Recurrent PC

[PCPatient]

My PC history as follows:

Quote...

At a general health check end 2010 (53 years old), 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 look-a-like 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 agreed with my doctor to continue with Casodex 150 and tamoxifen 10 mg for another 3 months.

If PSA stayed low by then, I will be off the treatment, but with monitoring of the PSA level, say every 3 months.

At a blood test in February, 2020, my PSA had dropped further to 1.08.

I finished another 3 months on Casodex 150 and tamoxifen 10 beginning of March, 2020, and beginning of June 2020, i.e. after a 3 months break from Casodex, I had a new blood test done. The result was a PSA increase from the 1.08 to 3.86.

I am going to see my doctor this coming week. I would be tempted to try Casodex 50 (instead of 150), to see if this could bring my PSA down to a more reasonable level, say around 1.

My reason for the Casodex 50 instead of Casodex 150 would obviously be to take a less stronger therapy, and the “fall-back” plan would be Casodex 150, if the Casodex 50 cannot do the job.

Basically, I expect I will not be able to get rid of PC, and I will have to live with it for the rest of my many days and years. I am hoping this can be done through a treatment with least possible side effect.

I would appreciate your comments and recommendations.

[Tall_Allen]

You never had an Axumin PET/CT? While you are off Casodex may be an ideal time to get one.

[PCPatient in reply to Tall_Allen]

Hi Tall_Allen,

Obviously, if I could have a scan done that could detect the location of my cancer cells, this could be the basis for a more targeted treatment.

I will discuss and check the options for a Axumin PET/CT scan with my doctor.

[Magnus1964]

I am not a fan of intermittent ADT treatment. I would stay with 150mg casodex and tamoxifen. Milk it for all its worth.

[TheTopBanana in reply to Magnus1964]

How come? Too aggressive side effects?

[PCPatient in reply to TheTopBanana]

Hi bluecatdog,

I have not had too aggressive side effects with Casodex 150. But if Cadodex 50 can do the job for a period, I can step up to Cadodex 150 later if necessary.

[Magnus1964]

If you go to 50mg casodex would you stop the tamoxifen?

[PCPatient in reply to Magnus1964]

Hi Magnus,

I am not sure whether I would stop tamoxifen. I guess I mainly get these to minimize breast tension from Casodex 150. I would assume these would be less by Casodex 50, but I am not sure. I will discuss this with my doctor.

I am obviously not sure if Casodex 50 can bring my PSA down to a level around 1, but if not, I will go back to Casodex 150, which, until now, has proven it works.

[Magnus1964 in reply to PCPatient]

Good luck to you my friend.

[Hidden]

First, understand that I am not critical of your treatment path. However, it has curiosity in my mind. You mentioned saving the arsenal and maybe that answers my curiosity....... with a Gleason 8, you surely have systemic disease; it’s just at bay and for ten years. That is good.

You might enter into a discussion on micro-metastasis with your pro. It could lead into another decision making process.

I wish you the best.

Gourd Dancer