WHAT SHOULD I DO NEXT ?

Greetings to all. I joined this wonderful PCa Support Group in September 2016.

I have just completed my 2 year continuous ADT2 ( Zoladex 10.8mg + Calutide 50mg ) which is a part of my initial treatment regimen. I am reasonably well informed about PCa but I am very much interested in getting the valuable advice of my friends here before I meet my Oncologist on 30th of this month. I want your replies on two questions :

1. Main question : What should I do next ? Simply, please tell me what you are going to do if you were in my position.

2. Taking into consideration my pathology at the diagnosis, the aggressive treatment I have taken with no loss of time and my present status, what would you say about my prognosis ? ( A guess would suffice )

Brief history of my PCa : I did not have any PCa related symptoms but a routine blood test indicated a high PSA ( 7.9 ). An immediate MRI Scan and a 12 core needle biopsy in March 2015 diagnosed a GS 9 PCa at my age 68 then. On 15th March 2015 I underwent a Radical Retropubic Prostatectomy. This was followed by 36 sessions of IMRT ( 74Gy ) along with a 2 year continuous ADT2 as adjuvant treatment.

Post surgery Pathology : No extraprostatic extensions, no seminal vesicle involvement, no lymph node invation, perineurial invasion present, Gleason sum score : 4 + 5 = 9 , positive surgical margins. Tumour burden : 40%, both lobes affected. Size of tumour : 12 x 10 mm. Staging : T2c No Mx

PSA Record : Before surgery - 7.9, Two weeks after surgery, before starting any other treatment - 0.079. ( March 2015 ) ADT2 started in April followed by IMRT in June 2015. PSA checked every 3 months during the treatment period up to date which has remained stable at 0.008 ng/ml ( 8 - machine noise ) . During this period I have checked my T level twice : 12.97 ng/dL and this April 7.18 ng/dL.

Side effects of aggressive PCa treatment : Lack of libido and 100% impotency. Loss of muscle mass and a slight drop in energy at times.

I have no other health issues. I am under the care of an Endocrinologist and all important metabolic functions are being checked regularly with the relevant tests and so far all are tip - top. I am very particular about my diet rich in vegetables that include antioxidants and anti cancerous substances such as brocolli, cauliflower etc. For Lycopene daily i take cooked tomatoes with olive oil. No red meat and dairy products but plenty of small fish, fruits and nuts. Green tea is my favourite. Vitamin D3 4000iu daily is the only supplement I take ( Please suggest any others if they are really beneficial ). Daily in the morning I do a 1&1/2 hour jogging session. There has been no increase in my body weight due to PCa treatments and it remains at 78kg with a good BMI. Physically and mentally I feel sound. I am very well looked after and supported by my family : wife, two daughters and my son who have given me a world of happiness with 6 grand children!

Limitations I face : There isn't a single Oncologist who specializes in treating PCa in my country. They treat all types. No hospitals or research institutes conduct any research on PCa. Advanced tests and scanning such as Gallium 68 PSMA PET and C11 Choline PET are not available. The nuclear bone scan available is very basic. T3 Multiparamereric MRI is the only reliable test if appropriate. Treatments come only from the text books. But I have learned the diplomacy of arguing with the doctors!

Back to my two questions : I am particularly interested in receiving the replies from Patrick, Nalacrats, Alan Mayer, Dan 59, Gusgold, Gourd dancer, Yost, Administrator Joel and any other good friends who are willing to help me.

Thank you for your time and kindness in advance.

Sisira

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