PSA Rising…on to CASODEX

Howdy,

Given your situation with a somewhat rapidly rising PSA, your stats are in the range now where a C11-choline/accetate or Feraheme scan could begin to detect the location of the cancer. This gives the potential for a cure if you have a focal metastasis. This is one approach you might want to discuss with your oncologist.

Best wishes,
Nellie

Post Edited (Riviere) : 7/13/2012 1:18:59 PM (GMT-6)

Thank you Nellie - I will definitely bring this question to the table.

Doc told me the prostate cancer review board at the hospital met to discuss my case and all felt that attempting to radiate the one "involved" pelvic lymph gland was not possible at this time. He did say it could happen down the line. Not sure why this is the case and I certainly plan on getting a fuller explanation next Tuesday.

Right now the goal is to slow down the doubling time of the psa. I do not know what they have in mind for an initial course of treatment but after this latest blood result, I fully expect it to begin this next week...

*
One other note?

OK, OK, I confess - I am still a smoker and have been told the smokes will have to go as a recent study, (consisting of post-prostatectomy/radiation + rising psa patients), shows a faster doubling rate among smokers vs. non-smokers.

Strong recommendation from a friend made to me was to quit once the treatments start as since I may be miserable with all of that I might as well add the misery of withdrawal. That should be fun, eh?

__

Age 62, dx age 60, PSA 2.9 ; detected by dre
Stage t3b Gleason 7 (4 +3) tertiary pattern 5
11/10 Post-prostatectomy path: extensive extra-prostatic growth 60% tumor both lobes; perinural + l seminal vesicle and lympho-vascular tumor invasion; Lymph nodes:14 right obturator; 9 left pelvic (no regional lymph node metastasis)
10/11 adjuvant IGRT radiation 8 weeks
4/10/12 psa rise from 0.3;0.5;0.9 indicated ineffectiveness of SRT – on to medical oncology
5/30/12 negative bone scan; ct scan showing enlarged adrenal gland and 1 pelvic lymph node "involvement"...
6/5/12 initial meet with med oncologist began daily use of pomegranate extract; need baseline psa w/same protocols
6/5/12 psa 1.5…7/10/12 psa 2.0
7/17/12 TBD med oncology

Bridgewater-  Also had a recurrence after surgery and RT. 3 month PSADT. My stats are below

1) ask for a sodium floride bone scan. it is NOT experimental and is able to detect METS much sooner than a traditional bone and CT. If you have METS outside your one Lymph, than removal of that Lymph probably isnt the answer.

2) curoius why you are only on casodex. Typically Casodex is combined with Lupron/zolodex, Its the Lupron/zolodex that does the heavy lifting is shutting down the testes production of testosterone. Casodex is an add on. Avodart is sometimne combined with the other two for a "triple" blockade effect. Casodex alone is a curiosity.

3) We pretty much all take some form of Pomogranete supplement, but if anything is experimental its that. There is no harm to it but is efficacy is unproven.

4. Are you comfortable with the expertise of your team? I ask because you are are a key stage and i find myself wondering about some of the advise your getting.

Bridgewater,

I echo keepingfaith" post in regards to the pet scan sodium floride known as (F-18) for bone mets and also include the (FDG ) test which looks for soft tissue mets.
See my husbands stats below as he had both tests where his 1 isolated met was found.

Good luck,

BOOGEE

It would be appropriate (according to my uro & oncologist) to start Casodex 1 - 2 months before going on Lupron or an equivalent where mets are known.

Hi again,

I have to say that this is the kind of "experimental" procedure I will be pursuing if I need to. Dr. Kwon is using C11 choline at Rochester Mayo with great success. Dr. Myers is using the Feraheme scan with great results as well.

Dr. Kwon from Rochester Mayo, who manages the C11 choline test, stated that the test was best for folks whose PSA was 1.0 or greater and rapidly rising. His video discussion is quite worth watching, and shows with actual scan results just how effective it is at finding PCa.

askdrbarken.wordpress.com/2011/12/25/c-11-choline-petct-scan-dr-eugene-kwon-mayo-clinic/

Here's a blog entry about the C11 acetate PET trial:

www.ob-ron.org/2012/05/tidbits-about-c11-acetate-petct-and.html

Here's an interesting study comparing F18 FDG Pet and C11 acetate pet:

www.ncbi.nlm.nih.gov/pmc/articles/PMC3129631/

Another interesting slide show compares various PET scans for prostate cancer:

apps.snm.org/docs/CME/PresenterItems/EventID_131/PresenterItemTypeID_1/Jadvar%2C%20Hossein.pdf

I hope this helps.

Nellie

Post Edited (Riviere) : 7/18/2012 2:31:19 PM (GMT-6)

Thanks for all of the replies - there is an awful lot here to look at...

Yes, Cape - the Charlie Horse is a great place but hoisting a few is verboten for me once I start on this drug.

I have a lot of confidence in my medical team - these are prostate specific medical oncologists at BIDMC one of the top hospitals in Boston and we do have a lot of dialogue - they are not closed minded and do have a plan here, so...

The C-11 pet scan info is much appreciated. It looks like it is in 'trial'.

Thanks all - the adventure continues.

Bridge