I have recurrent Prostate Cancer. Can some knowledgeable member tell me when my PSA is likely to reach 8 based on my previous PSAs which were:- 31July2015: .81; 29October 2015: .9; 28January2016: .87 and 21July 2016: 1.4.
I have been told I will commence Hormone treatment when my PSA reaches 8.
@+Burnett1948
There are many other factors besides PSA as to when Hormone Therapy or Androgen Deprivation Therapy (ADT) should be started.
Have you had a prostate biopsy? Have you had a full-body bone scan? Have you had CT's with IV contrast of thorax and abdomen? These are very important diagnostic tools to rule out the spread of prostate cancer. If the prostate cancer has already spread, then ADT should be begun immediately possibly with chemo----longevity is greatly increased with giving both at the beginning of treatment.
And beginning treatment, Firmagon is superior to Lupron, as Lupron has a characteristi"testosterone flare," which can give a little "jump start" to the cancer. And the classic triple blockade of ADT consists of Lupron or Firmagon, bicalutamide and Avodart.
The Avodart prevents conversion of testosterone to the more damaging DHT--dihydrotestosterone. The most most knowledgeable doctors prescribe this, also.
In addition, these days, the more advanced cancer treatment centers give some chemo at the beginning of treatment, along with the ADT to kill off as many cancer cells and metastases and micrometastases which give the best results for longer-term survival.
The earlier treatment is started; the better the results, obviously. Even if it's incurable, the greater number of cancer cells destroyed at the very beginning limit the future spread, obviously.
But a lot also depends on age and physical condition, also. If you're older and not in good condition, chemo in conjunction with the ADT might not be possible.
The old treatment was just one drug, such as Lupron, but now there are other combinations which are more effective.
This is not medical advice; it's information to present to your doctor and for you to do some research about. I wouldn't consider beginning ADT simply waiting for the PSA to rise; I'd request the doctor to consider beginning earlier, for better results.
CERICWIN
@+Burnett1948 Thanks Cericwin. I am a 68 Aussie. I had my Robotic RP in 2005 with 7.6 PSA after negative bone scan, MRI (said cancer inside organ) and biopsy of6 cores all Gleeson of 7 (3+4). PSA when down to .05. In 2009 I had Radiation when PSA reached .4; it came down to .08. In 2012 I found out ( another Urologist checked) my pathology from 2005 operation showed 6mm missed after I was told in 2005 pathology wasn't taken. I have since been told by the same Urologist that because my PSA has risen so slowly since 2005 I should live to 82 (the average life expectancy for men in Australia).He tells me I should have hormone treatment now. My Radio Oncologist disagrees. I will show your information to my Radio Oncologist. Again thank you.
@+Burnett1948 Cericwin I also had a Pet and CT scans about a year ago. It was clear.
@+Burnett1948. Cericwin could you please estimate another question? What is my PSA likely to be when my Prostate Cancer commences to matastasize? I have heard 80: then my next thought is I wonder how long it be in years to reach that stage?
There is nobody on this planet who can tell you when your cancer would metastasize. And the Gleason score is more indicative of the aggressiveness of your cancer. Metastasis occurs when cells break away and begin spreading through the body, like weed seeds taking root.......which is why early treatment is imperative. PSA has nothing to do with when metastasis occurs, it's only a rough and not very accurate indication of how the cancer is growing.
In my case, my initial PSA was 744, and the cancer had metastasized to all of my pelvic lymph glands, spine and sacrum. The ADT shrank the lymph glands and prostate, and even eliminated some of the small, suspected metastases in other areas, which weren't definite, but likely.
And, it's interesting since you have "1948" in your screen name and I was born in 1948---you're probably 68 years old, same as me.
Eric (CERICWIN)
@+Burnett1948 Thanks very much Eric. John
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- 31July2015: .81; 29October 2015: .9; 28January2016: .87 and 21July 2016: 1.4.
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The July/2015 and July/2016 readings are roughly one year apart. So your PSA doubling time is a little over one year --
. . . Let's say it's one year . . .
So you should have PSA = 3 (roughly) in July 2017, PSA = 6 (roughly) in July 2018, and PSA = 8 a few months after that.
There are more sophisticated ways to get the answer, but (based _strictly on PSA doubling time_) they'll give similar results.
Because of the nature of prostate cancer cells -- they are continually evolving -- you have to track you PSA with blood tests. DO NOT depend on calculations.
. CHarles
@+Burnett1948. Thank you cpcohen.CHarles. I didn't thinkmy PSA would reach 8 that quickly. Again thank you.
Maybe it won't. You'll be better off to watch it, rather than predict it.
. Charles
Just to suggest another option to you. I was diagnosed at age 52, had radical surgery. followed by external beam radiation 2 years later when PSA rose. A year later instead of hormone therapy by pill or injection, I opted for an orchiectomy (testicles removed) to stop testosterone production. Cancer free since. Now 76.
@+Burnett1948 Thanks; I need to think about that but great outcome for you.
I think the answers you have already received are accurate and useful, however I would like to add one more comment. Sometimes you can find a urologist or a radiation oncologist who is very expert in drug treatment, but it's not really their specialty. A urologist is primarily trained in surgery and a radiation oncologist in radiation. The doctors who specialize in using drugs (like ADT drugs) to treat cancer are "medical oncologists". Ideally, the best person to consult about if and when to start hormone therapy, which drugs to use, and whether to try a combination drug therapy, is a medical oncologist. And since there are at least 300 different kinds of cancer and no medical oncologist can be expert in all of them, the best of all possible doctors is a medical oncologist with a specialty in prostate cancer. The most likely place to find one of these is at a teaching and research hospital.
I think it could be worth your while to find out if there is a specialist of this type whom you could consult. He or she may be able to answer some of the excellent questions that Cericwin raised.
Determining when and how to move on to additional treatment is hard. There are tradeoffs. The treatments that, statistically, yield the longest symptom free life are probably the most aggressive ones with the most side effects. So in addition to all other medical concerns you need to take into account your desires for the future, what you believe is important to your quality of life, whether you have other health problems, and so on. I suspect that the doctor who recommended starting ADT when the PSA reaches 8 is recommending what he would do if he were the patient. It's a reasonable approach and a responsible recommendation, but might not be the one you'd choose when all factors are considered.
Best of luck.
Alan
@+Burnett1948 Thanks Alan, much appreciated.
@+Burnett1948.Thanks Alan.
I wouldn't trust your numbers enough to make a prediction.
Assuming that you have 3-4 years before ADT, I'd say (a) relax & enjoy them, (b) look into changes you can make to push the commencement date much further.
IMO, PSADT can correlate somewhat with inflammation. PCa triggers an inflammatory cascade in the cells, but this can be inhibited.
If I were to use a single marker, I'd go for albumin. It seems simple-minded that a blood protein not directly connected to PCa, could be predictive of survival, but ...
12 years ago, my albumin was 3.9. A man who headed up a group on the West Coast (USA) told me that men with albumin <4.0 don't last long. There are a lot of recent studies that back-up the importance of albumin across all diseases (& even in apparently healthy people.)
Unfortunately, albumin is being looked at as as a prognostic tool. Although inflammation is an artifact of disease, we know what causes it - activation of NF-kB (Nuclear Factor-kappaB).
There are many natural phytochemicals that can inhibit NF-kB. Most of the familiar names are polyphenols: Curcumin (micronized only), pomegranate extract, apigenin, fisetin & a dozen others. Side effects are rare; doses can be increased until you get the desired result. Obviously, albumin must be monitored.
My latest albumin number was 4.6. IMO, 4.5 is a good target.
Another good marker is CRP (C-Reactive Protein). Ignore the observed range - you want to be as close to zeo as possible. The upper part of the "normal" range is not a safe place.
If your current numbers indicate a serious inflammation issue, & you are able to correct that, I would be astonished if your PSA doubling time did not increase.
-Patrick
@+Burnett1948Thanks Pjoshea13. Patrick I have been eating/taking the foods you suggest plus wall nuts. I had a couple of months off pomegranate juice to get ready for a total knee replacement. I also started taking curcumin capsules not turmeric milk with black pepper. Also I eat broccoli. I will be back eating apples as well. Again thank you. John
Burnett, You can calculate your PSA doubling time by entering your PSA readings and dates into PSA doubling time calculator. You can also monitor how it changes over time. This is the link to the online MKSS calculator: mskcc.org/nomograms/prostat....
Good Luck
bb66
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