What next after radio therapy and Lupron?

[Cerano123]

Hello everyone.

First off, my prayers and best wishes to everyone here who is fighting PC as well as the care givers who stand shoulder to shoulder with our loved ones during their fight. My father, aged 70, was diagnosed last year in October. He had a Gleason score of 9 and radical prostatectomy in December 2017. Since then, he had 36 sessions of radiotherapy and has also been on Lupron (took his 2nd injection last week). He lives in Canada so folks who are getting treated there, I'd really appreciate your responses to my following questions:

1- He had a blood test last week for his Pca count. This week, he has an appointment to review the results with his radiologist. What should we be looking for and asking to be ahead of this fight?

2- After his radical prostatectomy, he had lost alot of wieght (lost 15 lbs). Now he is gaining weight and doing daily exercise (1 hr combination of walking and light weight lifting). Is gaining weight a good thing? He has gone on a mostly vegan diet. Any special diet he should have to prevent progression of this cancer?

3- The oncologist had said there was no metastasis to lymph nodes or bones. We want to ensure that after his radical prostatectomy, there has been no metastasis. How can me make sure of that? What tests can we do?

4- I've read alot about Zytiga but I am not clear as to when it needs to be taken? Can someone give me a brief understanding of when its required and any material online I can read about it?

Thank you! May you all be blessed with good health and a fulfilling life.

[Shooter1]

Mainly PSA at this point. After prostatectomy PSA should drop to near ZERO. Mine was a bitch and went up 10 points in six weeks after. With follow up radiation and lupron to kill T production, PSA should be very low to undetectable. If not, then cancer still active some were even if no mets showing. They have an insidious way of playing hide and seek with us. Weight gain is OK unless he was over weight to start with. Zytiga or Xtandi usually added if PSA shows rise while on ADT drugs, mine did, added Xtandi and dropped PSA back down showing it is working. Good luck on this long journey you are starting with us. Doug-AZ-USA

[Cerano123 in reply to Shooter1]

Thanks for the reply Doug! My dad is getting his Lupron injections every 4 months but recently the nurse asked him to come back after 3 months. Does it hurt in any manner if the patient takes the injection a month early?

Also, another question I had was how reliable is PSA test to check for metastasis? What can we do from our end to ensure we can have regular checks to catch any progression early?

[YostConner in reply to Cerano123]

You are watching for PSA trends. Assuming his PSA is very low now as it should be, a small rise in and of itself doesn’t give enough information. You’re looking for big movement or consistent movement. I have a really bad case, so don’t compare to me, but I’ve had PSA tests at least quarterly for the past 11 years. Best to you and your dad, and remember to take good care of yourself, too!

[Tall_Allen]

1. I assume you meant PSA. There is something called a Circulating Tumor Cell (CTC) count that actually looks for cancer cells, but it is a relatively rare diagnostic test. Because he is on ADT, his PSA should be undetectable.

2. If he has gained muscle mass, it is good. If he has only added fat, it is not so good. A recent large randomized clinical trial proved there was no benefit to increasing veggie intake in low-risk men who did it for 2 years. However, there are many other good reasons for adhering to a heart-healthy diet.

3. As long as he is on ADT and his PSA is undetectable, it is highly doubtful that any known scan can detect metastases. It would be a waste of money to try.

4. Zytiga has been found to improve survival among men who are NEWLY DIAGNOSED with metastatic PC, and in men who are detectably metastatic and castration-resistant. There has been only one small (100 men) trial among men with recurrences, but with short follow-up, there was not yet any benefit to overall survival. There was a benefit in progression-free survival. So no one knows yet if it is of any benefit in his situation, or if it just piles on unnecessary side effects.

[Cerano123 in reply to Tall_Allen]

Thanks Tall_Allen for responding to my post.

1- Yes, I had meant to say PSA. His current PSA came out as <0.008 (unit ug/L. | Methodology: Abbott Architect Immunoassay). I understand that this is due to his ADT Eligard 30mg and has 2 to 3 more injections left. After he finishes ADT, how long after that should he do his PSA test and at what periodicity? Due to his previously high Gleason score of 9, I just want to take extra precautions and be aware in advance of what can potentially be done to help catch any metastasis early.

2- Since my post, he has gained 10 lbs and feels energetic. I don’t see much muscle mass on the chest but arms and legs look toned. In all, I am seeing a positive sign of improving phsyique which is a relief.

3- I see that ADT is beneficial in keeping PSA to undetectable levels. My worry is what happens when ADT ends. I know that I should be looking at the PSA doubling in less than 4 to 6 months as a sign of recurrence of PCa and possible metastasis but since PSA tests are not always conclusive, should a PET scan or CT scan be done some time after ADT ends?

4- Thanks for the note on Zytiga. Does this fall under chemotherapy? And is it ONLY done for cases early metastasis only or does it help with late metastasis detection?

[Tall_Allen in reply to Cerano123]

He should have his PSA and his testosterone monitored every 3 months for the first year. It can easily take a year for his testosterone production to resume. Why don't you wait and see what happens? It causes much less anxiety to stick with what you know in the present moment instead of imagining future scenarios. Zytiga is a hormone therapy, not a chemotherapy.