Sedentary 75 year old

[Dondodoc]

New here, great to read posts. Following 3 years treatment by GP for BPH with finasteride, stopped due to side effects. 6 months later blood test showed psa of 11.2 and finally referred to urologist who confirmed metastatic pc, gleason 9. (thanks G P !) oncologist started zytiga + prednisone in January 2018, psa now 0.24. The moral of the story “ GP’s if in doubt pay to see an expert”. I just wish that I had visited this group 4 years ago.

[pjoshea13]

In the U.S., the advice given by the USPSTF [US Preventive Services Task Force] for men age 55-69 is:

"For men aged 55 to 69 years, the decision to undergo periodic prostate-specific antigen (PSA)–based screening for prostate cancer should be an individual one. Before deciding whether to be screened, men should have an opportunity to discuss the potential benefits and harms of screening with their clinician and to incorporate their values and preferences in the decision. Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many men will experience potential harms of screening, including false-positive results that require additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. In determining whether this service is appropriate in individual cases, patients and clinicians should consider the balance of benefits and harms on the basis of family history, race/ethnicity, comorbid medical conditions, patient values about the benefits and harms of screening and treatment-specific outcomes, and other health needs. Clinicians should not screen men who do not express a preference for screening."

The current USPSTF position is that the members are against screening, but men who want to be screened should discuss it with their doctors.

The advice to GPs is, basically, to not mention screening unless the patient brings the subject up, and then to throw a wet blanket over the topic.

"Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men."

You happen to be one of them, but I doubt that you & other men with advanced PCa would agree that "screening offers a small potential benefit".

-Patrick

[NPfisherman]

Welcome to the forum that we all wish we never had to join....Did they do anything besides Zytiga and Prednisone? Firmagon or lLupron?? Is your Prostate still there and what kind of metastasis and where? If still localized, Brachy Boost may offer you an answer.

Sorry to hear your news, but you joined a Band of Brothers and Sisters....

We'll help if we can....Good luck....

Fish

[Dondodoc in reply to NPfisherman]

Hi, no just zytiga and prednisolone. prostate not removed Ca spread to pelvis/hips, like many here it’s fingers crossed time. Thanks for reply.

[Magnus1964]

Your experience has been repeated many times over the last several years. It seems the insurance companies didn't want pay for all of the PSA testing and got the standard of care changed. They are now paying for more expensive advanced prostate cancer treatments.

[Hidden in reply to Magnus1964]

That sucks big time. I was put on the cheaper less sensitive test . United health care Medicaid Medicare . I insisted last test to only get the more sensitive from now on . My high PSA was only 20 . got to push for it. Because I’ve had no signs for 42 months they get lack. $$$

[NPfisherman]

Why did they not put you on Firmagon, Trelstar, or Lupron? These are standard with Zytiga and Prednisone and would drive you to "undetectable". As for the metastatic lesions, how many and where exactly.?? Trying to give you a hand...

Fish

[Dondodoc in reply to NPfisherman]

Sorry I should have added that I have 3 monthly injection of Prostap similar to Lupron apparently. Oncologist has merely stated spread to bones lesions seems a term not used in UK. Any help is appreciated Fish.

Don

[NPfisherman in reply to Dondodoc]

If your PSA is stable or not falling....consider adding Indomethacin to Zytiga to break any resistance...possibly get you to undetectable:

ncbi.nlm.nih.gov/pubmed/277...

Also, it may be better to be on dexamethasone since it may be the better partner....

ncbi.nlm.nih.gov/pmc/articl...

Anyway....good luck....

Fish

[Tall_Allen]

In fact, there was a recent study that showed that men treated with finasteride or dutasteride (5ARis) in community practice delayed diagnosis of high risk PC.

jamanetwork.com/journals/ja...

This occurs, as it did with you, because the patient and doctor did not understand how the drug affects PSA - it lowers PSA due to BPH, but it does not affect PSA from prostate cancer. Used correctly, it can improve the diagnostic ability of PSA. For pre-treatment PSA under 10 (before a 5-ARI), I think patients should be more attentive to the pattern, and not the absolute level (doubled or not). For men taking a 5-ARI, these two situations should trigger concern:

(1) Elevated PSA that does not go down after several months taking a 5-ARI

(2) Elevated PSA that goes down after several months taking a 5-ARI, but then rises while taking it

[j-o-h-n]

Greetings Don, You are now a member of the club... You are in the right place now... Don't look back... Aim straight ahead. Give us more info on yourself if you wish. All info is voluntary. BTW you'll be around for a very very long time.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 06/10/2019 5:15 PM DST

[Hidden]

Welcome abroad !