What opitions are next for me

[ken12491]

Just had my 2nd f/u PSA test from my SRT ----

age - 67 - dx at 65 - Regional, with SVI - g-9

All scans 2 of each, bone and PETs were clear - one PET was taken the day 1 day berore the start of my RT ( 40 rounds IMRT )

For another non-related issue I had ( minor back ) - 2 MRIs were done of spine and pelvis - both clear --- July 2018

Also had a bladder cystoscopy in July 2018 - clean - negative, again a different issue.

SRT started May 5 2018 ( the Lupron part ) 4 months before RT

And had 40 rounds of RT that began 9/6/18, ended Nov 1, 2018

From May 5, 2018, I was on Lupron, within 30 days, PSA fell to zero and stayed there ( tested about 7 times )

T - Level -- low 20s all along the was with zero PSA

First test after SRT 12/17/18 - PSA was. .19 -- T - Level was 421!

Second test was on 1/7/19 - PSA is now. .25 - T- Level down to 300

Lupron hits us all hard, but somehow I managed as most do.

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If my Dr. wants me back on Lupron, I'll do what he says.

But what other opinions could be afforded to me?

I suspect none would be of a curative nature, would they?

Any thoughts would be appreciated.

Ken

heard different answers, and there very well could be since we are all different people but,on average, what is the time from BCR to metastasis?

the PSAs of .19 and .25 would indicant failure I am assuming, correct?

[Tall_Allen]

Yes, your persistent PSA does reflect treatment failure.

What was the treatment field of the SRT? That will determine whether there are potentially curative options left.

Median time from BCR to detection of metastases on a bone scan/CT is 8-10 years.

[ken12491 in reply to Tall_Allen]

Thanks, TA - u seem to be the most informative around.... the field for IMRT was 25 to the regional/node area and the last 15 at the bed itself. Were u the one who told me about the ' TOAD ' study?.... I'll google it, but if I recall, the study said to start treatment at PSA 1 or was it 2 - perhaps I'm just confused. And who is to say, that the PSA is bad or just normal remaining tissue?

[Tall_Allen in reply to ken12491]

TOAD was about early vs deferred salvage ADT:

thelancet.com/journals/lano...

The rise in PSA is NOT from benign tissue, if that's what you mean. Small amounts of benign tissue do not put out that much PSA.

[ken12491 in reply to Tall_Allen]

TY again --- so, the NET was it's better to treat early than late with ADT------ and the 16 and 30 deaths were all from PCa? ----- if what I said here is correct - I misinterpreted what I first thought - and that was, there was no significant benefit to start early, whereas, this study proves/points the opposite - sooner the better... My uro says he would have me back on ADT at PSA 1.0.

I 've asked u this b4, but u declined due to the insignificance prediction tools u have - but I implore u to take 5 min and do just the one tool on the site of SMK -- that one tool is --- plug in my #s, urs or anyone's and give me your opinion - I showed my PCP today and he was amazed... " Males Life Expectancy Survey ' -- only 17% died at 10 yrs, w/o any PCa treatment at all --- this is a SMK tool!!!! It bases the prediction of the current and past health of a man --- meaning, at 10 ys u are more likely to die from other causes...My RO basically didn't even acknowledge the tool, but I am pushing the point to get the question answered with mgmt at the hospital. Be great to chat with u at some point... huge asset u r to people here...

[Tall_Allen in reply to ken12491]

In TOAD, there is short (5 yr) follow-up and a relatively small sample, so none of the deaths were directly attributable to prostate cancer. Dr Duchesne makes the point that cancer affects the whole body so that overall mortality is associated with prostate cancer. if she does a follow-up in 5 more years, there will be a more convincing answer. Here are her comments:

"The results delivered by this trial have been both unexpected and thought-provoking. Despite the fact that the trial recruitment was prolonged and fell well short of its target, the results are clinically and statistically in favour of immediate intervention when survival and disease progression end points are considered, with hazard ratios around the 0.5 mark. The key clinical point is that we can now advise men what likely lies ahead of them, who is at greater risk if delaying treatment, and what delays they might achieve if that is their choice.

"The results also add further weight to the hypothesis that treating small volume or occult disease is more effective than treating overt disease. This trial was predominantly for patients who had failed curative treatments, but who had only microscopic disease at randomization. This concept obviously underpins the use of adjuvant therapy, but here we are treating only those known to have disease, rather than the whole population most of whom would not benefit from adjuvant therapy. PSA as an early harbinger of relapse is useful indeed.

"Where the unexpected results are concerned, we have the following: firstly that the effects on overall survival are not just from a reduction in prostate cancer deaths but also from deaths from other causes. Other trials have also shown this, which suggests a real finding, the causes of which remain unclear. Secondly, the effects on global health-related quality of life, at least over the first two years, showed no major difference between immediate and delayed therapy, meaning that men may choose to start relatively early with major detriment. This may relate to the use of intermittent schedules for two thirds of both arms, which did not appear to have an impact on disease control (data not shown in the publication), despite the lack of firm evidence supporting its use. An exploratory unplanned analysis in fact suggested that the highest survival rate was seen in men treated with immediate intermittent therapy.

"One of the most thought-provoking findings was that the development of the castration-resistant phase occurred significantly earlier in the men who started treatment after a delay, a counter-intuitive finding. This may again be linked to treating low volume disease before it grows resistant clones."

As for the MSK nomogram - how long would you like to live? If you are fine with just living 10 more years, then you may elect to have no further treatment.

[ken12491 in reply to Tall_Allen]

Your sure u don t work as a scientist at SMK ---- u appear to be more knowledgeable then anyone I spoke to so far....Let me tell u something my unknown friend --- if the odds were in favor of 10 yrs of life with quality - I would take it... I m an incredibly lucky guy and accept my mortality.

Despite living a clean life, food, exercise, all that I was told to do - I had a major HA 3 yrs ago ---the works bypass and came close to dying just 3 yrs ago - married my best friend at 19, 2 grown dau, SOLs that will care for the family when I do finally go and 5 healthy beautiful g kids... I adore my family and they still like me!!!- despite being a sorta of old guy at 67 --- they still count on me for a lot... not just for my money - I was grossly overpaid in the 40 yrs in corp America and killed the market most yrs - gave a lot back and still do...My Drs knowing me, could not figure out what caused the HA ---- My dad gave me a lot, but he also had the same thing he had at 57, his HA - all genetics I was told. All my clean living bought me 7 yrs - happened in my gym, 1 mile away from the hospital.

You might have already picked up that I am a double, triple aaa guy and worry about almost anything...

I listen to a few SMEs and make my decisions based on what I take in from them - you, in 3 weeks would be one of perhaps 5 I would take input from...

I wish u the best --- u are a strong man with a great wife as a partner --- lucky men we are..... Ken.

[Tall_Allen in reply to ken12491]

I'm not married, but thanks anyway. If the MSK nomogram shows that because of your heart attack, you are highly likely to die from that in the next 15 years, then it is reasonable to forgo treatment until pain makes it necessary.

[ken12491 in reply to Tall_Allen]

well, it really doesn't says in those exact terms (HA ) - it tales in a health history looking at u, ur age, etc and plugs in ur PCa # -- gives u that output. I was really lucky on the HA, when it was caught, where and the quality of the surgeon who treated me - getting the bypass when I did, was a big positive break for me. Sounds odd and the recovery was terrible, but I'm glad to have had it and be fully repaired...

[Tall_Allen in reply to ken12491]

That's the problem with nomograms - they only tell you what the average is. individual results vary a lot.

[j-o-h-n in reply to ken12491]

Average = 6 of one or 1/2 dozen of the other...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 01/09/2019 4:41 PM EST

[Hirsch]

No one considering abiraterone?