I am scheduled for a prostadectomy in August, but I hesitate to do it based only on my biopsies of last February. I follow most of Chris Werk's suggestions and had lowered my PSA from 22 to 7 with the best herb supplements (Curcumin Phytosome, Astragalus, Berberine, Quercetin, Saffron, Apigenin and more.)
What kind of tests should I get to find out if my cancer (Gleason 7, 3+4) could be diminishing? CT test or PET or what? Or just another PSA test? Had a bone scan in March, was negative. Isn't it wise to know my current condition before surgery? I do not want surgery if I might be on the road to recovery. I need to know where I am in this before proceeding.
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CarrotBoy
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I don't know of any testing that is definitive in this regard, including PSA. I know that my own PSA went from 20 to 13 in 3 short months of a very restrictive diet. But even if we assume that we are knocking back the cancer load itself (rather than just PSA expression) in the short term, with a particular intervention, how do we know what that means for the long term?
We know that remission/regression of cancer in response to medical treatment can be temporary. So I would expect that to also be true of NON-medical intervention. That is not to say it is impossible that your cancer is on the way out, never to cause problems, but just to say that 1) I don't know how likely that is, and 2) I don't know an easy or reliable way to confirm that process as sustainable.
Of the common medical interventions (RP, RT, chemo, hormonal, immuno) there are arguments to be made for or against any of them, in various contexts of disease stage and risk. There are different kinds of genetic and other testing that might help give likelihoods of how aggressive your cancer MIGHT be, or of which therapies MIGHT work better. But we are still waiting for types of testing/screening that reliably predict the futures of "intermediate risk" cancers. If PC is about anything, it's about uncertainty.
In addition, let's suppose you DO proceed to get one of the PSMA scans or mp-MRI biopsies that gives you a better idea of where you stand now. How is that going to help you know of any progression or regression of the cancer, if you don't have any of those scans from months/years ago? For that matter, how will that knowledge help you know where your cancer is headed?
If these more refined scans didn't cost a fortune. we could all start them in our thirties and forties and keep track of how our pre-cancers and early cancers were developing over the many decades that we are likely to have them, since they are generally so slow-growing.
If i have to do everything again, I would not start any treatment without having a PSMA PET/CT (Ga 68 PSMA or 18F DCFPyl), to know with better precision where the cancer is located in my body. PSMA PET/CTs changed the treatment plan in around 40 to 60% of patients in some studies.
There are some clinical studies for these PET/CTs in the USA which could apply to your situation
A PSMA PET/CT is not the SOC, it is not perfect but it is the scan with best sensitivity to identify cancer in the whole body. You could also get a mpMRI since PSMA PET/CT scans may miss small cancers with low Gleason score in the prostate.
Hey CB! Get all of your scans and proceed. The nutrients are helping you . But they won’t kill pc . Best bet is a clear cut Rp and you just might be done with pc for good? I wasnt a candidate for an RP . Wish that I was ? . Waiting increases chances for pc to take off.. Find out where you’re at and don’t look back . You have a chance at a cure in my unprofessional opinion... I did much alt med myself along with our conventional RT and adt .. if you can avoid those and chemo ? Do it . Only you can decide what’s best for you . Good luck 👍
With PSA already relatively high at 22, and Gleason 3+4=7 from biopsy, with 4 months having passed since then, I believe I would first look for the best available RO and facility with the intention of beginning that treatment (likely ADT followed by RT) as soon as possible, while in parallel pursuing scans to find out whether detectable metastasis has already occurred. Regarding RP versus RT: RT appears to have the advantage over RP regarding long-term ED: Even if the surgeon claims a good probability that "nerve sparing" surgery will be successful for regaining erectile function, there will likely be a significant risk that it will not succeed, resulting in ED from that time onward. Also, although it is true that prostate cancer generally develops rather slowly, based on the high PSA, it seems possible that it could be close to crossing the boundaries of the prostate. If PC turns out to have progressed to outside of the prostate by the time the RP will have been performed, adjuvant or salavage radiation treatment (ART or SRT) will likely be called for, incurring the side-effects of both RP and RT.
If I had it to do over again, I think I would opt for ADT+RT instead of RP. I had PSA of 14.5, 3T MRI, and biopsy Gleason 3+4=7, and an optimistic prognosis from the urologist/surgeon for nerve-sparing RP. However, the nerve sparing was only partially successful, and the pathology turned out to be somewhat adverse (T3a N0; positive margins and extension into bladder neck, although all <2 mm), such that there is a significant probability of SRT in my future. (Fortunately, 16 months following RP, my PSA has remained below the limit of detection (<0.014 for the test used), so I hope that will continue. Regarding the ED, I'm thankful for TriMix, but regret needing it.)
There have been a lot of previous posts on this web site regarding RP vs. RT. Here's a the URL for one of them (see especially the reply from Tall_Allen):
One way to think about it is, if the supplements and dietary changes have resulted in the cancer becoming less active, perhaps even shrinking, the surgery could be more effective in terms of the quality of life issues-nerve sparing and the like. A 3t MRI should give and indication of tumor volume and location.
The tests will never indicate an improvement...Advanced Prostate Cancer doesn't work that way. Surgery, if that is your choice...should be done ASAP to prevent additional injury...escape of cancer cells into your system.
I don't know if all the herbs you are consuming are doing anything much to reduce Pca but they may be reducing Psa. I have no clue if the herbs would interfere with PsMa Ga68 PET+CT scan which is now regarded as best scan to have when Psa is between 2 and 10, and it may show where all your mets are and well before any CT scan shows mets.
I had inoperable gleason 9 in 2009, Psa 6.0, age 62, in 2009. I am still very much alive, but will begin a second round of Lu177 next 24 July.
I had initial EBRT, ADT and other suppression drugs and chemo, and only Lu177 has seriously reduced met numbers.
If you have Pca that does not generate PsMa then PsMa scan won't show it, so then best scan may be PET FDG, which should show where radioactive sugar is being absorbed at mets, and also PG. I had both types of scans in recent past weeks and all my Pca is now in bones only, and there is no Pca that is not generating PsMa expression, so I expect next round of Lu177 to work OK. Psa is now about 20, but I have high QOL without any pains.
One more thing to consider: your approach so far has been to treat the cancer as a problem that might respond to systemic changes as well as to direct local treatment. You might ask yourself, why should you imagine that no cancer cells have "escaped" and taken up residence outside the prostate? Is there some mechanism that prevents that? Given the extremely long growth period of PC, to some of us that seems very unlikely.
That does not mean a local approach is of no benefit. But it would mean that a local approach ALONE may not be curative for systemic disease, if you are among those who believe (quite rationally) that much/most PC is just that. So as you debate between RP or RT or both or neither, as your mode of local intervention, you might also have the other debate of whether your systemic treatments will consist only of diet/supplements (unproven) or will include SOME form of hormonal therapy (proven).
I have now opted to ignore the local approach and take the hormonal approach only, after an initial period of taking the diet/supplements approach only. That decision was made AFTER scans found some mets, but I think I would have come to the same decision even if the mets had not yet grown to be detectable.
So I think you could have these debates even without knowing your PSA or having a biopsy or getting further scans, by asking yourself what you would do under various possible testing outcomes. Whatever feedback these tools give you on the CURRENT state of your disease, the fact will remain that you have a certain FORM of what is known as "hormone-sensitive cancer" and that the form of cancer will evolve over time, with or without treatment (whether local or systemic).
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