I have positive regional lymph nodes, no treatment. There is only palliative cancer management. It turns out that the radiotherapy you performed was very successful. Thanks a lot. When I come to Turkey I will thank you properly.
My last measured test level PSA 0.007. Is this a pretty good result? And radiotherapy still works and can further reduce PSA. Now I take an eligard which also lowers the PSA. I have an idea to start taking Casodex 150 for a double blockade. My goal is to lower uPSA further and reach a level of uPSA <0.003 where the cancer appears to disappear, as stated in a study by John Hopkins Medicine -
“If your PSA level is less than 0.003 ng / ml, you could be sure that all your cancer has been removed. On the other hand, if your PSA level is greater than 0.003 ng / ml, you might choose to be monitored more closely for PSA recurrence in the immediate years ”- hopkinsmedicine.org/brady-u...
Although this refers to after surgery, not after radiation, I think it essentially reflects the presence or absence of cancer cells. So by analogy. I hope with double blockade and the effect of radiation, to reach uPSA <0.003 in the hope that this will be the treatment for my lymph nodes. This has not been proven, but there is no other treatment. Could this be true?
Thanks for the well-conducted irradiation.
study by John Hopkins Medicine , shows that with a PSA 0.003 there will be no recurrence. - “If your PSA level is less than 0.003 ng / ml, you could be sure that all your cancer has been removed. On the other hand, if your PSA level is greater than 0.003 ng / ml, you might choose to be monitored more closely for PSA recurrence in the immediate years ” - hopkinsmedicine.org/brady-u...
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Thanks. That means you can still have potentially curative radiation to your pelvic lymph nodes. That is a more useful strategy than chasing down every last bit of PSA.
Irradiation of the pelvic lymph nodes has bad side effects and is not justified according to SPPORT
.
“Additional analyses of the SPPORT trial will focus on the magnitude of difference between the experimental treatment arms to isolate the impact of pelvic lymph node treatment relative to androgen deprivation therapy. The research team also described preliminary data that for those with a very low PSA on study entry, there was no improvement from PLNRT+PBRT+STAD over PBRT+STAD”
You misunderstood that. The "low PSA" referred to in SPPORT refers to the PSA after prostatectomy, not the PSA after taking ADT. SPPORT was a clinical trial about salvage radiation. All men in the study had a biochemical recurrence after surgery - PSA reached at least 0.2- some higher, but no one less. All men in the study were subsequently treated with salvage radiation. In two of the groups, men also had short-term (4-6 months) of adjuvant ADT. In one group, recurrent men had salvage whole pelvic radiation (sWPRT) and adjuvant ADT. In that group, the men who had low PSA before the ADT+sWPRT, did not benefit from the sWPRT.
I do not have surgery. My positive pelvic lymph nodes are many. First I will reach 0.003 Maybe when PSA <0.003 I no longer have cancer cells. If not, then I will irradiate the nodes.
SPPORT was only among men who have already had surgery. You will have cancer cells even with PSA<0.003. PSA is only a biomarker - it does not mean you don't still have cancer. It only means that the cancer you have does not form tumors big enough to create their own blood supply. ADT alone does not cure cancer.
Thanks. I thought that at this PSA level <0.003, all cancer cells died. Low testosterone from eligard now 5 ng/dl and blockade of receptors by kazodex150 have killed cancer cells
Thanks. I thought that ADT at a PSA level <0.3 kills cancer cells, at a PSA <0.03 it kills a lot more. And at PSA <0.003, it has killed so much that our killer blood cells can handle it
Irradiation of the pelvic lymph nodes has bad side effects and is not justified according to SPPORT
“Additional analyses of the SPPORT trial will focus on the magnitude of difference between the experimental treatment arms to isolate the impact of pelvic lymph node treatment relative to androgen deprivation therapy. The research team also described preliminary data that for those with a very low PSA on study entry, there was no improvement from PLNRT+PBRT+STAD over PBRT+STAD”
You should consider that you are on ADT and probably you have a testosterone below 50. The result of your radiotherapy treatment will be really shown when your testosterone recovers to normal levels or at least well above 50. It is different from the JH study where the patients had RP without having ADT.
It was not clear if you had radiotherapy to the regional nodes. If you have only regional nodes and you do not have distant metastases, radiotherapy could be curative if whole pelvis radiation is performed.
Irradiation of the pelvic lymph nodes has bad side effects and is not justified according to
SPPORT
“Additional analyses of the SPPORT trial will focus on the magnitude of difference between the experimental treatment arms to isolate the impact of pelvic lymph node treatment relative to androgen deprivation therapy. The research team also described preliminary data that for those with a very low PSA on study entry, there was no improvement from PLNRT+PBRT+STAD over PBRT+STAD”
IMHO, you can not apply your situation to the SSPORT trial since you did not have RP and BCR, besides your PSA is so low because you are on ADT.
If you initial diagnosis was prostate cancer with cancer in the regional lymph nodes and without distant metastases and you decided to be treated with radiation, lymph nodes treatment should have been included. This treatment should be associated with ADT for 18 months or more.
Whole pelvis radiation does have side effects but the rate is low, according to the SSPORT trial:
"Rates of severe side effects (grade three or higher using CTCAEv3.0) were low across treatment groups. During treatment, the main additional severe effects from PLNRT were in relation to blood/bone marrow events. For long-term effects, blood/bone marrow events were also slightly higher in the PLNRT arm, but only for grade 2+ events (4.1 percent), not grade 3+ (1.1 percent)."
I'll appreciate if you could post the link to your quotation, since I could not find a paper published in a peer reviewed journal mentioning your quotation.:
“Additional analyses of the SPPORT trial will focus on the magnitude of difference between the experimental treatment arms to isolate the impact of pelvic lymph node treatment relative to androgen deprivation therapy. The research team also described preliminary data that for those with a very low PSA on study entry, there was no improvement from PLNRT+PBRT+STAD over PBRT+STAD”
The preliminary analysis refers to patients who had a previous RP and increasing PSA and where treated when the PSA was very low. I assume they did not have evidence of regional lymph nodes involvement, only PSA disease with very low PSA values. Again this was preliminary analysis, who knows what happened in the final analysis.
Your situation is different, you know you have prostate cancer in the regional lymph nodes, and I believe it should be treated, the same way the primary cancer was treated.
Thanks. The article (no a published paper about the study) indicates that the favorable findings of whole pelvis radiation is the treatment of cancer in regional lymph nodes that is not usually detected with regular scans. They said:
"The degree of the effectiveness of the combination is surprising, but makes sense when you consider other more contemporary evidence using newer PET scanning methods showing that pelvic lymph node recurrences are more common than previously appreciated."
You do not have a recurrence. I believe your original diagnosis indicated that there was cancer in the regional lymph nodes.
Irradiation of the pelvic lymph nodes has bad side effects and is not justified according to SPPORT
“Additional analyses of the SPPORT trial will focus on the magnitude of difference between the experimental treatment arms to isolate the impact of pelvic lymph node treatment relative to androgen deprivation therapy. The research team also described preliminary data that for those with a very low PSA on study entry, there was no improvement from PLNRT+PBRT+STAD over PBRT+STAD”
Irradiation of the pelvic lymph nodes has bad side effects and is not justified according to SPPORT
“Additional analyses of the SPPORT trial will focus on the magnitude of difference between the experimental treatment arms to isolate the impact of pelvic lymph node treatment relative to androgen deprivation therapy. The research team also described preliminary data that for those with a very low PSA on study entry, there was no improvement from PLNRT+PBRT+STAD over PBRT+STAD”
In Dec 2009 and age 62, I had a Gleason 9 diagnosis when Psa was 6.0. and PG was found to be inoperable. So my PG was not removed during attempted surgery in April 2010.
I was put onto Eligard ADT after 1 month of Cosadex and Psa went from 8 at op to 0.08 about 0.08 18 months later. If I had had continuous Eligard, perhaps Psa may have gone down further but clinical practice histories of many men show it is not wise because then Pca will become resistant to Cosadex and mabe ADT sooner.
Now Pca produces more Psa than does the PG when there is zero Pca present. And it seems that if a man with Psa of say 1.0 at 60 which is not unusual for men who will never get Pca, and If that man had ADT and Cosadex, it possibly may reduce the Psa to 0.003.
So while any PG tissue remains in a man's body there is Psa generated. If 95% of PG tissue with its unique DNA structure is removed in an RP, there is still 5% left, and it may or may not begin to get Pca as time goes by, and if Cosadex and ADT is used to reduce Psa to an almost un-measurable level of 0.003, then IHMO, it just does not mean the Pca has gone. It means that the man is getting good suppression of Pca growth but if the primary treatment was EBRT and PG was not removed, then Psa of 0.003 is a good result, but it still does not mean Pca is gone, it just means Pca is well suppressed as well as the Psa also produced by healthy cells in PG.
Now if a man stops having any ADT and Cosadex after the initial EBRT, and Psa drops to below 0.003, and stays there for 5 years without any further treatment, THEN a man might begin to think he has remission, which is extremely rare for anyone with Pca.
In my case, I had 2 years of initial treatment of ADT with EBRT at 8 months after start of ADT, in late 2010, and to see if treatment had worked I stopped ADT in late 2012, and by mid 2013 Psa moved from 0.08 to 8.0, and I was back to square one and have had ADT ever since, plus Cosadex and Zytiga until they failed one after the other, then chemo which failed then Lu177 which also now has failed, even when combined with Xtandi, so plan is not to get more Lu177. But I have survived over 10 years with good QOL and maximum Psa was 50, when I quit Chemo in late 2018.
At no time did I ever assume I'd live another year with good QOL, but I have had a good QOL, and cannot complain because nearly all other men my age of 73 have bigger health problems than I have. I have seen friends become alarmed when Psa went from 0.01 to 0.02 over a 6 month time. But this is not a worry because a man can function perfectly well with a Psa of 10 or more.
But if Psa moves from 0.01 to 0.02 in a week, then to 0.04, 0.08, 0.16, 0.32 0.64 1.28 each week over a 7 week period, IT IS A WORRY. The speed of Psa increase shows Pca is dangerous, because doctors remedies may not work in time to keep Psa suppressed.
And while Psa may be suppressed, Pca growth and spread may still be occurring but at a slowed down rate, and I watched my PsMa scans show an increasing number of mets as each treatment failed. Very many mets became large enough to be seen in scans, and I don't know how many microscopic mets were present at diagnosis but maybe there were hundreds. Usually, even if only 1 met can be seen in a PsMa scan, a man can assume there are lots more.
The work by John Hopkins is good, but I think yo may find that having Pa > 0.003 when NOT on any treatment at 5 years after the initial treatment means that you have remission. Most of us here have to put up with Pca being like a dreadful weed, it keeps growing again after each lot of treatment is applied and then fails.
The idea of hunting down every bit of Psa is a bit simplistic when the ADT + Cosadex is keeping Psa production extremely low at 0.003. If there was some Pca active but in a tiny amount, it may never be seen in a any scan until becomes big enough to be seen in PsMa scan so docs would never know where to apply additional beam radiation until they knew where active Pca was located. You can't shoot ducks flying above if they are size of a fly, or if the ducks are invisible. A spot of Pca remains invisible if it produces low Psa, and low PsMa.
And some Pca will not produce any Psa or PsMa and always remain unseen until and FDG scan is done. I have seen men have a PsMa scan and this shows Lu177 will work well, but then they get poor response with Lu177 because there is mutated Pca present which cannot be seen in Psma scan so Lu177 won't work. I am now worried about this possibility with my own Pca now.
My Pca began in maybe 2004, 5 years before diagnosis in 2009, so my Pca could be 16 years old, and it would be stupid of me to assume it has not mutated into maybe 2 or more types of Pca which may or may not be easily treated. Docs said I had a good response to first 4 shots of Lu177, and Psa went from 25 to 0.32 in one year but now Psa is zooming up, and its not entirely known why or how well a second round of Lu177 will work. I talk to doc giving Lu177 next Friday and I'll ask for FDG scan and see what he says. I'm also booked in to get genetic testing done for rogue Pca cells in blood, and I may have PARP treatment with Olaparib, but outcome is uncertain. Not for 1 minute did I ever assume I would not need all this varied treatment as time went by.
I doubt anyone can assume they have seen the last of having any Pca present after any kind of treatment, unless they live to pass the test of almost zero Psa after 5 years with no treatments.
There are men who get an RP when Psa is low, and Gleason score is low, and they live on for 20 years without any expense on more treatment or feeling threatened. One friend had just such an outcome with his RP, but he's got complete ED at 80. But who is he going to make love to? Having sex was all over for him 20 years ago. He didn't need ADT, and he benefited from having high testosterone. But 5 years ago, his Psa rose from being <0.01 to about 0.4 and he had 70Grey EBRT, same as I had in 2010, and Psa continues to be < 0.01, and he still does not need ADT. He's lucky, because there are so many cases where an early enough RP still allows Pca progress to occur, and added EBRT does not work, and ADT is needed.
There is a point where threat from Pca killing us soon may not be higher than having a fatal car crash, or being eaten by shark at a beach, or having a heart attack. The trick for survival is to minimize the chances of what identifiable things might kill us and take affordable action in a timely manner, and hope for best.
We all will have a different of experience of Pca if we get it.
PSA that low while on ADT plus Casodex is not the same as very low PSA “at study entry”. If you know you have cancer in the pelvic lymph nodes then clear that out with pelvic EBRT (supported by at least 6 months of ADT). ADT alone will not kill the cancer, only suppress it.
Irradiation of the pelvic lymph nodes has bad side effects and is not justified according to SPPORT
“Additional analyses of the SPPORT trial will focus on the magnitude of difference between the experimental treatment arms to isolate the impact of pelvic lymph node treatment relative to androgen deprivation therapy. The research team also described preliminary data that for those with a very low PSA on study entry, there was no improvement from PLNRT+PBRT+STAD over PBRT+STAD”
You keep repeating that one sub-group analysis, which is statistical. Pelvic LNRT often does not have any significant or serious SEs or complications even though there are risks as with any Tx. It is certainly easier than prostate bed RT. I had PLNRT last Fall for two positive nodes and it was very easy. The newest IG-IMRT technologies are very precise at reducing risk to nearby structures (ureter, blood vessels and bowel). So your PSA at entry was 0.3 (mine was .24). Go for the only possible chance for "cure" that you may have. That was my own choice and IMO what I suggest you consider. Fearlessly.
My positive pelvic lymph nodes are many. First I will reach 0.003 Maybe when PSA <0.003 I no longer have cancer cells. If not, then I will irradiate the nodes.
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Diagnosed with stage 4 prostate cancer June 23. Chemotherapy 6 sessions and now on Nubequ. PSA was 147, now 2.4
Should I undergo Triplet therapy?
List of drugs by their metastatic prostate cancer cancer fighting properties 
pluvicto + docetaxel 
