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Cancer: Prostate Message Board


Cancer: Prostate Board Index


[COLOR="DarkGreen"]Hi Gleason9 (Tom),

Welcome to the board! :wave: May I assume from your chosen identity that you are the ninth son in the Gleason family? ;) (Lame joke, but humor helps, sometimes even bad humor. Anyway, I'm glad you are with us. I'm sorry about that double hit with lymphoma. :( I'll make some comments below about triple blockade, but I'm not sure how it would dove tail with treatment for lymphoma. :confused: My hunch is that both could be done in parallel. We've had some folks with that double hit in our local education and support group and on this board, so it's not common but not extremely rare either. At least it is low grade. At least one of our support group guys had treatment and knocked it out as far as could be told.

I' responding to your first post, but have read through your post #5, including helpful responses from Baptista. I am now in my eleventh year of intermittent triple blockade, with maintenance (finasteride), for a challenging case of prostate cancer as my sole therapy. I'm now five months into my third vacation from the Lupron and bicalutamide. Life is good! :D[/COLOR]

[QUOTE]I recently underwent robotic surgery for what was believed to be Gleason 7 T2b prostate cancer. The post-surgery pathology report upped the score to Gleason 9 with right-side positive margin, but didn't find any other evidence of spreading except perineural invasion. (They did find low-grade lymphoma, however. :( ). My PSA six months prior to surgery was 14. My urologist, etc., dropped the ball and didn't do a pre-op PSA test to get a good idea of my doubling rate.[/QUOTE]
[COLOR="DarkGreen"]That's too bad, but you still have some good clues. (I never got a handle on my doubling time either. My first ever PSA was 113.6, and within two weeks I had my first Lupron shot.) When you look at your score of 4 two years ago, your score of 7 one year ago, and your score of 14.7 six months ago, it suggests a doubling time of somewhere between six months and a year. Specific dates might make the picture clearer, but there is always the chance that some growth in healthy tissue or especially some infection or inflammation could also be contributing, which would increase the doubling time of the cancer (a good thing). Unfortunately, there's no way of telling. At least you have some tentative figures.

If that rise from 7 a year ago to 14.7 six months ago is solely due to the cancer, that adds a risk factor, and it's worth making sure your doctors know about it. In essence, a PSA velocity of more than 2.0 per year in the year prior to diagnosis is a fairly strong indicator of a more aggressive cancer, in addition to the usual risk staging characteristics (PSA level, Gleason score and stage). Unless the rise you experienced is mainly due to one of the non-cancer factors, which is probably not that likely, your rise is in the higher risk area.

You can check the research on this by going to www.pubmed.gov, a site we can use on the board because it is Government sponsored. (It's our gift as taxpayers to us and to the world. PubMed electronically provides leads to all the significant medical papers published all over the world, providing abstracts in English for the vast majority of them.) Dr. Anthony D'Amico, a prominent radiation expert in Boston led the team, so you could search PubMed for something like (without the quotation marks)" d'amico a [au] AND prostate cancer AND "Preoperative PSA velocity" AND 2004 [dp] ". I think that will get you right to the paper or to a small group where the right one will be obvious. I have the paper, and I strongly recommend you get the whole paper. There are a lot of medical libraries around that will give access to patients. Mine even copies articles I want for me. If you have questions about the paper, I can probably answer them.

Though you will see that being at higher risk in this way affects a patient's chances, keep in mind that the men whose results were tracked were treated a long time ago as prostate cancer time is counted (things move fast in research and development for us). Therefore, results today, for men treated intelligently, partly as a result of the D'Amico research, should be much better. :D

By the way, Dr. D'Amico is the same doctor who pioneered the now universally used low-, intermediate-, and high-risk categories based on PSA, Gleason, and stage.[/COLOR]

[QUOTE]So now, I visited an oncologist who wants to do standard hormone therapy and radiation. I'm currently undergoing tests, but I've also been doing research and found references to triple hormone therapy.[/QUOTE]

[COLOR="darkgreen"]I am so not fond of the idea of standard hormonal therapy, probably meaning just a single drug, for a patient with a case history like yours! (Then again, I'm a survivor with absolutely no enrolled medical education under my belt.) I'm convinced that we patients with extra high-risk case characteristics need full triple hormonal blockade, hopefully intermittent, which is very often possible, even for us high-risk guys.[/COLOR]

[QUOTE]It is clear that I have high-risk prostate cancer, and I can assume that micromets are still in my body after the surgery. I like the idea of hitting them hard right away.[/QUOTE]
[COLOR="darkgreen"]Right, and AMEN![/COLOR]

[QUOTE]Because of that, I wonder if the recommended approach might not be as effective.[/QUOTE]


[COLOR="darkgreen"]I'm thinking it would not be as effective as you need.[/COLOR]

[QUOTE] It would seem that radiation would only be done to focus on the remaining positive margins, especially since there was no evidence of the cancer having spread beyond the prostate. [/QUOTE]


[COLOR="darkgreen"]I think Baptista addressed this, right?[/COLOR]

[QUOTE]I would think that other therapies could deal with the positive margin just fine without the risks, expense, etc., of radiation. [/QUOTE]

[COLOR="darkgreen"]Hormonal therapy might be able to deal with the margins, but usually it does not totally kill such cancer, as I believe Baptista also indicated.[/COLOR]

As for the standard hormone therapy, it seems that it is both not enough and yet too much. It isn't broad-spectrum enough, and it is continued far too long, leading too easily to resistant cancer.

[COLOR="darkgreen"]My impression is that single drug therapy, or even two drug therapy (LHRH-agonist plus an antiandrogen is typical) are more prone to earlier resistance than triple blockade, especially if the latter is intermittent. There's a lot of informal information about this, but only a handful of published studies on triple blockade. Doctors who are not expert in hormonal blockade greatly overestimate the potential for early resistance with triple blockade (and for other types). I can explain the likely reason for their misconception, but for now, it may encourage you to know that many of us respond well (to first line hormonal therapy) for ten to eleven years, or indefinitely. After that, there is second line hormonal therapy, and there are other non-chemo options.[/COLOR]

I have read the Leibowitz documents, but have not yet reviewed the books from other practitioners. But I'm hoping that this would be a good treatment option for my high-risk case.

[COLOR="darkgreen"]"Dr. Bob" Leibowitz's writings are what initially persuaded me to switch away from external beam radiation to a reliance on hormonal blockade as sole therapy, back when I was deciding around May 2000. For a long time he focused his writings on men who had not had surgery or radiation, just focusing mainly on men going straight to triple blockade as their sole therapy.

One other major practice with many triple blockade patients has published two books that cover triple blockade as well as many other topics. The first is "A Primer on Prostate Cancer--The Empowered Patient's Guide," originally published in 2002 but revised in 2005. It's by Dr. Stephen B. Strum, MD, and Donna Pogliano. It has a long secton on hormonal therapy (aka androgen deprivation therapy), and it has two graphs of success with triple blockade, including one that is specifically for men with prior surgery, prior radiation or both. Both tables are encouraging. Do you have the Primer?

The other book has just been published. It's "Invasion of the Prostate Snatchers--No More Unnecessary Biopsies, Radical Treatments Or Loss of Sexual Potency," by Dr. Mark Scholz, MD, and Ralph H. Blum. It has at least three chapters with key information about hormonal therapy, though it calls it by the awkward name "Testosterone Inactivating Pharmaceuticals" (TIP).

A third practice has also resulted in a book. Dr. Charles "Snuffy" Myers, MD published his book "Beating Prostate Cancer: Hormonal Therapy & Diet" just a few of years ago. It too has great information about this strategy. Dr. Myers has the unique qualification among these authors that he was on triple blockade for nineteen months for his own challenging case of prostate cancer.

While some of the information in these books overlaps, I am convinced the patient who is contemplating hormonal therapy will learn a lot from reading all three. Both practices have ample experience with men who are starting blockade after recurring following radiation or surgery.

There are also several prostate cancer newsletters that often feature information about triple blockade.[/COLOR]

[QUOTE]Since I live near the Twin Cities in Minnesota, it would also be nice to find a local oncologist who uses a triple hormone therapy. Mayo is even close, if they would support this treatment. Any recommendations would be wonderful.[/QUOTE]

[COLOR="DarkGreen"]I do not know of any such doctors near you, but the headquarters of the national education and support group Us Too International is in Downers Grove, Illinois, not that far from you. They might have some fairly "local" knowledge of doctors who know the ins and outs of triple blockade. You could also check with the Scholz/Lam and Myers practices for leads. [/COLOR]

[QUOTE]I would appreciate any advice you folks would care to give.

Tom[/QUOTE]

[COLOR="darkgreen"]Just a parting thought: you may not have recurred, even with that positive margin. Have you thought of insisting on an ultrasensitive PSA test to substitute for that conventional test your doctor is using? Personally, with your history, I'm not impressed that the doctor chose to monitor with a conventional test. :( However, please remember that I lack medical credentials.

Take care, and good luck,

Jim[/COLOR]





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