Update on my situation-- seeking input

We will be leaving for California on Wednesday. We will try and make a good vacation of this. We will be seeing our daughter and my stepmother. We will be seeing the Dodger/Mets game Friday night. Our daughter will be taking us out to a nice restaurant, too (my birthday was last week and of course we had Father's Day)....and....

I have an appointment with Dr. Lam.

As indicated in my signature, I've failed surgery and SRT. My PSADT was 3 months. Dr. Lam suggested I try Avodart by itself and it has stopped the rise sigificantly (lowered it and now so far a small rise). My current PSADT is 15.27 months.

Nevertheless, this is my first face-to-face consultation with Dr. Lam (previously we did telephone consults). So, I'll be giving blood then too and I'm sure much of our conversation will be what if. (They prefer I do the bloodwork there at my appointment, but I doubt if they will have the results). So, the advice I'm seeking is, what do I ask. So far, I have:

1) Discussion of my current situation (he may say quit farting around and start the HT now).

2) Bostwyck testing? Diploid DNA? Is there any value here?

Goodlife -- we have all kicked the idea of when to start HT.

The QOL issue says to delay as much as possible.

But there seems to be the argument that starting sooner when the tumor burden is low leads to better results and perhaps a long vacation from HT after a year.

Anyway, that will certainly be a major topic of discussion when I see Lam

Mel

First of all I believe you are seeing one of the top PCa Docs in the country without a doubt, I hope his opinion trumps all but sometimes it doesn't hurt to beat some ideas around as long as you don't get overly sensitive about the responses and I've never know you to so here goes:

1.  If I'm not mistaken I believe you and Lam have discussed Sand  Lake and your decision to maybe allow it to develope a little more sounds spot on to me for you.  Maybe even go thru one round of HT(with time on and off it should give you at least 2 1/2 to 3 years) which should allow the scan to be more widespread throughout the country and the spot radiation the same.  Let's talk about QOL for a minute, I would tell you that the earlier you get on it the better QOL you would have over a longer period of time (I did 2 years of HT) meaning, you will probably be on HT for a shorter period of time if you start sooner  and I would argue that your time off would be longer because you would hopefully drive the cancer father into a short term remission.  Obviously I was pretty lucky with the side effects during my time on HT but the thing that no one can refute is you can stop anytime you want if things get too tough.  Sure it takes a little time to get out of your system but you know that ultimately you will return to normal unless you have been on HT for a really extended period.

2.  I believe that Dr. Lam falls in the group to not allow tumor burdens to grow, hit it hard and soon. Although in general I believe this to be the prevelant thinking I think it will become even more crystal clear with the new drug options and the ability to extend treatment.  I'm obviously not an expert but I have never heard of any other cancer being allowed to grow for X amount of time before treatment begins, if it's there treat it. The idea is if there is no actual "cure" then this disease can be treated as a chronic issue, if it doesn't get too far out of hand originally, with the new options available. We're not there yet but hopefully we're not too far away.

3.  You might ask him if you have the ability to start on something other than the usual ADT 3, maybe a clinical trial of Zytiga or MDV 3100.  I understand that they're looking at both of these drugs much earlier in the rotation of meds.

Good luck

David

P.S.  The avodart idea was fantastic, changing your PSADT from 3 months to 15 months is incredible, hell you're almost in with the AS bunch.

I have thought about the possibility of doing some of the newer drugs before HT. However, this is not yet standard protocol and I am not yet willing to be in a "trial." But if I can delay HT for a year or two, the protocol might be different, indeed entailing one of the newer drugs.

But, again, I'll see what Lam says.

I do agree with the concept that in the long run one is better off hitting it early and hard with ADT3. But if I can stall longer, given the current much lengthier PSADT, I would prefer to do that.

If you look at my signature, you will see that my PSA was aboiut 3.5 in late February. I had started Avodart the first week of January, so I thought it failed. Dr. Lam said to do the end of March PSA and if it goes above 4, call him for some last minute details and we start HT. I suspect he was just being nice as we both knew that the next PSA would be well above 4. So, it was a very pleasant surprise when it suddenly dropped. The avodart kicked in nicely.

I hope he still says 4 would be a good line in the sand. That would still be hitting it pretty early.

Mel