AM

Get the psa rechecked at monthly intervals to see if the psa stays at .05 on subsequent tests; or to see if the psa on the next tests go to .07, then .09, then 1.3. That will tell you what is going on. If it keeps rising, then it is likely that there is some cancer left. It would help to get your pathology report to know what might be going on. I would guess that the surgical margins were negative and there was no extra capsular extentison and the seminal vesicals and lymph nodes were negative. 

Sometimes after surgury the surgeon can leave a little bit of the non-cancerous prostate tissue behind and if that happens you will get a low but stable psa reading on each test. .05 is low. Undetectable psa (what you would like) is a result of less than .01 or less than .02.

Incontinence can take a little more time to heal so do not give up yet. Keep doing the Kegels. Mens side effects to incontinence can vary widely from just a couple of drops of urine per day to complete incontinence; so talking to your friend is not a good indicator of what your husband can expect as it varies quite a bit from man to man. 

I am not sure what the doctor told you that might be untrue, but almost all men have some level of urine control problems after surgury, compared to where they were before the surgury.

I would not worry at all about this. 

Gene

RE: Advance Prostate Cancer

by genemyers - May 15 at 2:21 AM

I do not know what drugs you have available in India, but in the US chemotherapy with Taxotere would not be the only option.

If you father has failed Zytiga, then before chemotherapy, I would talk to your doctors about enzalutamide or Xofigo as a more tolerable treatment.

If I am interpreting you correctly, your dad went off all Zytiga treatment for a month and did not go on another treatment right away? With a Gleason 9 and metastasis, this should not have happened.

Your father’s case is complicated and this is where the art of medicine comes in for the doctor to decide what is appropriate to give him given his abnormal blood tests: RBC count, hemoglobin, platelets. Will have to defer to the doctor about the next treatment option because of this. 

Prednisolone alone will not do anything on this cancer.

See if your father can be put on Denosumab for bone integrity. But it might be too late at this time.

Gene

 

So sorry to hear about your father with advanced disease. 

Not sure what happened with the annual psa blood test results as this should have been caught way earlier than a psa of 600. This is a medical mystery.

You will be able to tell a lot by the psa tests after your dad starts on the Firmagon. How fast the psa goes down and how low it goes will give you an indication of how good the drug treatments are going to be to keep the disease in check. Frequent psa tests are called for. 

Your doctor is right about the use of Docetaxel earlier rather than later. 

Agree with the head oncologist on life expectancy. See how he responds to treatment will say a lot about life expectancy. It could be many many many years.

With Firmagon and Docetaxel on the way, you dad is going to be getting two heavy duty drugs. Possibly helpful but lighter drugs that could be added to the mix are Casodex, Avodart, and metformin. Talk to your doctor as he/she will have an opinion on this.

A 75 year old in the hospital who cannot walk would be a little concerning on Docetaxel, because Docetaxel tends to beat men up with each successive round of the drug. You cannot wait, but hopefully you father will be up and around before he has to start the Docetaxel. The faster the physical therapy works the better. The more energy your father has and the more vital your father is, the better he will be able to tolerate the Docetaxel.

Be careful in giving your father supplements during chemotherapy, as they may interfere with the chemo drug. In my humble opinion, the supplements with the best activity specifically for prostate cancer that has some evidence behind them are:

Curcumin/(Tumeric)

Vitamin D3,

Pomegranate,

Resveratrol.

I will let other people on this site address alternative treatments, diet, iodine, baking soda, etc.

I think in general, you are in good hands and your doctors have made the right key decisions.

Hope this helps. Gene.

 

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About genemyers

Patient
Prostate Cancer
Alternative Treatments, Chemotherapy, Diagnostic Imaging, Diet, Hormone Therapy, Radiation, Side Effects, Supplements, Surgery

RP for prostate cancer; Currently monitoring Ca status with psa tests, have undertaken diet changes and supplements to keep Ca in check. Interested in current diet and supplements that suppress cancer.

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