Advanced Prostate Cancer
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Hadi1954

I am 63 years old. in Feb 2014, I was diagnosed with Prostate Cancer, Gleason Score 4+3 and preneural invasion. PSA was 4.18 . I had Radical Prostectomy in June 2014, . Pathological report showed all leanph nodes and seminal vesicles were intact. 50 days after surgery PSA detected 0.01 then it went up to 0.04, 0.14 and 0.24 and finally to 0.305 on Sep 20 2015, MRI showed a new tumor in prostate bed with dimension 10 *18 mm. an a suspected leanph node with 14 mm enlargement in mezzo rectum, both my Urologist and Oncologist recommended Radiation Therapy. My urologist believed that the leanph node is not involved, but my Oncologist told me that could not take risk and started aggressive radiation in 35 session with 3D Conformal Technic to pelvis on Dec 2015. 3 month after finishing treatment course, MRI and MRS was was taken from Pelvis and Abdomen distinguished that the tumor disappeared and the leanph nodes showed normal appearance and all organ were intact. but PSA rises to 1.03 in spite of successful Radiotherapy, with showed there is still something wrong. my Oncologist Started four month ADT in May 2016 with Eligard and then switched to 10.8 Zoladex in every 3 monthes the PSA dropped gradually to 0.036 in March 2017. after that the PSA trend reversed to.05, 0.067 and now is 0.77 so I went again for MRI that showed normal condition in Pelvis and abdomen. I had not any side effect with Radiation Therapy but my blood sugar increased to 212 and my blood pressure also increased after ADT, but now both are under control.

I had my normal life and activity in spite of little tiredness.but it seems that castration resistance is performed and my Oncologist now thinking about add Casodex to my treatment plan.

I appreciate to get advises from any of this community to fight with this brutal disease and win.

22 Replies
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Rise of PSA to .77 on ADT means you have crPCa...ADT + Zytiga better than ADT + Casodex

Gus

4 likes
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Gus,

I agree, that Zytiga with Lupron is better then Casodex with Lupron. However, if his testosterone is below 20; then while on Lupron if his PSA increases does that mean the only reason this could happen is if he is CRPC?

Rich

3 likes
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BigRich

thanks for your comment,

My oncologist wants to stop PSA rising, in the last Lab report , Testosterone also started rising with PSA, what does it mean, if adrenal gland started to produce more testosterone, then it means that casodex as CYP 17A inhibitor could be the best choice.

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sorry BigRich,

Zytiga is CYP17A inhibitor not casodex

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Lupron as well. Shouldn't they have started Lupron from the get go? That and chemo (docetaxel) now while things are still in early stage and localized.

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You said that your T level was rising with PSA, but you did not say what is your T level. Are you castrate? If you are not castrate then ask about using Firmagon before you move on and assume that you are castrate resistant.

Joel

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Hi Joe

Yes, I'm castrate. this is some data about my T & PSA level

DEC 01 2016 T 0.100 ng/ml PSA 0.059

Mar 01/2017 T 0.063 PSA 0.034

Jun 01/2017 T < 0.025 PSA 0.050

Oct 01/2017 T 0.068 PSA 0.077

as you see my PSA level seems not in critical value but please be aware that my PSA was 3.42 before Radical Prostectomy.

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Not a Doctor--but as an interested party, I am not certain you have gone Castrate Resistant, from your data and treatment history. The Pca just does not show up in the prostate bed, if surgery was successful. I would guess that some cancer material that may not show up on scans was left behind. That there may have been positive margins, after surgery that was missed. If so you may be Micro Metastatic, and not Castrate Resistant yet---where Pca cells escaped, and may be circulating, in your lymph system, or blood system, that had once landed, and you got them with radiation---leaving behind possibly Pca cells looking for a landing spot.

JoelT, gave some good advice--I myself would think of the addition to Casodex, Avodart, and Metformin. Ask for an E2 test next time you get a T and PSA--as Pca cells have receptors for Estradiol. E2 near 20 is supportive to treatment--IMO.

Nalakrats

1 like
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yes, it could be. but the other scenario is far distance metastases. my oncologist afraid of stopping ADT,in order to let the tumor grows until detectable in imaging . and prefer to keep PSA as low as possible.

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Could you please specify the unit measurement of this 20 for the Estradiol test?

Sisira

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Above question is for Nalakrats.

Sisira

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The typical Measurement is in Picograms per Millimeter---which is expressed as pg/mg. Sorry did not realize that some would not know this. Anyway you have it now.

Nalakrats

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Mr.Nalakrats,

I have more confusion now about the way you have expressed the unit measurement. Picograms per Millimeter. Millimeter is a linear unit! and also in 'pg/mg' you have given 'mg' should read as milligrams. Our labs some times give different units and also we are not Experts like you. Anyway thank you for your response.

Sisira

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Should have been Milliliter---T is in Nanograms per Decaliter, I.E. a weight per volume

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I didn't ask anything about T. What do you mean by your 'pg/mg' for the Estradiol test? Is it correct?

Sisira

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I was using T as a measurement of a weight/volume, as an example--as E2, is measured as a weight per volume--Let me repeat:

E2 is measured as pg/ml, which you can times by 3.676, which then = Pmol/Liter.[Molecular Weight is 272].

All you have to be concerned with is the measurement of pg/ml. Over 40 Some of us consider dangerous for those with PC. Under 30 is again by some of us is better. But if trying to keep E2, from being a factor to supple a Hormone to Pca cells, some of us, like to be at about 20. But maintaining at least 15 for some bone health.

Are we done on this subject?

Nalakrats

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Mr.Nalakrats,

When you are requested to make a simple clarification regarding the unit measurement of a blood test which you have incorrectly stated, you are trying to teach us molecular theories! Please don't try to throw your ' kitchen-sink' at everything!

Yes, I am done with your shoddy replies.

Sisira

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I made a typo---assh---. Go fishing with the gators. I am helping lots of people here, and I do not need to argue with people like you who prefer to be buried up to their armpits in pig feed. And who are you to Demand Requests--I think you must have a belief, that you are King of Something. Lacking self esteem might be your area of expertise.

Nalakrats

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Self esteem is not Self Importance! Bullshit, fully ignored.

Sisira

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You and I are in a similar place. My PSA rose to 1.89 after RP and radiation, and on Lupron for about 18 months from a post RP level of 0.05. So my oncologist put me on Casodex six weeks ago. In his view, the combo treatment might not be effective for long (if Lupron failed quickly, so will Casodex in his experience) but why not get as much out of is as we can. My PSA this week was down to 0.8 and we hope it will do down even further. So, yes, there are more effective treatments out there now, but I'm saving that arrow in my quiver for now. Good luck on Casodex, I didn't have any new side effects from it at all and it's a simple pill I take at night.

1 like
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First you say your PSA is .77 then you state .077..if you want advice get your act together

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Hello gusgold

It was mistyping. 0.077 is correct. Until now I learned a lot, let’s exchange idea and information

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