New member

[Advman]

New member here. 72 years old. Local biopsy April 2017, 4+5 aggressive cancer. Decided on MD Anderson for treatment Jun 2017, robotic surgery. Confirmed 4+5, primary tumor: pT3a, 3 of 24 lymph nodes involved. Six weeks after surgery Aug 2017, PSA was .06. MDA urologist started me on Lupron. 6 month shots Aug 2017, Feb 2018 and Aug 2018 with PSA <0. Tolerated it fairly well. Gave me a holiday for Feb 2019 and Aug 2019, PSA was still <0. November 2019 my local doctor exam showed PSA .12. MD Anderson said wait until Feb appointment to do anything. Don’t know as much as I should, but this site is helping! Any thoughts or suggestions of what to expect would be appreciated. Thank you!

[AlanMeyer]

If your surgery was not successful in eliminating all of the cancer, and it appears that it was not, the two possibilities are salvage therapy and long term cancer control with drugs.

Salvage therapy attempts to find and destroy the remaining cancer to produce a complete cure. The generally accepted and probably best method is with radiation. The statistics I've seen say that it is successful less than half the time because some cancer has already escaped the area near the prostate and could be someplace, or many places, in the body with no way to tell where. The best chance for success is when the PSA is very low, less than 0.4 or better, 0.2, but even then, with a Gleason 9 cancer, my understanding is that your chance of success is still less than 50/50.

Drug therapy usually starts with androgen deprivation therapy (ADT) with drugs like Lupron and Casodex. It destroys your sex drive (if you still have any) and causes uncomfortable side effects. However I have known men who have lived 10, 15, or 20 years on it. Most men don't live that long but more than a few do.

I suggest that you read up on "salvage radiation therapy" and "androgen deprivation therapy", in preparation for your February meeting. It's important to know something about these alternatives so that you can ask good questions and understand the answers. If you can get your appointment moved forward, that's not a bad idea either.

If your oncologist believes that there is a decent chance that radiation will work, I think it's worth trying. It is a chance, even if not a great one, at a complete cure. If it fails then it's still possible to use ADT, and in fact the radiation oncologist may offer you ADT before and along with radiation.

Best of luck.

Alan

[Tall_Allen]

Salvage radiation of the prostate bed and the pelvic lymph nodes. But first, get an Axumin PET scan to make sure you don't have any large distant metastases.

[Advman]

Thank you guys for your input, will let you know how it goes!!

[tallguy2]

And I "3rd" it!

[RonnyBaby]

I also agree with the others - we are fortunate to have their experience to help guide us when we become another casualty of the %&%# disease.

For arguments sake, my DX was not all that different than yours - G9, stage T3B (node positive) no sign of distant mets, although my PSA was much higher (over 300).

What was different was that surgery was not considered an option in my case - they thought I was too advanced at that time (May 2016). I had the recommended / applicable scans to ensure we knew what we were dealing with.

So far (on an ADT vacation since (July 2018)) so good. My 'T' has recovered to within the norms on the charts (low side but still in the normal range) while my PSA slowly rises (last checked 3 months ago at +0.22). We have set a target on how high the PSA can go, but we are a long ways from there - at least for now - I can always hope and pray ......

I feel considerably better than I did even months ago. I'm wondering IF I'm in remission. I'm 67 (felt like 85 for a while) but feel like I'm getting stronger, as opposed to going the other way.

I suspect that some radiation treatment might be in order for you - might be the best shot at aiming for a potential cure. The doctors tell me ' there is no sign of any form of major cancer that we can detect (on a macro scale)'. It is possible that there is something happening on the 'micro' side, however, BUT I will not allow that to affect my attitude. Why would I want to freak out over something that might be happening ? Time will tell IF I'm facing future treatment(s), but I went from thinking I was dealt a death sentence to a person who has a 'second chance' at living the rest of my life with a more appreciative attitude towards what really matters in this world like the love that is around us along with the people we care about.

It is still fairly early in the 'game' for you but I suggest that you do your homework in reading and researching the particulars of your type of PCa. Today's patients are facing better outcomes than those that came before us. You should be one of them - be optimistic and fight back to the best of your ability. Advancing science with new standards of care are making a positive difference.

Keep us posted.