Important to read from my Dr.Oncology

[NOCanceros]

Hello Good People

My Dr.Weise from Germany answered my mail about my PSA level from 0.16 to 0.4 and he suggested the following :

It is documented that when you don`t take bicalutamid your psa levels rise. That could be remaining healthy prostate tissue, but it could also be a sign of microscopic disease somwhere else. How would you feel about taking bicalutamid 150 mg/d for 3 months, then stop and do psa testing. Should PSA levels rise above a certain cut off point (there is not recomendation on which level, we could for instance take 0,5 ng/ml) you start it again. It is called intermittand antihormonal therapy.

Regards

George

[LearnAll]

Thanks for update.

[GP24]

The European guidelines recommend against ADT for a rising PSA without anything visible with imaging.

uroweb.org/guideline/prosta...

However, if the patients is afraid and asks the doctor to "do something" the Urologist will usually start with ADT early. Not knowing if this has any benefit regarding overall survival but causing significant side effects.

In this situation some doctors, usually the better ones, recommend intermittent Bicalutamide therapy. This reduces the PSA value without the usual side effects of ADT and helps with the anxiety of the patient.

Your currently invisible micromets may become a problem in about ten years or so.

[LearnAll in reply to GP24]

"in 10 years or so...!!!"

In 10 years or so...on continuous lupron..person might be dead due to heart attack, stroke or just major bone fracture....and in 10 years or so..many newer and better treatments will be there than Lupron.

Lots of research is happening in the world and covid19 is accelerating the research process on immunity, cancer etc.

[depotdoug in reply to LearnAll]

Well said LearnAll. Newer and better and more QOL and QOC is want we all want.

Me too. Bring on the newest best teatments. I'm ready for them.

[Magnus1964]

I have never been a fan of intermittent ADT. I have not been convinced that it gives the cancer a chance to work around the ADT drug.

[Tall_Allen]

As I understand your situation, you recently completed salvage radiation to your prostate and cancerous pelvic lymph nodes (after unsuccessful primary radiation ) with adjuvant ADT, and you do not yet know if it is successful. With adjuvant ADT, one cannot do intermittent ADT. With cancerous pelvic lymph nodes, you need 2-3 years of continuous ADT in order to cure you.

[noahware in reply to Tall_Allen]

I think he has already had over half a year off of bicalutimide, after about a year on. So being continuous is a moot point now, right?

[Tall_Allen in reply to noahware]

Thanks for explaining. His treatment makes no sense to me, but if he is happy with it...

[NOCanceros in reply to Tall_Allen]

Hi Tall_Allen

Is there another solution,that my psa level rising from 0.16 to 0.4 ,in this case what you think have you any suggestion any answer will be appreciated.

Thanks

[Tall_Allen in reply to NOCanceros]

I already told you what I think.

[NOCanceros in reply to Tall_Allen]

Hello Tall_Allen

You wrote the following :With cancerous pelvic lymph nodes, you need 2-3 years of continuous ADT in order to cure you,its interesting and what kind of ADT to be used during 2-3 years ,i appreciate your answer.

George

[Tall_Allen in reply to NOCanceros]

Any drug similar to Lupron.

[depotdoug in reply to Tall_Allen]

"With cancerous pelvic lymph nodes, you need 2-3 years of continuous ADT in order to cure you."

Yes, I understand Lupron Depot, I'm on 90 day injections, add Abiraterone only 250mg so far/prednisone.

Is two to three years of continuous ADT a Gold Standard for curing or squashing my pelvic Lymph node cancer "Avid" spots?

[Tall_Allen in reply to depotdoug]

I'm not sure it is a "gold standard," but it is a standard of care as an adjuvant therapy to radiation of the pelvic lymph nodes.

[depotdoug in reply to Tall_Allen]

Thxs,

Pending my next Monday’s CT Ab/pelvis/chest and NM bone scan;

I should ask my MO about salvage radiation of those metastatic pelvic lymph nodes. But that’s speculation.

Once again Tall_Allen depotdoug is looking for appropriate attack plan for my disease progression. But my MO is not an RO. He should realize that salvage radiation is a pliable option though.

[Tall_Allen in reply to depotdoug]

I was responding to an OP who was having salvage radiation of pelvic lymph nodes when that was the only source of cancer. It is inappropriate to take what I say as applying to your very different case.

[depotdoug in reply to Tall_Allen]

Got it. Will keep things in perspective. Try to. Thanks

[noahware]

It appears the total time you were on bicalutimide 150mg was about a year, and you have been off it now for about half a year, correct?

So clarify the plan a bit more. Is it to go back on bicalutimide periodically for only 3 months at a time, off and on? That is not a normal form of intermittant therapy, at least in the US.

It seem like 3 mos. is enough time to bring the PSA back down but perhaps not enough time to actually trigger an enormous amount of cancer cell death. It also seems like a quicker path to becoming resistant, where the drug fails to block the AR receptors to the detriment of cancer growth. Not sure, just my thoughts...

[NOCanceros in reply to noahware]

Hi Noahware

Any suggession about my psa rising level from 0.16 to 0.4 in this case what shall i do..........!

Thanks

[noahware in reply to NOCanceros]

I can't say at what level of PSA, as it rises, to do something. Just that if it were me, I think if I started on bicalutimide I would stay on it at least a year UNLESS my PSA started to rise while I was on it.

If PSA stays low while on it, that's great, but if PSA rises while taking bicalutimide then it is time to discontinue and try another therapy

[LearnAll]

NOCanceros...Restart Bicalutamide and monitor PSA every 2 to 3 weeks. If it come back down to 0.2 , this means bicalutamide has lot of juice left and should be continued. I think that is what your German Doctor suggested as I understand.

[NOCanceros in reply to LearnAll]

Thanks i appreciated.

Have a nice time and cure.

Regards

George