Recurrent PC

[PCPatient]

Beginning of May 2019 I wrote below:

Quote...

I'm new here. 61 years old.

At a general health check end 2010, a PSA of 28 was detected. After MRI, CT scan and biopsy, cancer in prostate was detected with Gleason score of 8. I had hormone therapy with Casodex 150, followed by Radiation treatment for a 7 week period from March to August 2011.

After treatment, my PSA fell to a level around 1, and was constant at a level between 0.5 and 1.5 up to 2018. At a blood test in Feb 2019, it had suddenly increased to 4.5, and again to 8.5 in March 2019, and 8.7 in April 2019.

MRI and CT scan detected a small local tumour in one side of prostate (after further tests, this turned out not to be a tumour).

I had another MRI done, which came out negative. I then had a very detailed Biopsy done, 24 samples, and all came out negative?

I had a bone scan done, and this one also came out negative?

Could it be prostatitis instead? I completed 6 weeks on antibiotics.

I had a blood test done end of May, and this had dropped from 8.75 to 7.9, so the week, after completion of the antibiotics, I was hoping for a "positive" blood test. The result just came back with an increase to 12.75!?

Had another PSA check a month later, which came back at 12.5, i.e. no change.

So I started a 150 mg + 10 mg tamoxifen a day therapy. This has been going well so far, without any notable side effects.

I obviously hope this will keep possible PC at lymph notes at rest. I was scheduled to have a new PSA test app. 2 months into the treatment.

The blood test was done last week, and came out with a PSA of 1.65, so it looks like Casodex has its desired effect.

I have no idea how long I should continue the treatment? Initially, I have Casodex and tamoxifen for 3 months. Could it be an intermittent treatment, e.g. 3 months treatment, then wait and see with regular PSA check, or?

I have agreed with my doctor to continue with Casodex 150 and tamoxifen 10 mg for another 3 months.

If PSA stays low by then, I trust I will be off the treatment, but with monitoring of the PSA level, say every 3 months, and be ready to re-start the treatment again, if the PSA should start rising again.

Any comments or suggestions are most welcome.

Anybody who could share experience from similar treatment?

[Jimhoy]

What is your T #’s during all this?!!

[PCPatient in reply to Jimhoy]

Hi Jimhoy,

What do you mean by T #'s?

[Jimhoy in reply to PCPatient]

What is your testosterone numbers while monitoring your PSA?

[PCPatient in reply to Jimhoy]

In March 19 my T value was 4.64.

[Jimhoy in reply to PCPatient]

4.65? Or 465? The later I assume with the time that passed!!!

I was warned about rapid increases in PSA prompting ADT intermediate use to end!! Sounds like you got some of those little bastards lying in wait or even chopping as we speak. Not sure it’s time for a vacation!!! I’m just coming up with my T level now so I can’t comment other than what I’m told. No experience yet!!

[Jimhoy in reply to PCPatient]

I am getting started with what sounds to be similar to your treatment. I’m still in the off ADT mode and waiting. So as you are, I’m fact finding. Me because chemical castration is no longer a viable option for me due to severe side effects!!

[Magnus1964]

If your PSA does rise again it ma may be time to consider Lupron.

[Tall_Allen]

Were your pelvic lymph nodes treated when you had radiation? Have you had an Axumin PET scan?

[PCPatient in reply to Tall_Allen]

Hi Tall Allen.

Target constraints for the radiation were prostate and PTV 68 and PTV 50 (whatever that means?).

My PET scan was using 18F-Colina. I do not know whether this is comparable with the Axumin PET?

[Tall_Allen in reply to PCPatient]

It probably means your pelvic lymph nodes were treated with 50 Gy, which is fine, and your prostate was treated with 68 Gy, which is low by today's standards if that was done in 7 weeks. Axumin or a PSMA PET scan is much better than 18F-Choline.

[Fairwind]

As TA suggested, you should seek out one of the new, very sensitive scans that perhaps can locate the tumor and the reason your PSA keeps going up..Much easier to treat if you know exactly where it is..Right now, both you and your doctors are just guessing..

[PCPatient in reply to Fairwind]

Hi Fairwind,

Well, I agree it would be preferable if we could locate the tumor. I am not sure whether I can get a better scan than the 18F-Colina I have had?

If I have small tumor(s) in the pelvic lymph notes, and these cannot be detected in a scan, I do not have a better solution than the Casodex 150 treatment, and especially if it is working. Obviously, there is no guarantee Casodex will continue doing the job.

[larry_dammit]

Welcome to our brotherhood. Wow what a ride That would of scared me to death. Have you discussed chemo Something in you is triggering the PSA. Good luck with the monster 🙏🙏🙏🙏

[PCPatient in reply to larry_dammit]

Hi Larry,

I assume a small tumor in the pelvic lymph note, that cannot be detected in a normal scan, is the cause of the rising PSA. I have not discussed chemo, and I would not consider this, as long as Casodex is doing the job.

[larry_dammit in reply to PCPatient]

Every Doctor is different. When I was diagnosed in august 16. With stage 4. In my spine ribs and lymph nodes I did a 2 week stay with Casadex then straight to chemo. 6 rounds. With Lupron and xgeva shots every 28 days. Psa has been <0.05 since chemo

[j-o-h-n]

Where are you being treated and the doctor's name(s)? All info is voluntary but it helps us help you and helps us too. Thank you.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 11/28/2019 9:40 PM EST