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Advanced Prostate Cancer
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PSA Results-Cautiously Optimistic

Hi All,

At diagnosis my Dad's PSA was 488. After first chemo treatment and ADT it dropped to 6 and after the second chemo infusion is now at 1.2.

I am happy he has responded so well to treatment as the cancer had metastasized to multiple bones and lymphnodes at the time of my Dad's diagnosis.

Now on to the tough part-monitoring. The oncologist said they are going to complete the 6 rounds of chemo and then have him stay on ADT indefinitely.

My concern is of course, a rise in PSA indicating return of cancer as well as becoming castrate resistant. When is it appropriate to take "holidays" from ADT?

Also, I'm trying to figure out next steps...do we sit and wait until PSA rises again? Try and live life as normally as possible without the sneaky cancer looming over our heads. Any advice is appreciated.

As always, thank you guys in advanced. I'm thankful for you all as a wealth of knowledge and encouragement.

Also added a special picture of my Dad and his second grandchild. He has 3 total, soon to be 4 as I am due in March 😊

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As he continues with ADT + Early Chemo, the PSA may drop even lower. He's having a very good response so far. The slow effects of being on ADT for months and years are likely to be part of his new normal. "Breaks" from ADT are typically not advised for wide-spread advanced metastatic disease. The next year or two may turn out to be some of his best- feeling and best-capable time along his individual path. Staying active and exercising often helps lessen some effects of ADT. With bone mets, he might also ask about one of the bone agents, perhaps Zometa (zoledronic acid) or Xgeva (denosumab).

"Living in the present moment", and doing some of those "follow your bliss" and family/travel/experiential things earlier, rather than later, when he might be constrained out of them by how he feels, or by future treatment side effects, might be a good idea. Getting a Stage IV cancer diagnosis does have a way of helping to clarify such priorities in life. Of course it is a good use of time to keep learning about future treatment options and discussing them with his doctors and doing some practical broad planning for eventualities, but it's also good to stay grounded in the non-medical good things from day-to-day. At least in my experience. He may not be technically "curable", but he (and those he loves) can certainly be "healed" in many ways.

Hugs have lots of intangible medicinal qualities, too. Big Lupron Hugs, all around!

Charles

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Well said Charles

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One of the best posts ever

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Amen, Charles!

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Appreciate the advice Charles! Will also be reviewing Zometa or Xgeva moving forward as my Dad has begun to experience mild discomfort in lower back where cancer spread.

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I went through a combined treatment of six cycles of taxotere, 25 radiation treatments and 18 months of ADT after surgery and salvage radiation both failed. That regimen started in Jan 17 when my PSADT and PSAV were less than three months and PSA was climbing to 4.8 I went to Mayo and had a C11 Choline scan which showed four pelvic lymph nodes with PCa.

The first two ADT and docetaxel treatments dropped my PSA from 4.8 to less than .1 and it stayed there. The original treatment plan called for 24 months of ADT but based on emerging studies about 18 months of ADT being more than enough and no value added to further ADT I discussed with my medical team stopping at 18 months, they agreed.

My last Lupron shot was in May 18, PSA in Aug was <.1, Testosterone was <3. In Oct PSA was <.1. testosterone was now 135. My urologist and I agreed on a plan that includes monitoring and consults every three months. He is switching me to ultrasensitive PSA.

If or when my PCA returns we will allow for several readings to determine PSADT and PSAV, locate the recurrence using imaging such as the C11 Choline scan or one of the other PMSA based PET/CTs, then decide on treatment based on what is best at that time.

Mine is an aggressive cancer, GS 8 even in the face of an excellent surgery and pathology report, which had negative margins, no ECE or seminal vesicle involvement, only 10% of the prostate involved...but 18 months later, PSA was .2 then .3. Salvage radiation failed too, started that with PSA .3, 90 days after it was .7 then 30 days later 1.0!

So, I would do some research and ask questions, it may be ok to stop ADT at some point, actively monitor and have a plan should the PCa return. When you say your medical team said ADT for life my BS detector went up!

The goals of my treatment were the elusive cure as I was N1, if not that then a long progression free survival period (the ADT holiday!) and longer overall survival. Too early to tell obviously but I do feel better after stopping ADT with the return of testosterone. My medical team and I call this the "whack a mole" treatment plan.

Last thing, while on ADT your medical team should always monitor his testosterone, it should be less than 20, anything higher may indicate resistance or mean adding another ADT drug to the treatment.

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Thank you so much! I had no idea to even monitor testosterone levels. You guys are continually adding to my tool bank.

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My first holiday from HT lasted about 14 years then back on for HT for 2 years followed by another holiday of 2 and a half years. I am now on HT and if I get PSA down to undetectable for 6 continuous months I will take another holiday. MO says his treatment plan calls for HT until failure but will go along with my plan. We agreed that if I do take a holiday I will restart HT if PSA goes up to 2.0.

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Thank you for your input. I agree with HT holidays and will be seeking a second opinion once my Dad gets on a long term insurance plan. It's always best to check!!

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All I have to say is "that kid is cute, is she for sale?". I'll definitely return her when she's a teenager...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/27/2018 4:53 PM EST

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Right. She uplifted our spirits so much during my father's hospitalizations. The nurses gave her a stethoscope and she would check on her Grandpa and the baby in my tummy. Such a blessing ❀❀

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Was she able to let you know if she's gonna have a baby brother or a baby sister (or maybe one of both)? Nothing like kids.... Her Grandpa is lucky...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 11/28/2018 11:16 PM EST

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With the ADT, I imagine the Docs are hoping for a level PSA; they will determine whether Dad should or could stay on ADT; perhaps even ADT3, which is, I believe Lupron+Casadex+Avodart...I’ve seen patients remain on this regimen for at least a year. Once PSA is level then a break would be in order; but continue with intermittent ADT.

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Awesome! Appreciate the input πŸ‘

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Sounds like your dad's cancer responds very well to treatments. I hope he responds equally well to ADT drugs and enjoys many years of good health.

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Thank you for the well wishes 😊😊

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