3rd time around

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3rd time around

by klondikegeoff on Mon Nov 12, 2018 09:56 PM

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Quick summary. When we lived in AZ, I had prostate cancer in 2001 and had external beam radiation. Everything  was fine until 2009 when PSAs started rising, after biopsy, sure enough, that sucker had recurred. My radiation oncologist suggested active surveillance but readings still continued to rise, so had brachytherapy with 82 radioactive iodine needles in left side.

All was fine with PSAs at 0.01 until just recently when my urologist  had me take PSAs every three months. Starting in Feb it was up, with following results:
2/26    0.3
6/12     0.3
7/20     0.4
11/9    1.4

So, obviously, the thing is coming back. As I  am 91, don't expect there is much I can do, but that is the question. I have not had nor want a biopsy unless there is something that can be done without horrible side effects. I have enough now from the brachtytherapy, having to have strictures removed five times.

If nothing, I will just have to wait it out, but as I have had two close friends died horrible drawn-out deaths after it metastasized, I am not happy about this. Should i see an oncologist?

Geoff


RE: 3rd time around

by genemyers on Tue Nov 20, 2018 06:12 AM

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So a couple of quick thoughts.

Follow the psa and see what the doubling time is: get a couple of more readings. Get another reading to confirm the 1.4 in 2-3 months as it is the outlier at this time.

RT does not kill all healthy prostate cells and I would expect readings of .3 after EBRT, not .01. But will go with the .01.

Standard treatment would be to start on Lupron but for a 90 year old, unless you are in really great shape that might kick you in the butt. You could try a one month shot and see how you fare and if it is to much stop it.

My number one approach would be to do monotherapy with casodex plus or minus Avodart. This is more tolerable, not as strong as Lupron, but in a case like yours where there is a little bit of psa rising, it is usually enough to suppress it, maybe for a couple of years.

AT 91 you are unlikely to die of metastatic prostate cancer. My number 2 choice would be to do watchful waiting while the psa goes up, to even 20-40 and then if you are inclined taking Lupron. At that point Lupron will likely bring it back down to close to .1. Calculate the doubling time after a couple more psa readings and estimate how long it would take to get to 20-40 psa.

RE: 3rd time around

by klondikegeoff on Tue Nov 20, 2018 04:50 PM

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Thank you so much for that valuable information.

I had planned to continue with PSAs every three months to see what happens. If it continues to grow slowly, well, so be it.

I did not knw about Lupron, will do some reseaarch. My Urologist said to wait too.

Unlike the last two times, watchful waiting was not for me as i was in great shape, and knew I had a lot more time to go.

Now, not so much. :-)

I really appreciate your excellent response. I have copied and pasted into a documnt so will remember. Any advice for bad memory?

Klondike

RE: 3rd time around

by genemyers on Thu Nov 22, 2018 05:50 AM

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I think it is important that you get another PSA reading soon at the same lab that produced the 1.4 reading. The 1.4 reading could be an outlier; it does not fit the pattern.

I know a couple of men that had surgery or radiation and are elderly and the psa came back after primary treatment but the cancer did not act very aggressive. It is almost like any surviving cancer after surgery/radiation came back in a weakened state. They were able to easily control the disease with Casodex which is very mild, but you need to understand the side effects. You can go on and off of it. Start at 50 mg per day and if that does not control it you can go to high dose casodex which is 150 mg. per day. This is called sequential androgen depravation therapy by the doctor’s.

Unfortunately you have to think about how long you expect to live. When you get your next psa reading, calculate the psa doubling time and project what age you will be, when your psa might get up to 50-100. That is the point where symptoms may start to occur. When I tell this to men in a similar situation to yours, they often come back with an answer of 130 years old. 

You did not give your original gleason score, but in any case, even with a psa of 50-100, one shot of Lupron would be highly effective, so you have a back up plan if you want to just do watchful waiting and follow the psa.

Most doctors will say to do watchful waiting with their intent being that if the psa rises to high for your comfort, to give you Lupron.

If it was me, I would watch the quarterly psa readings and agree up front with your doctor, what reading in the future to do treatment. At that point I would look at the Casodex/Avodart option. 

Best wishes

Gene

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