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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Thanks Mart & Thanks Jim:),
I went to urologist day before yesterday and after looking at the bone scan and the pelvic CT scan he said it was good that the spread has not started but he was in doubt about the PSA level (56.9) as person without metastasis usually has much lower PSA.
He suggested a repeat of the PSA and we followed suit.The latest reading is 52
He said if the PSA level came out to be below 20 then he would prefer surgery and if more then he would go ahead with hormone therapy.Today we are supposed to visit him once more for his suggestions.

What are the side effects of hormone therapy and are they tolerable? how is the quality of life affected by this? Now he is leading a normal life and his other parameters like diabetes and hypertension and the creatinine well under control.
If there is side-effect how to counter it? and other than the treatment what do you suggest the patient to do to increase his well being (you suggested diet, exercise, and prayer before please elaborate).
Is it important to lower the PSA level.If it remains upward of 50 what happens?
HT is administered over a period of time and then withdrawn.What is the time period that a patient is kept on?

To answer Mart's question "whether my dad is insulin dependent ?" the answer is "no". He has been on a single tablet of Diamicron in the morning for over 5yrs now and his diabetes is well under control.
Mart, I have question for you as you are very closely watching a person in his fight against PC. How difficult is it for the patient's family members to help the patient take the right decisions? And what should they do to cope with the pressure that this disease wrecks on the entire family.



It has been turbulent last one month and you people, Jim and the rest forum members have been source of good information for me and you have been part of my struggle against a formidable road-bump in my life.Thanks a zillions times.
May God always be with us to see us through this journey.I pray that He gives strength, courage and conviction to us all. Keep the faith.:)

Brendon:wave:
[COLOR="DarkGreen"]Hi Brendon,

I'm responding to your post #11 of a few days ago. Here's what you posted, in part:[/COLOR]

[QUOTE]Thanks Mart & Thanks Jim:),
I went to urologist day before yesterday and after looking at the bone scan and the pelvic CT scan he said it was good that the spread has not started but he was in doubt about the PSA level (56.9) as person without metastasis usually has much lower PSA.[/QUOTE]

[COLOR="DarkGreen"]His analysis appears sound to me.[/COLOR]

[QUOTE]He suggested a repeat of the PSA and we followed suit.The latest reading is 52[/QUOTE]

[COLOR="darkgreen"]There is some day to day variation in PSA, and that might account for the decrease. However, it's good news that the PSA is not increasing at a rapid clip and may be increasing only slowly if at all. :)[/COLOR]

[QUOTE]He said if the PSA level came out to be below 20 then he would prefer surgery and if more then he would go ahead with hormone therapy.Today we are supposed to visit him once more for his suggestions.[/QUOTE]

[COLOR="darkgreen"]I don't know of any top surgeons who would be comfortable with surgery on a man aged 77, especially one with diabetes. The usual cutoff is around 69 or 70, though the use of modern techniques is notching that upward slightly for men in good shape with a long life expectancy. The reason for the cut-off is that older men typically have a much harder time with the side effects, and that is in the balance together with the fact that the period of possible benefit from the surgery is not as long.[/COLOR]


[QUOTE]What are the side effects of hormone therapy and are they tolerable?[/QUOTE]

[COLOR="DarkGreen"]I and some other board participants have posted about this a number of times. You might want to check my post of 9/18/2010 in the thread "Thinking of triple hormone therapy". I also started a thread about this on 3/6/10 titled "Hormonal Therapy Side Effects: Likelihood, seriousness and countermeasures." The books mentioned earlier (the Primer, Invasion and Beating) contain excellent information, much of it not overlapping.

In a few words, the most bothersome likely side effect is hot flashes and sweats, but often these are less bothersome for older patients. I'm now nearly 11 years into this, and during the last 19 month cycle of full blockade, ending in April, the flashes and sweats were barely a minor nuisance for me, often barely noticeable. Loss of interest in sex affects 90% of us to some degree (often nearly total loss while on the LHRH agonist drug), but that often does not matter much to men in their upper 70s and older. A likelihood of losing some bone density is one of the more serious potential side effects, but there are excellent countermeasures. Exercise (aerobic and strength) are very important in holding down several of the side effects, and age 77 is not too old to exercise.

For some men, one or more of the side effects will make hormonal therapy intolerable. However, countermeasures can often make it quite tolerable.[/COLOR]


[QUOTE]how is the quality of life affected by this? Now he is leading a normal life and his other parameters like diabetes and hypertension and the creatinine well under control.

If there is side-effect how to counter it? and other than the treatment what do you suggest the patient to do to increase his well being (you suggested diet, exercise, and prayer before please elaborate).
[/QUOTE]

[COLOR="darkgreen"]Mart has posted about diabetes, and I think I may have also earlier on the thread. It deserves extra attention while on the LHRH agonist drug. I'm convinced that exercise and other lifestyle tactics, especially nutrition and diet, are very important in achieving success here. I just had my annual physical a few weeks ago, and my fasting glucose level was perfectly normal, indicating no diabetes despite being on intermittent hormonal blockade for nearly 11 years.

Hormonal therapy can contribute to hypertension. Once again, exercise, nutrition and diet can play a major role in countering this. My blood pressure tends to be on the low side and is absolutely not a problem.

Casodex (generically available as bicalutamide, much less expensive) can cause liver damage in a few men, but is easily monitored with a liver function test, which catches any problem before harm is done.

Is creatinine a kidney function test, or liver? It's late, and I forget. My impression is that kidney function is little affected, if at all, by hormonal therapy.

A statin drug may be helpful in preventing or controlling high or increased bad lipids, especially bad (LDL) cholesterol, which hormonal blockade can boost in some men. Diet and exercise also help.

The books (the Primer, Beating and Invasion) provide a wealth of detail. Please take a look at the previous related posts or a book or two first, and, if you have questions, I'll get into specifics.[/COLOR]


[QUOTE]Is it important to lower the PSA level.[/QUOTE]

[COLOR="darkgreen"]Yes. In men with challenging cases of prostate cancer, especially if the PSA is high, PSA is typically an excellent indicator of the extent and aggressiveness of the cancer and how it is responding to treatment. [/COLOR]


[QUOTE]If it remains upward of 50 what happens?[/QUOTE]

[COLOR="darkgreen"]That is an extremely unlikely scenario, but it would suggest either that administration of the hormonal therapy had been flawed, or that the patient, despite not having been on hormonal therapy before, had cancer cells that were already at the outset more or less independent of the testosterone level - highly unlikely. The PSA level is likely to plumet. I'm convinced, based on advice from experts, that the PSA really needs to drop to less than (<) 0.05, and even better to <0.01. If it does not, then other tactics need to be put to use. "Beating ..." by Dr. Myers is especially informative about that.[/COLOR]


[QUOTE]HT is administered over a period of time and then withdrawn.What is the time period that a patient is kept on?[/QUOTE]

[COLOR="darkgreen"]"Invasion ..." is good about that, as I recall. These days a lot of doctors are keeping patients on therapy for 9 months, which to me is a minimum. The experts I have followed prefer to keep patients on until the PSA reaches <0.05 or <0.01, unless the patient is having extraordinary difficulty in tolerating the therapy. Some patients, often with extensive metastases, do not get their PSA low enough to make withdrawal reasonable, so they stay on the therapy continuously.[/COLOR]

[QUOTE]...
Mart, I have question for you as you are very closely watching a person in his fight against PC. How difficult is it for the patient's family members to help the patient take the right decisions? And what should they do to cope with the pressure that this disease wrecks on the entire family.[/QUOTE]

[COLOR="darkgreen"]I'll answer too. Of course a great deal depends on the patient, and also on the family. Dr. Myers' book "Beating ..." gives a huge dose of optimism to those involved in fighting the disease. I feel it should be required reading for all involved with advanced prostate cancer. Understanding the disease can go a long way toward lowering the pressure. Ultimately though, I feel the patient should make the key decisions.[/COLOR]


[QUOTE]It has been turbulent last one month and you people, Jim and the rest forum members have been source of good information for me and you have been part of my struggle against a formidable road-bump in my life.Thanks a zillions times.
May God always be with us to see us through this journey.I pray that He gives strength, courage and conviction to us all. Keep the faith.:)

Brendon:wave:[/QUOTE]

[COLOR="darkgreen"]You're welcome.

Hang in there.

Jim :wave:[/COLOR]





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