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Cancer: Prostate Message Board


Cancer: Prostate Board Index


Hi Rhonda,

I'm so glad that Irv continues to do well. I did expect it, but this disease sometimes upsets our expectations, and it's reassuring to have a good result.

You both have worked hard for this vacation, and I hope it is a very long one! :)

About getting a PSA test with a lower limit, I think it could be done without too much trouble, but the test with a lower limit of <0.02 is very good. Based on the way Irv has responded, I'm convinced his PSA is <0.01. The outfit my doctor uses in the states is LabCorp, and the actual LabCorp lab he sends the sample to is in North Carolina. Most likely LabCorp has other labs that handle <0.01 tests. The blood draw would probably be the same, though a vial with a special preservative (for mailing) might be used. I believe the sample is refrigerated and sent with a coolant. I'm thinking that being at <0.02 is good enough. Getting the exact level would be nice to know, but not essential as I see it.

About Avodart: On Wednesday I received a DVD with the talks from the 2011 Prostate Cancer Conference from last September. Dr. Myers, who uses Avodart a lot in his practice, talked about what he looks for and his approach to dosing. He wants to see DHT drop to less than 5. (As an example, I'm thinking my DHT is probably less than 5 now; he advised my regular oncologist and me to switch from 10 mg finasteride to Avodart in order to get my DHT on vacation down from 11. After switching, DHT was 5 at the last test and likely lower now.) He said that after a patient has been on Avodart for a year, he has him taper the dosing to three times per week - Monday, Wednesday and Friday - instead of daily. After that, he has him taper the dose again to Tuesday and Thursday. He did not say it, but I believe he meant that he has the patient taper if he is able to maintain a DHT below 5, and return to more frequent dosing if the DHT goes to 5 or above. Perhaps someone reading this can confirm it. It's something to consider, but, unfortunately, most doctors, even those familiar but not truly expert with hormonal blockade for prostate cancer, probably will not be knowledgeable about this.

Those tests you listed all look useful. The key tests as I see it are PSA, testosterone and DHT on a continuing basis, with a bone density test since that has not been done before. It's likely it will show some decreased bone density because of the hormonal blockade. Did Irv take a bisphosphonate drug along with calcium and vitamin D supplements? If so, that may have protected him against density loss or minimized loss. It's likely bone density will increase as testosterone is recovered during the vacation. My oncologist also routinely has me do a complete blood count and a comprehensive metabolic panel with almost all blood tests, and several times a year he does a five minute physical exam, checking for key clues. I'm not sure how much that reflects his own experience and practice above essential requirements, but the track of results has come in handy now and then, as it did in interpreting the recent unprecedented elevation of my creatinine level that was found just before the scheduled contrast CT scan.

It's almost a certainty that the PSA will rise [I]very[/I] slowly as testosterone recovers. It's quite likely that the level will remain below the lower level of the test for a while, <0.02. Once you both are comfortable with the pattern of increase, you may feel that testing every two, three or four months is sufficient. It's not a situation where there will be a sudden jump. Here's hoping that the vacation is permanent or at least many years long!

You asked about that ambiguous image on the CT scan. Your logic makes sense, but my oncologist is always thinking, what difference will a result either way make in our decisions? If the image is just catching scar tissue, it should be the same. If the CT caught cancer, there's a strong chance it won't show up now, but you would not know whether the treatment knocked it out entirely or just reduced it to now to a very small volume of dormant prostate cancer stem cells that may come back at some point. Do you see some other value?

Here's a caution about a development that caught me slightly off-guard as I started my first vacation period: as testosterone returned, so did a bit of aggressiveness - more like the normal male pattern. I felt that very clearly in driving behavior, and I could also sense it in social situations. In general that's fine, but it takes more active control to act like a gentleman when you have your testosterone back. Moreover, since Avodart is stopping conversion of testosterone to DHT, many of us will have a higher level of testosterone than we have had before. Mine went to more than 1,000 during my first vacation period, which is above the normal reference range by 200-300 points, and my experience was not unusual from what I've learned. All of this is not a problem, but it helps if you are ready for it.

Of course it is [I][U]great[/U][/I] to once again have all the benefits of testosterone! :cool:

Take care,

Jim:wave:





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