Follow up PSA - Interesting Quandary

Had blood work done last week and the PSA rose to 0.44 from the .32 three months ago.

Background, Surgery in Sept 2008 - Positive margin - pT2C NOMX Gleason 7 (3+4) PSA rising since surgery. 6-7 months doubling time.

Uro has given three choices.

1. Wait another three months..but that wouldn't be beneficial and I would be in the same shoes as today with higher numbers

2. Begin a 4-month shot of Eligard (administered by him)

3. Radiation to full pelvic area

I was a bit surprised about the Eligard shot as an option with my low psa numbers.  But he mentioned that at this low level it would also present a cure in as much as the radiation would.  He is leaning towards radiation however, but added that the side effects from Eligard would revert after stopping the injection treatments.  I asked how many shots and over how long a period of time, and he said probably just one shot that would last about four months.

This puts me into a bit of a quandary (Zufus Twilight Zone).  It would seem on the outset to take the shot and have as good of a chance of a cure without the risk of radiation.  However on the flip side, I am not so optimistic with the HT either...much less being administered by the uro rather than a medical oncologist.

I am scheduling the usual consultations with the radiation and medical oncologists and will make my decisions from there.

But if anyone has any inputs or suggestions, it would be much appreciated.  And I know that nobody here is a medical doctor and I will take your responses as a brother in this disease and any advice that is given is in support only.

Thanks to all here...

>> It would seem on the outset to take the shot and have as good of a chance of a cure without the risk of radiation.<<

sorry for your problems but i'd seek other qualified opinions ASAP.

ed

 

LV,

Within the parameters set forth by you, I am no an MD, I offer the following.

You know that I have been through surgery, SRT, METS radiation and have a PSA of 3.9 (up from 2.2 in SEP 2010). My meeting with my ONCO the other day I expected him to start with HT discussions and he surprised me by saying let's wait until May and have a one year follow-up on Bone Scans and such.

I am not a fan of going on HT for my own selfish QoL reasons, but still this surprised me.

Something you said struck a cord though, your doc said that the shot now "would present a cure as much as radiation would".

This is from the Eligard Web Site;

"ELIGARD is a prescription medication for the palliative treatment (management of symptoms) of advanced prostate cancer. ELIGARD is an LHRH (luteinizing hormone-releasing hormone) agonist. It is designed to reduce the amount of testosterone in the body by reducing the testicles' production of testosterone. It is not a cure for advanced prostate cancer."

Even the drug manufacturer states that it is only palliative. So that is something I would chew on for a little while.

There are a great many medical papers out there that discuss the whys and when of SRT and their value. You should take a look at some of them also.

I know that this doesn't answer some of your questions, instead it may raise a few, but that is what we are here for also. We provide support and bring things up for discussion and discovery.

Good luck my brother in your quest for the right answer for you and your PCa,

Sonny

So I see that in the time it took me to write my post our brother Bronson arrived at the same conclusions. I gotta learn to type a little faster or at the least be less verbose. LOL

Sonny

Thanks Sonny,

I agree it seemed a little odd as the company stated it was for advanced cases. If it wasn't for the clout that my uro has in the medical field, I would have taken a different approach.

But I think what I understood from him, was that in cases where there is a very small amount of cancer remaining that this could be as effective as radiation. I have never heard of this method and was wondering if this is a new approach in dealing with the disease.

Interesting concept anyway, even though it is out there in left field.

Les,
There are a lot of experienced doctors that are convinced that early HT can result in a cure for a certain % of patients. probably somewhere in the 30% range. Liebowitsz, Strum, Scholz and Myers all believe this and have seen enough of these cases in their paractices. If I were to get HT I would get it from an experienced medical oncologist that is very familiar with PC patients and not from a urologist or normal medical oncologist.
JT

Les, it is thought provoking at the least, and presents you with at least the possbility of an alternative to SRT (the gift that keeps giving and giving, lol). My body has been perm. damaged by SRT, and will never be the same again. Rare case? Perhaps, but there are lots of cases of people having severe reactions to radiation. Least you have an option on the table to consider. But you will need the best of the best medical oncologist, as JohnT suggested, to help thinkn through this option.

David

I like John's thinking about whom should treat a BCR patient. Brief words from me (lol).

Post Edited (zufus) : 1/18/2011 1:21:11 PM (GMT-7)

Zufus....thanks, but am I suppose to read between the lines. Are you saying I should fire my uro? He said that HT is an option, however he said in the same converstation that he was leaning towards radiation. Didn't sound like he was thinking about profit only to me. Sure he would make a profit on the shot, but not the radiation.

Would you mind maybe speaking in terms that someone like me (who is dumb) could understand better what the jist of your post was about.

Thanks,

Zufus....thanks for the clarification. I had already decided before I even posted this thread, that if I go the HT route, it will be done by someone other than my uro. (From JT's advice that he has given over and over as well as yourself from many posts in the past)

I am in a similar situatio, although my pending BCR will be much shorter time-wise. I also asked about HT in conjunction with SRT. The experts I spoke with recommended RT and NO HT for now.

Let us know what the other experts you speak with think

Mel

Hey Les - only thing I can offer is a couple (or more) COLD Ones. Just say when

Steve...is that before or after or both...lol