What's Next?

[StuartS]

Situation: Age 75 Based in UK (Scotland): 2018. Gleason score 3+4 - 7. Biopsy was 12 core with 8 targeted. Results were targeted 8 = 4 positive - General 4 = Nil positive. Noted as Stage T3a. PSA 33.2 but no mets and MRI/Bone Scan and x-ray all show no indication that PC has spread other than bulging of the capsule.

Started formal treatment in Dec 18 – was advised that cancer was Locally Advanced - Treatment started with 3 weeks of Bicalutamide then overlapped with Lupron with a one-month injection late December 18, followed by a program of 3-month injections Jan 19 through to Oct 20. Treatment included 22 sessions VMAT (RapidArc) which was completed in Jul 19, resulting in 60 Grey over a four-week period.

During Lupron treatment, PSA level of <0.1 was recorded on all bloods post Apr 19 to until Oct20, and T showing <1.0.

Completed Lupron treatment (7 x 3monthly injections) Jul 20.

Entered Active Surveillance with blood tests every 3 months until Jul 21.

Blood tests reduced to every 6 months after Jul 21, last one being Mar 23.

Figures as follows: Jul 21 - T15.7 PSA 0.1; Oct 21 T14.6 PSA 0.1; Feb 22 T18.3 PSA 0.1; Oct 22 T16.3 PSA 0.1; Mar 23 T22.1 PSA 0.1

Currently my T is rising and my PSA remains static.

I have consultation with my consultant Oncologist 14th April, so what would I expect his recommendations to be regarding continued treatment?

Any thoughts/comments appreciated.

Thanks

[chaddfgc]

Having been on both Casadex with Lu-pron injections, I'm curious, what are your side effects currently if any?

[StuartS in reply to chaddfgc]

Hi chaddfgc., currently no side effects however, I completed the Lupron injections in Jul 20, but had numerous side effects through until Aug 21. Brain fog, depression..., short tempered etc., so was relieved to eventually complete the Lupron and get my life back to something like normal.

[chaddfgc in reply to StuartS]

This is the first time in my SBRT/ADT post radiaton that I've heard of the term " Brain Fog" which explains my golf game frustrations. Seriously now I know it's not my fault. Thanks for that.

[pkat in reply to chaddfgc]

I had my last Lupron shot June 2022. Side affects were hot flashes, lack of energy etc. That is all in the past. My testosterone is just now starting to recover. PSA a month ago was .05 up from .03. Testosterone was only 31, I was hoping for a quicker recovery.

[Tall_Allen]

You didn't have hormone therapy long enough - it should have been for 2 years:

prostatecancer.news/2022/01...

It should also have included your pelvic lymph nodes as in the POP-RT trial:

prostatecancer.news/2021/08...

Hopefully, salvage radiation of the entire pelvic lymph node area + 2 years of hormone therapy can still provide a cure. I wouldn't wait for a PET scan.

[StuartS in reply to Tall_Allen]

Hi TA.

We're you responding to StuartS post. If so, both articles you sent links to were publushed after my ADT was completed.

[Tall_Allen in reply to StuartS]

Yes, I was responding to your post. My purpose wasn't to criticize your doctors, it was to help you understand why your treatment may have failed, and how you can still correct it.

[StuartS in reply to Tall_Allen]

TA..., many thanks for the clarification. I will fully digest the reports. However, I did have 2 years ADT the 7th three monthly Lupron injection was at month 21, and would have been in my system at the two year point..., or so I was advised by my cancer team. I am somewhat concerned however by your comment that my treatment may have failed! What have I missed? I understood (again from my cancer support team), that I was doing good. PSA stable and T just above the preferred max 20.

What should my Onc consultant be advising regarding additional treatment on Friday?

Thanks

[Tall_Allen in reply to StuartS]

My misunderstanding, sorry. I thought you were posting because of treatment failure. I see now, that you were treated optimally and are doing great.

[StuartS in reply to Tall_Allen]

TA.. meant to add that I am on the "add aspirin" double blind trial at the moment.

[StuartS in reply to StuartS]

Thanks..., sharp intake of breath...., and cancel the meeting with the funeral directors for the time being!