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Cancer: Prostate Message Board


Cancer: Prostate Board Index


[QUOTE=rup;4084830]My father (82) was diagonised for Prostate Cancer and his PSA count was 133 at that time. Rectal Biospy concluded that he had Prostate Cancer. So we gave him hormonal therapy (3 monthly implants). Now since 6 months his PSA count is .15 and .2.
I would like to know if this means that he does not have cancer ??[/QUOTE]

Congratulations to your father on that wonderful decline in his count! :D :jester: :cool: That's the kind of response we hope to see in his situation, but it does not always happen. He may be on the road to achieving the kind of control of cancer you need so that the cancer is not a great threat to his life or well being. But the downside is that he almost certainly still has prostate cancer, though cancer that is knocked back on its heels and staggering due to the blockade.

His experience and mine were close: I started with a baseline PSA (first ever) of 113.6 on 12/4/2000, began Lupron (highly similar to Zoladex that I'm guessing your father had), experienced a typical and sometimes dangerous "flare" to 125 measured on 12/20/2000, and added Casodex several months later. By September 2000 my PSA was leveling off at about 0.6.

By then I had learned that you really want your PSA to drop to less than 0.05, which should be your father's next goal, and according to recent opinions of experts in hormonal blockade, it's even better to get that count down to less than 0.01. (I've done that twice, and my current PSA on my third round of intermittent triple blockade (Lupron, Casodex 50 mg daily, and finasteride 10 mg daily with Boniva in support) is 0.07 and falling at a rate of 25% a month) now at age 66. It's likely it will take additional drugs to do drop his PSA from where it is now, either an "antiandrogen" like Casodex (now generic bicalutamide and considerably cheaper than Casodex with the price dropping as time passes), or a "5-alpha reductase inhibitor" (5-ARI) like Avodart or generic Proscar, which is known as finasteride.

Has your father been evaluated for bone density, which hormonal therapy tends to decrease? Many of us benefit from bisphosphonate drugs like Boniva plus calcium and vitamin D3 to support it; Fosamax is now available generically as alendronate. Stronger bisphosphonates are also available.

However, at age 82, his other health conditions, life expectancy, and quality of life can be as important or more important than additional cancer control. It's an individual thing, but best evaluated based on a foundation of fact. In that regard, there are several very well rooted unfavorable myths about hormonal blockade therapy, as well as some true information about side effects and countermeasures to prevent or lessen them.

That's all I have time for for now, but I hope to continue later and would be happy to answer any questions. (Two outstanding books that cover hormonal therapy well are: "A Primer on Prostate Cancer - The Empowered Patient's Guide," Strum and Pogliano (2005), and "Beating Prostate Cancer: Hormonal Therapy & Diet," Myers (2006). The Prostate Cancer Research Institute (Dr. Strum was a co-founder) also has published a lot of excellent information about hormonal therapy. Dr. Myers has a highly informative newsletter, Prostate Forum, that often covers hormonal therapy, something he was on himself for his own challenging case of metastatic prostate cancer.

Take care, and again congratulations to your father on his response! :)

Jim :wave:
Hi Jim,

Thanks a Million for your valuable inputs based on your personal experience.
Yes, he has been taking Zoladex implant & Casodex 50 mg.
Now his oncologist has suggested that he should not take this medication for 3 months. (Hope thats ok).

Because you have had similar experience, can I take the liberty to ask you a few more queries...

Unfortunately, the rectal biopsy turned out to be a very painful experience... he had excessive bleeding and had to be admitted to ICU for 2 days.

And the worst part is that after this procedure, he was not able to walk properly... and now after 6 months, it has deteriorated to such an extent that now he is not able to walk at all. Since last about a month, he has gone really weak and is not even able to sit up by himself. Needless to say, he has to be attended to on his bed for everything. He complains that his feet become heavy and we have to massage them to make him feel better.
To add to his misery & pain, he also has gout, so when he has gout attack it become unbearable.

My question is ...
Is this side effect of rectal biopsy... is it reversible. Any other similar experiences or remedy for this kind of situation...

Inputs / suggestions are highly appreciated.

Thanks & regards,
RUP





[QUOTE=IADT3since2000;4085261]Congratulations to your father on that wonderful decline in his count! :D :jester: :cool: That's the kind of response we hope to see in his situation, but it does not always happen. He may be on the road to achieving the kind of control of cancer you need so that the cancer is not a great threat to his life or well being. But the downside is that he almost certainly still has prostate cancer, though cancer that is knocked back on its heels and staggering due to the blockade.

His experience and mine were close: I started with a baseline PSA (first ever) of 113.6 on 12/4/2000, began Lupron (highly similar to Zoladex that I'm guessing your father had), experienced a typical and sometimes dangerous "flare" to 125 measured on 12/20/2000, and added Casodex several months later. By September 2000 my PSA was leveling off at about 0.6.

By then I had learned that you really want your PSA to drop to less than 0.05, which should be your father's next goal, and according to recent opinions of experts in hormonal blockade, it's even better to get that count down to less than 0.01. (I've done that twice, and my current PSA on my third round of intermittent triple blockade (Lupron, Casodex 50 mg daily, and finasteride 10 mg daily with Boniva in support) is 0.07 and falling at a rate of 25% a month) now at age 66. It's likely it will take additional drugs to do drop his PSA from where it is now, either an "antiandrogen" like Casodex (now generic bicalutamide and considerably cheaper than Casodex with the price dropping as time passes), or a "5-alpha reductase inhibitor" (5-ARI) like Avodart or generic Proscar, which is known as finasteride.

Has your father been evaluated for bone density, which hormonal therapy tends to decrease? Many of us benefit from bisphosphonate drugs like Boniva plus calcium and vitamin D3 to support it; Fosamax is now available generically as alendronate. Stronger bisphosphonates are also available.

However, at age 82, his other health conditions, life expectancy, and quality of life can be as important or more important than additional cancer control. It's an individual thing, but best evaluated based on a foundation of fact. In that regard, there are several very well rooted unfavorable myths about hormonal blockade therapy, as well as some true information about side effects and countermeasures to prevent or lessen them.

That's all I have time for for now, but I hope to continue later and would be happy to answer any questions. (Two outstanding books that cover hormonal therapy well are: "A Primer on Prostate Cancer - The Empowered Patient's Guide," Strum and Pogliano (2005), and "Beating Prostate Cancer: Hormonal Therapy & Diet," Myers (2006). The Prostate Cancer Research Institute (Dr. Strum was a co-founder) also has published a lot of excellent information about hormonal therapy. Dr. Myers has a highly informative newsletter, Prostate Forum, that often covers hormonal therapy, something he was on himself for his own challenging case of metastatic prostate cancer.

Take care, and again congratulations to your father on his response! :)

Jim :wave:[/QUOTE]
[COLOR="DarkGreen"]Hi again RUP,

I'll insert some thoughts in green.[/COLOR]

[QUOTE=rup;4085702]Hi Jim,

Thanks a Million for your valuable inputs based on your personal experience.

[COLOR="darkgreen"]Your welcome! Your father's numbers are so close to my own that I feel a certain sympathy.[/COLOR]

Yes, he has been taking Zoladex implant & Casodex 50 mg.
Now his oncologist has suggested that he should not take this medication for 3 months. (Hope thats ok).

[COLOR="darkgreen"]I am a huge fan of intermittent therapy, even for high risk guys like your father and myself if results support that course, but it strikes me that going off therapy after just three months, if I understand his case correctly, is premature. I suspect the result will be a rapidly climbing PSA.

That's based on observations by researchers that PSA production by cancer cells is initially suppressed by hormonal therapy even though the cells themselves still live and are capable of recovering. Over time, many of the cells themselves die, except apparently the stem cells. However, my impression is that it takes at least nine months of continuous hormonal blockade to reach maximum cell kill, and, in my case, it is likely that it takes longer. (Normally my PSA drops slowly relative to other men on single, combined and triple hormonal blockade, and your father had a rather rapid drop to .2, so probably would achieve maximum cell kill faster, but I doubt that he is there after just three months.)

There are several doctors/practices that I consider leading experts in hormonal blockade, and I believe the former Strum/Scholz practice, now continuing as the Scholz/Lam practice in Marina del Rey near LAX in Los Angeles, is arguably the leader in thinking about how long to remain on full therapy. They like to see their triple blockade patients achieve a PSA of less than (<) 0.05 and hold it there for at least a year before going off the heavy duty drugs. If a patient cannot do that, they consider it a clear diagnostic indicator of more aggressive disease that requires a shift to more aggressive medical tactics. Since most men will be able to drop their PSA to <0.05 in several months, the time on full therapy is generally about a year and a half before going intermittent. Dr. Charles "Snuffy" Myers, another leading expert in hormonal blockade, now likes to see patients get their PSA below 0.01 before they go to intermittent therapy. Both practices believe very strongly in using a 5-ARI (5-alpha reductase inhibitor) class of drug, either Avodart or finasteride (Proscar, the generic version) when the heavy duty drugs are stopped. The Scholz/Lam/Strum and colleagues group has had impressive papers published in prestigious peer reviewed journals that support that approach (triple blockade with a 5-ARI drug as maintenance). The Prostate Cancer Research Institute, to which these doctors have donated an amazing amount of time, has published information about their approach and findings, and the language is much easier to comprehend than what you find in their medical journal papers.

However, technology is rapidly moving forward in prostate cancer, so it's possible that your father's doctor has picked up a new way of doing intermittent blockade that uses a very short "on-therapy" period. I've heard that some respected doctors are experimenting with this. I suggest that you call your father's doctor and try to smoke out whether the doctor is just taking a blind stab at the problem or whether he is basing it on some solid experience with intermittent blockade and high risk patients.

If you would like, I could refer you to the formal medical journal articles, but they are hard to read in this case. If you would like that, I've studied them and could help answer questions.[/COLOR]


Because you have had similar experience, can I take the liberty to ask you a few more queries...

[COLOR="darkgreen"]Sure. Happy to help! :)[/COLOR]

Unfortunately, the rectal biopsy turned out to be a very painful experience... he had excessive bleeding and had to be admitted to ICU for 2 days.

And the worst part is that after this procedure, he was not able to walk properly... and now after 6 months, it has deteriorated to such an extent that now he is not able to walk at all. Since last about a month, he has gone really weak and is not even able to sit up by himself. Needless to say, he has to be attended to on his bed for everything. He complains that his feet become heavy and we have to massage them to make him feel better.
To add to his misery & pain, he also has gout, so when he has gout attack it become unbearable.

[COLOR="darkgreen"]I would like to emphasize that I am not a doctor, just a now-savvy patient, but your father's experience after a rectal biopsy is highly unusual. I strongly suggest that he get a second opinion about what is causing his problems and what might be done. It's possible that even legal issues may be involved relating to the performance of the biopsy.

Has your father had a bone scan for cancer, or a bone mineral density scan? To me, both would be warranted for a man who had such a high PSA, though the cancer bone scan is virtually useless unless men have a fairly high PSA or other suspicious characteristics.

I'm so sorry your father is in such misery! :([/COLOR]

My question is ...
Is this side effect of rectal biopsy... is it reversible. Any other similar experiences or remedy for this kind of situation...

[COLOR="darkgreen"]I hope you will get some other comments from patients or supporters who have encountered similar issues, but the swelling issue may be edema, and there are ways to cope with it and resolve it.[/COLOR]

Inputs / suggestions are highly appreciated.

Thanks & regards,
RUP[/QUOTE]

[COLOR="darkgreen"]Take care,

Jim :wave:[/COLOR]





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