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Cancer: Prostate Message Board

Cancer: Prostate Board Index


Merry Christmas ! And congratulations again for your long hard-fought and well-earned success in achieving cure. Your co-worker's act of kindness in the time of despair and desperation provided you with the needed help and inspiration just like myself in my own current situation. Your responses to my posts have helped me in my time of need and brightened my vision of my dreaded G8 PCa disease. Similar to your experiences, all throughout my life, I have encountered various doctors that I felt did not provide the right advice or recommendations. As a result, I ended up paying for the consequences. In this fight against PCa, one wrong decision will most likely have very bad consequences.

In the last post, I asked about the AXIUM scan, and your advice turned out to be spot-on. My AXIUM scan is clean. And my PSA on 12/13/17, four (4) weeks after the start of Triple Hormone Blockade (THB) with 1 x Casodex and two (2) weeks after my first Lupron shot was 0.34, a 93.4% drop from my BPSA of 5.2. My Oncologist and Urologist think that this is really good progress and scheduled me for Proton Therapy starting first week of January next year.

Despite these positive developments, my doubts linger. During my last visit with my Radiation Oncologist about two (2) weeks ago. I asked for the AXIUM scan in order to obtain a more accurate picture of potential metastasis. He countered by saying that my chance of having metastasis is negligible, an AXIUM scan will only provide at most a marginal return. He then proceeded to prove his statement by pulling up the Sloan Kettering cancer center Prediction Tool / Prostate Nomograms page and typed in my profile and PCa staging information, The numbers that came out surprised him: Organ-Confined Disease 21.2%, Extracapsular Extension 75%, Lymph Node Involvement 28.3%, Seminal Vesicle Invasion 30%. These numbers are far from being negligible! So he immediately ordered the scan. At this point, my question is that with these numbers, there is a good chance of microscopic metastasis with Lymph and Seminal Vesicle involvements. Then, how can Proton Therapy be the optimal treatment for me ? Wouldn't IMRT be the right choice ?

I hope you can shed my light on this situation as you always do. Thanks in advance. And again, Merry Christmas.
Gaining Knowledge, Starting Casodex®

In the past week 18 years ago, I was learning a lot about prostate cancer thanks to help from a friend. He had also been diagnosed recently, and somehow he began subscribing to an outstanding newsletter from a medical oncologist who specialized in prostate cancer.

On leap day in 2000 I attended a lecture on hormonal therapy (androgen deprivation therapy – ADT) at a prominent prostate cancer education and support group in the area. I learned a few important points, but I also realized that the speaker, a well-regarded local medical oncologist, was ignorant of some of the key points I had learned from the newsletter. My awareness was growing that there were important differences, sometimes vitally important, in the skill, perspectives, and talent that different doctors had to offer. One of my regrets over the years is that friends I have known with prostate cancer were too attached to doctors who were unable to give them the life-saving or extending help they needed. I remain thankful that somehow I was able to find doctors who knew how to help me (or thought they did, and it turned out they were right). I also met a couple of patients who would become friends for years, though one, with a highly challenging case (PSA over 400 at the start), would pass on within several years.

On March 1, 2000 I made an appointment to see a local radiation oncologist. While I was planning to have radiation at that major mid-Atlantic center, I wanted to get a feeling for what my local radiation folks could offer.

On March 3, a Friday, I started taking the antiandrogen drug Casodex®/bicalutamide that had been prescribed by the mid-Atlantic centers radiation oncologist. His strategy was to shrink my prostate a bit and also use combined ADT (Lupron® plus Casodex®) to better combat the cancer. Back in those days, that tactic was known as MAB – Maximum Androgen Blockade; that term is still used, but for my money, it is very important for most of us to add a third drug - Proscar®/finasteride or more likely these days the more potent Avodart®/dutasteride, plus supporting drugs and side-effect countermeasure tactics – to achieve the best blockade. There has been great progress in development of much more powerful antiandrogen drugs in recent years, but I’ll address that in a blog post.

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