I've had a PSA recurrence of 0.4 at 18 months after RALP & aRT.
My Gleason was 9, my PSADT is 1.8 months:
8/10/19: <0.1........8/20/19: 0.1......11/7/19: 0.3...….12/9/19: 0.4
I have an MO appointment on 12/31. I am choosing Quality of Life over Quantity. I've read of the side effects of hormone therapy. I know some men tolerate it well. I think I'd rather go with a clinical trail.
What questions should I ask the MO?
Thanks
Hey guy! I’m so sorry for this uptick in PSA . It’s still low though .. But m on a trial that has served me well so far . I think you will stop this with a new approach . Others will chime in . I just want to wish you well . Good luck Scott ..
The treatment that is most effective and has by far the longest history is Androgen Deprivation Therapy. There is no treatment that is more proven or has the best chance of being effective.
On the other hand, Clinical Trials are unproven treatments. Many of those trials also require you to be on ADT. Many others require ADT plus other treatments such as Docetaxel chemotherapy.
With Gleason 9 and PSADT of 1.8 months, I would be concerned about the cancer taking off and becoming symptomatic. Not trying to worry you, but I think you should look long term when thinking about your quality of life.
I've had symptomatic advanced prostate cancer so I'm biased toward treatment as being the best way to have quality and quantity of life.
Wishing the best for you in your decision.
You can have an Axumin PET scan to confirm (and possibly zap) any visible metastases, or you can just start on ADT. With a PSADT of 1.8 months, it is certainly needed to slow the progression. The questions about it are:
• what kind of ADT? There are many choices: bicalutamide 50 mg (from once a week to every day) or 150 mg/ day, estrogen patch (with or w/o tamoxifen), GnRH agonist (e.g., Lupron), Firmagon, Lupron+bicalutamide
• intermittent (many ways of doing intermittent) or continuous
• augmented ADT on a clinical trial
• biomarkers and scans to track progression
• management of side effects, including diagnostics like DEXA scan, RBC count, etc.
• diet and exercise plan
Thank you sir, I'm writing all of this down to take to my appointment.
With a Gleason 9 and PSADT of 1.8 months you should start with ADT. The PSADT indicates mets.
You write: "I am choosing Quality of Life over Quantity." In this case I would recommend 150 mg Bicalutamide/Casodex monotherapy which has fewer side effects than Lupron. This is an alternative ADT treatment mentioned in the UK prostate cancer guidelines (NICE):
"1.5.9 For people with metastatic prostate cancer who are willing to accept the adverse impact on overall survival and gynaecomastia with the aim of retaining sexual function, offer anti-androgen monotherapy with bicalutamide (150 mg)."
To avoid gynaecomastia you can take 10 mg Tamoxifen.
Thank you GP, take notes for my MO.
I am afraid your MO will give you two choices: start Lupron now or start Lupron in a few months. He will follow the US NCCN guidelines and these do not mention Bicalutamide monotherapy or the estrogen patches Allan mentioned.
You are correct. It's hard to get a doctor to go "outside the box" and recommend other treatments such as Bicalutamide or Estrogen patches. Both these treatments generally have a better side effect profile than ADT but have fallen out of favor. I do see a problem with Bicalutamide long term though since it eventually becomes an agonist for PCa. And the patches may come back into favor after the ongoing PATCH clinical trial.
He might be able to get away with intermittent ADT.
Lupron will also stop working in the long term. I do not know whether Lupron will work longer than Bicalutamide, however, the objective of 5_plus_4 is quality of life. Patrick pointed out recently that you can continue with Flutamide after Bicalutamide stopped working.
Here's an article about Bilcalutamide monotherapy after RP. It is approved in many countries, possibly because of the lower cost. Side effects are better except for gynecomastia.
There are many of us here who are on ADT and live great enjoyable lives. I am one. My MO strongly suggested weight training three days a week for all muscle groups. I feel great and other than a decreased libido I wouldn’t know I’m on anything. He told me those that weight train do quite well. He was right.
Schwah
I looked up the side effects of Vantas and these are about the same as the ones caused by Lupron: rxlist.com/vantas-side-effe...
hot flashes (flushing), reduced sexual interest, impotence, weight gain, shrinking of the testicles, mood swings, tiredness, breast tenderness or swelling, etc.
If you lower testosterone and, resulting from that, estrogen, you have to expect these side effects. Maybe the supplements you take mitigate these side effects. If you take phytoestrogens this may be the case.
In 2010, I was a 5+4 also and had RP, aRT and followed it up with combined ADT (goserelin + bicalutamide) etc etc. I would do it differently now. With a fast PSADT I would get a PSMA scan (with or without FDG) and treat early with Lu177, if you can afford it and bear the logistics of travel. I had high PSMA avidity with a PSA of 0.5ng/ml.
Hi Chris, you still have alternatives: Casodex 150mg plus an additional combination of various drugs e.g. Fenbendazole, Mebendazole, Metformin, Atorvastatin, Celecoxib, malaria drugs, cholera vaccine and many others.
Of course, the right diet (e.g. pomergranate juice, green tea, a lot of vegetables, fish from the northern seas, turmeric, grape seeds extract etc...) and a lot of exercise.
I am currently taking Casodex 150mg plus Atorvastatin/placebo (clinical trial). I took Casodex earlier in 2006 for over two years. Before, I had one-time breast radiation 10 Gy for each breast. This prevented the breast from growing. No problem with sex! I think Nalakrats have lot of experience in using these drugs, if you ask him, he can offer you the right combination.
Do you take any other medicines, e.g. for blood pressure...? Do you know "Joe Tippens protocol"?
donits,
You mentioned Fenbendazole and Joe Tippens protocol. Have you tried it or considered it? I just saw the video and am so hopeful. Thanks, dusty -
Hi, I am not taking fenbendazole yet because my psa is still slowly decreasing. For now casodex is effective and maybe also atorvastatin (but I do not know that). If casodex is not effective, I will try fenbendazole immediately. Have you become acquainted with the methods of cancer treatment in COC (Care Oncology Clinic UK)?
MERRY CHRISTMAS!
I did not intend to write anything against the supplements you take. I just thought a phytoestrogen like Genistein may mitigate hot flashes. Estrogens do that.
I don't think you will find a promising therapeutic clinical trial that does not require ongoing ADT, both in active treatment and placebo arms. You actually need to be on ADT now. Why not try Firmagon (degarelix) for a one month shot and you will be ADT in 24 hours. See how bad it is. Try adding an estrogen patch to eliminate hot flashes and support your bone health. You can always stop it.
Just be concerned when the PSADT is above 4.0ng..Says DR Chris King Top Oncologist UCLA..
Further: I also chose bicalutamide 50 mg daily with finasteride 1.0 mg daily as I felt so bad on standard (Lupron, etc.) ADT. You still have circulating testosterone with this regimen so QOL is definitely better. Few or no hot flashes, some libido and sexual capacity remains, less brain fog and fatigue. It kept my PSA between .02 and .04 for over four years before failing. Now I'm on to other treatment but those were good years!
Correction. Sorry I meant it was dutasteride (generic for Avodart) 1.0 mg/day. It is much more potent in blocking conversion of T to DHT than finasteride, though some have mentioned including both.
Ask about using estradiol patches for testosterone reduction . Refer to the PATCH trial in the UK which has shown its results vs lhrh agonists like Lupron. I’ve been on the patches since February with great results. The only side effect is gynecomastia. See my profile.
Bob
I guess your odds are 5 to 4 that whatever you choose will be best for you... never look back.....
Good Luck, Good Health and Good Humor.
j-o-h-n Sunday 12/22/2019 2:18 PM EST
I have only been on ADT for three months, but I think the key to tolerating it is excessive and weight training. I know the symptoms can get worse over time, but I have had little side effects and am going on 3 three months now.
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