Update and question

Dana

Sounds right to me. Such a small PSA increase could be due to a number of things.

You and Bill go enjoy life!

HUGS!

Bud

Thanks a bunch for the replies and support! Yikes-sorry for the typo-but the number was 1.3 six months ago and then 2.5 three months ago, who knows what the test yesterday will say. Does that change anyone's answer? It seems to me his doubling time is awful fast for them to be so unconcerned about waiting for it to go up more before treating it.

Thanks Andrew! Yeah, I'm thinking more like you. I don't understand how the dr. could tell him come back in three months when he doesn't even know what the test results said yesterday.

Thanks for your reply Boogee! I lost my signature somehow, I'll try to recreate it, but if it doesn't work, here are the stats: SO diagnosed 4/15/09 age 47 1/15/09=PSA 10 Dx 4/15/09=Right side= Gleason 4+4=7, 40% involved, 5 out of 6 cores positive, perineural invasion present Left side+ Gleason 4+4=8, 60% involved, 5 out of 6 cores positive, no perineural invasion present T2c 5/14/09=Robotic surgery at Cleveland Clinic by Dr. Gong pre-op PSA 15, MRI shows extracapsular penetration Pathology 5/21/09-T3a, N1MX, positive margins, 1 out of 13 lymph nodes positive, left nerves spared 7/7/09- pad free 7/10/09- PSA 1.1 7/25/09-PSA .2 11/9/09- PSA .3 10/10- PSA .02 1/7/11- PSA .01 3/12- PSA 1.3 6/12- PSA 2.5

Thanks for your input and thoughtful reply Goodlife. I remember you from when I was here last, glad you're still here. What you said was very insightful and helpful to me. But now I'm wondering even I even understand HT at all. I thought the idea of HT was to try to stop the spreading of cancer to more lymph nodes, bones, etc. and the doctors we spoke to earlier seemed to want to start it right away as soon as there was a sign the cancer was back, as if letting the number get higher would mean it had spread even more. From what you're saying, it seems there's doubt as to how much it's spread based just on the PSA number. Am I understanding you correctly?

Thanks again to everyone for your helpfulness, this is really confusing me!

Dana

Dana,

From my layman's understanding, HT does one thing, it chemically castrates us, and dries up the primary food source for the PC.

It appears that PC can and does mutate, or learn how to feed off other sources besides testosterone. Once it had metastasized to the bones, it has learned that bones are ok to eat. Apparently, it also takes nourishment from the testosterone in the blood stream, so we generally see an improvement in the mets initially, but HT does not kill the cancer, just cuts off one of it's main food sources.

It just seems to me that it is a finite treatment. Eventually, we will see PSA rise even though we are on HT. Even then, there are many ways to slow it down, but currently there are no ways to kill it that I know of.

But, there are at least a 100 drugs in various stages of development that may prove to be the silver bullet.

I guess for me, I am developing a plan that says as long as I feel good with no side effects, I will probably hold off on HT if my PSA starts to climb again, until I know I have mets. Most of the time, mets won't show up on normal bone scans at lower PSA levels.

I guess for me, if I was Bill, I would just relax as much as I can, enjoy the rest of the summer, live the good life, and wait and see what 3 months brings. If he can't stand the wait, maybe ask the doctor for another PSA at 45 days, but if it is higher, it just adds to his anxiety.

Goodlife

Dana, I would like to answer you, by copy part of my answer to a similar question in another thread above, my answer would be the same to either of you posters:

"That depends on a lot of things, including how his oncologist feels about the use of HT. My oncologist, affiliated with MD Anderson, is not of the school of early HT intervention. Many oncologists are split on this. While some would push for HT immediately, other doctors, like mine, do not. He's watching over me, and he's not in any hurry to pull the HT trigger, pushing me into even more serious QOL issues. I am already dealing with severe Chronic Pain & Fatigue as the results of my "cancer treatments".

As long as he feels I am not in danger of immediate metatasis, he is for holding off on jumping into HT. He has had patients with post-PSA as high as 100 without any metastisis. He has even talked about bypassing HT when and if the time comes, and use a chemo agent such as Taxotere instead to shock the cancer instead.

My point, different oncologists take different views, depending on the needs and conditon of the patients. Even in the 3rd Revision of "Surviving Prostate Cancer", by Patrick Walsh, he still strongly does not believe in early HT intervention."

David in SC

I picked up the previous numbers: 1/7/11- PSA .01 3/12- PSA 1.3 6/12- PSA 2.5   To get really precise, you use the full date and run these through a calculator - there are several on line. For example, my doubling time is decreasing, going from about 100 days down to 74 (maybe 72, I've misplaced the chart). The doubling time is very significant, and mine is pushing me toward HT at the next test.   Someone mentioned the fact that appointments are scheduled before you get the test results back - that is exactly how mine is done. Has a lot to do with the insurance company and how they pay in my case. I get blood drawn at my exam/consult. Insurance won't pay for a blood draw if there is no appointment, and the doctor charges for a minimum office visit even for a blood draw, so that becomes a one-stop. Then I schedule the next appointment for the first day at or after the window that insurance allows (three months), because my uro is very busy, and to wait a day or two could cost weeks in the schedule. If the blood work is really bad, then insurance will pay for a followup visit as soon as possible.   We have the discussion of what comes next based on good or bad blood work, so the followup would likely not be needed, unless a shot is in my future (it is, I'm just putting it off under the quality of life discussion mentioned above).

A three month doubling time does qualify as important enough for a follow up (at least for me) if he wants one. His uro should explain what the parameters he uses are. 

The uro told me what I should do, but I am the one who must decide what I want to do next. They can't give me a Lupron shot unless I consent and pay.

 

I'll agree that an oncologist is a valid (and perhaps better) choice at this point, and you may want to do that.

In my case the oncologist and uro are exactly in line with each other, my uro being perhaps more aggressive as to seeking options. We did try to go the Zytiga route, but because of the early trial termination, my insurance won't cover it until I am refractory.