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Posted 1/21/2011 9:41 PM (GMT 0)
I had lunch with a friend who had a radical prostatectomy about five years ago (Gleason six, cancer confined to prostate).  about two years ago, his PSA began to rise.

He was scheduled for salvage radiation, and then requested a second opinion.  As I understand it (I'm making a long story very short ... and leaving a lot out), the folks at the University of Colorado suggested that the increase may be due to residual prostate tissue.  He decided to take part in a trial where his only treatment was Avodart.

His PSA has not risen over the past two years. 

Has anyone else tried this secondary treatment, and if you have how did you do/ are you doing?

Posted 1/21/2011 10:04 PM (GMT 0)
RCS,

It's a Phase III trial with/without Avodart. The old protocol number is 042010 -062. The new number is 072010-085 if anyone is interested.

I am scheduled to begin consultation and prep for the trial late next week. I don't know what leg of the study I will be on yet.
Posted 1/21/2011 10:11 PM (GMT 0)
les and/or RCS, any info about daily dose or details of the study?
Posted 1/21/2011 10:19 PM (GMT 0)
James,

I will let you know more end of next week.
Posted 1/22/2011 12:57 AM (GMT 0)
Les,

Thanks for the information .... and, good luck with the trial.

James,

Sorry, I did not ask.  He did say he took one pill per day; however, I do not know the strength ... I'll ask.

Posted 1/22/2011 1:06 AM (GMT 0)
Interesting study,
I know of quite a few 5-ARI studies are ongoing right now. But I have to say that if his PSA has been stable and he is not experiencing BPH symptoms that I would wonder if his PSA would still be stable without the dutasteride regimen. That would stand to reason if all he has benign prostate tissue.

Good luck if you enter the study. keep us posted...Both you on your friend and Les...

Tony
Posted 1/22/2011 1:27 AM (GMT 0)
It sounds interesting.
I was on Avodart after high grade PIN was found on a biopsy, but before I was diagnosed. The urologist was attempting to prevent prostate cancer from developing. I was on it quite a while. At first my PSA nose dived and stayed low, but then started heading up again and the next biopsy found cancer.
Posted 1/22/2011 1:36 PM (GMT 0)
Tony

That makes me think ... how many guys have had salvage radiation therapy when they did not have a recurrence of prostate cancer but had benign prostate tissue?

 

Posted 1/22/2011 2:42 PM (GMT 0)
RCS, that's what I am wondering. I am beginning to think that benign tissue plays a larger role in post treatment patients than may be realized. There's a study out this week, in the newspaper, where they used Avodart for pre-treatment men to drive the psa down, and then they could get a baseline of when there was actual cancer forming, since the psa had been forced down but then began to rise. Supposedly will give a better feel for when to begin more aggressive testing and biopsy. They even was able to do some early correlation on aggressiveness. In this months online Journal of Urology.

It'd be good to have a drug that could reliabily force 'good' benign prostate tissue psa down and keep it down, then when a real PCa reoccurarance starts you would know which was which. Those .04's to .19's would be able to plan better, wouldn't they? Like I said, I suspect there's more to benign tissue psa after treatments than we understand now.
Posted 1/22/2011 10:16 PM (GMT 0)
James,

Thanks for the information and citation.

I guess the benign tissue is left behind because the surgeon somehow missed it or left it on purpose; which leads me to wonder how much benign tissue does it take to raise PSA to 0.2?  I could see the surgeon leaving benign tissue next to the sphincter in order to preserve continence or near nerves to spare erectile function ... but how much, and would it be enough to drive PSA up to 0.2?

 

Posted 1/22/2011 10:38 PM (GMT 0)
My Doc put me on Avodart to see if the rise in PSA count was due to PCa or BPH. He said that if the PSA number continued to increase while I was on the Avodart then he would be positive that I infact had a reoccurarance ... and I did! One problem with the Avodart is that it can mask the true PSA number. Even the maufactures own website states that you may infact need to double the reading. An example of this would be if while on Avodart you have a PSA reading of .08, your actual PSA could be as high as .16


Larry
Posted 1/23/2011 12:46 AM (GMT 0)

larryandangieohio said...


(snip)

........One problem with the Avodart is that it can mask the true PSA number. Even the maufactures own website states that you may infact need to double the reading. An example of this would be if while on Avodart you have a PSA reading of .08, your actual PSA could be as high as .16.......

Another example of misreading the poorly-written note on the label info.

Regarding Avodart (dutasteride), here is the warning, verbatim:

"Effects on Prostate-Specific Antigen (PSA) and the Use of PSA in Prostate Cancer Detection[b/]

Dutasteride reduces total serum PSA concentration by approximately 40% following 3 months of treatment and by approximately 50% following 6, 12, and 24 months of treatment. This decrease is predictable over the entire range of PSA values, although it may vary in individual patients. Therefore, for interpretation of serial PSAs in a man taking AVODART, a new baseline PSA concentration should be established after 3 to 6 months of treatment, and this new value should be used to assess potentially cancer-related changes in PSA. To interpret an isolated PSA value in a man treated with AVODART for 6 months or more, the PSA value should be doubled for comparison with normal values in untreated men. Any confirmed increases in PSA levels from nadir while on AVODART may signal the presence of prostate cancer and should be carefully evaluated, even if those values are still within the normal range for men not taking a 5-alpha reductase inhibitor.

The free-to-total PSA ratio (percent free PSA) remains constant at Month 12, even under the influence of AVODART. If clinicians elect to use percent free PSA as an aid in the detection of prostate cancer in men receiving AVODART, no adjustment to its value appears necessary."

NB: This applies to men taking the med for BPH, which is the "label" use!

Once one is dxd with PCa, the PSA value is what it is.
Posted 1/23/2011 1:10 AM (GMT 0)
I have been on Jalyn since October 2010. It combines Avodart and Flomax. It is being used with Eligard as my combination hormone therapy. I had IMRT throughout Nov and Dec and HDR brachytherapy in Dec. I will have my first PSA test in March.

I am not aware of any side effects of the Avodart in me, though I have had the normal side effects from the Eligard. My uro said it is important that I am religious about taking the Avodart as he will have to take into account the PSA reductive action of the Avodart and he needs accuracy and consistency.
Posted 1/23/2011 1:19 AM (GMT 0)

JNF said...
I have been on Jalyn since October 2010. It combines Avodart and Flomax. It is being used with Eligard as my combination hormone therapy. I had IMRT throughout Nov and Dec and HDR brachytherapy in Dec. I will have my first PSA test in March.

I am not aware of any side effects of the Avodart in me, though I have had the normal side effects from the Eligard. My uro said it is important that I am religious about taking the Avodart as he will have to take into account the PSA reductive action of the Avodart and he needs accuracy and consistency.

Sorry to say that the uro might be a fine surgeon, but he's out of his depth now. As for the "reductive action," he is flatly wrong. See my last post.

I strongly recommend consulting a real cancer specialist, a medical oncologist; preferably one who is well-trained in tx of PCa.

"I believe it is a mistake for many urologists to be involved in the endocrine therapy of prostate cancer. Let me state why.
Urologists are surgeons and many times surgeons rush to a treatment without really understanding what they are doing."
-- Stephen B. Strum, MD
Medical Oncologist
PCa Specialist
Posted 1/23/2011 1:21 AM (GMT 0)
How much benign prostate tissue would it take to drive a psa to .2?
The answer is .2ccs of tissue.
Posted 1/23/2011 2:07 AM (GMT 0)

John T said...
How much benign prostate tissue would it take to drive a psa to .2?
The answer is .2ccs of tissue.

The formula for PSA from benign cells is x (benign) times .0666 = PSA. Or, x times .0666 = PSA.

So the formula for that x factor is .0666 / .2 = 0.333cc.

I think. idea
Posted 1/23/2011 5:41 AM (GMT 0)
While my SURGEON is the one administering my HT (Eligard) at the direction of my radiation oncologist, the surgeon was forthright enough to tell me (when I inquired about having a medical oncologist supervising my HT) that should I decide I was paying too many doctors bills, he should be the one I should drop....While he is a partner in a large urology center in Denver, he is strictly a robotic surgeon, not a urologist..As far as I know, there are no medical oncologists working at this facility...

Urologists and Medical Oncologists just don't seem to get along...Most PC patients have to take it upon themselves to visit with a medical oncologist. Their urologist certainly isn't going to give them a referral..I had to go back to my PCP for that...
Posted 1/23/2011 2:44 PM (GMT 0)
I could see how a surgeon could leave between 0.2 to 0.333 cc (0.01 to 0.02 cubic inches) of benign prostate tissue.  This isn't much tissue.

Since this amount of benign tissue will apparently drive the PSA up to a level (0.2) that will trigger folks to start salvage radiation, I would guess there have been several guys who have gone the SRT route based on a PSA rise caused by benign tissue ... I know my friend was, untill he went for a second opinion. 

I really did not know that such a small amount of benign prostate tissue could cause such a rise in PSA, nor did I understand the role of Avodart and other drugs in addressing this problem.  I've learned a lot. Probably another good reason to consider a surgeon with 250 plus operations or to consider some sort of radiation as a primary treatment. Did anybody understand all of this before your operation ... I didn't and my doctors nor my reading came close to covering it.

I've learned more following inputs on this forum than I ever learned on my own.  Thanks for all of your imput.

Posted 1/23/2011 3:58 PM (GMT 0)
RCS,  Thanks for posting the info about benign tissue and Avodart.  I had a very small rise in my PSA 30 months after prostatectomy and went ahead and started SRT.  Both my uro and radiologist suggested it could simply be benign tissue but neither mentioned Avodart.  I'm not sure what I would have done had I had that option.  I had a large volume of gleason 5 cells and we collectively made an educated guess that it was most likely a recurrence.  So, if my PSA goes to zero after SRT the question will be why: SRT worked, or benign tissue and would have gone to zero on its own, or maybe the pom juice did something ( just kidding). 

Carlos

Posted 1/23/2011 4:20 PM (GMT 0)
So, one can be on Active Surveillance AFTER surgery? Interesting. Never seen this in the literature.
Posted 1/23/2011 4:32 PM (GMT 0)
tar,

i sure was on AS after my surgery, and watched BCR happen before my eyes, and since SRT, been on AS as well, waiting to see if the SRT has worked or failed. Almost never a time you can breathe too easy.
Posted 1/23/2011 4:35 PM (GMT 0)

RCS said...
I had lunch with a friend who had a radical prostatectomy about five years ago (Gleason six, cancer confined to prostate). about two years ago, his PSA began to rise.


He was scheduled for salvage radiation, and then requested a second opinion. As I understand it (I'm making a long story very short ... and leaving a lot out), the folks at the University of Colorado suggested that the increase may be due to residual prostate tissue. He decided to take part in a trial where his only treatment was Avodart.



His PSA has not risen over the past two years.



Has anyone else tried this secondary treatment, and if you have how did you do/ are you doing?

I strongly endorse any clinical trial at the University of Colorado. The director of research is my doctor and the success of the University's research I'll attest to and my signature will verify. I was a TFT candidate but I know of the avodart/proscar study. BTW there's only an enzyme difference and I was told between avodart and proscar/finasteride. I know some insurance will push patients to generic finasteride before they'll approve avodart. Thus some patients are on finasteride instead of avodart. Your friend is not only in good hands but is geographically very lucky to be near the CU Med Ctr to partake in their research. I wake up grateful every day I was.
Posted 1/23/2011 5:18 PM (GMT 0)
Mycroft,
Strum uses .066. Many other doctors now use .1, I think a range of .066 to .1 would reflect the range of psa from benign prostate tissue.
Posted 1/23/2011 7:02 PM (GMT 0)
Mycroft......I see you are my kind of guy, firing a doc (can I get an amen!). Enjoyed reading your bio info and inputs. To bad Dr. Strum has retired, but before he left the scene he posted some very interesting quotables for PCa patients on PPML and such. Personally, wish we could have cloned him. Donna P. the co-author of the book has moved on to a different venue and is like into healthy food growing and useage type things, last I talked to her, maybe has a book into that subject land.
Posted 1/24/2011 1:21 AM (GMT 0)
Not sure where Mycroft received his MD but I was told this my two MD's

Avodart can lower your PSA levels. The PSA (prostate specific antigen) blood test is a common way to screen for prostate cancer (see Prostate Cancer Screening). Your healthcare provider will need to adjust your PSA test result (by doubling it) if you are taking Avodart. Or, your healthcare provider can use a slightly different blood test (the "percent free PSA" test) that does not need to be adjusted.

Avodart will reduce the amount of PSA measured in the blood. A physician will be aware of this effect and can still use PSA to detect prostate cancer


I ADVISE EVERYONE TO CHECK WITH THEIR DOCTORS AND SEEK THEIR OWN ANSWERS.
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