ADT PSA target levels

thejam, I can only tell you what I would do if I were in your shoes.
The ADT will shrink the tumor, but not completely eliminate it. Eventually, the ADT will cease to work and then the tumor will grow to what it was and then more. The surgery will remove the tumor, and I would go through with it. Gleason 9 is nothing to mess around with.
I am all for improving your diet - go for it - but the best time to do that was 20-30 years ago. I would get the surgery, continue with the diet, and see if it seems that everything was successfully removed (via PSA tests post-ADT when your doc approves of going off it).
I wish you the best!
Jeff

Are you also considering radiation therapy while waiting? In intermediate and high risk men, like you and I, a combination of brachytherapy and external beam has shown to be more successful than surgery with fewer and less significant treatment side effects. ADT usually precedes radiation and chemo. Yours is one of the very few cases where it precedes surgery. ADT physically changes the prostate tissue and most surgeons find it more difficult to operate after ADT.

The ADT alone will most likely not be curative. Your PSA will never be truly 0. It may get to an undetectable level, but not 0. And as long as you have a prostate or PCa there will be some expression of PSA.

There is no evidence that diet will cure your cancer. With G9 dx you will need to either have surgery or radiation to attempt a cure. With G9 waiting to remove or ablate the prostate will just increase your chances of the cancer spreading and becoming not only incurable, but often uncontrollable. With G9 you are playing with fire, be very careful.

Thanks for replies.
I'm in Canada so you have to understand the health care system can be a very slow process to navigate,unfortunately for me in my circumstances. I fully intend to get surgery asap and my first appointment with my rarp surgeon is March 4th. I probably could have had open surgery by now in our Winnipeg cancer clinic(no rarp in Winnipeg) but I decided that rarp was the better way to go so I need to go to Toronto for that, hence the 5 month delay to get an appointment with that doctor. In the states I would think it would have been done in less than a week. Many Canadians don't wait and do have the procedures done in the states but I can't afford it. Our Medicare here is basically free but wait times can be brutal for certain health issues.
I am very concerned about the delay so that's why I have incorporated so many lifestyle changes. I'm a big fan of Dr Gregor (nutrition facts.org) and there is a ton of info about cancer and how to fight it with diet, and highly recommend his site to all. I don't mean to create a conflict of interest in endorsing it but his info is all validated and very informative.
So yah I want to get fixed asap and in the meantime am fighting it every which way I can.
I looked at radiation and brachytherapy but thought surgery was the better way to go. I didn't know ADT before surgery made it a more difficult surgery, my first doctor and his staff never mentioned a thing about that. I will ask my new doctor if I need to change my approach but time is not on my side, so hopefully he can still do a good job of it.

Post Edited (thejam) : 2/2/2019 7:45:08 PM (GMT-7)

thejam said...
Basically my strategy before my surgery rolls around, is to have the ADT kill the majority of the cancer and then through nutrition, supplements, diet, and lifestyle make it hard for the cancer to survive. Deprive it of every nutrient it needs. Only eat food that has anti cancer properties and are proven to fight, eliminate, and kill off cancer cells. There is no other alternative for me that I know of that is affordable. I'm hoping I can do enough on my own where my new surgeon/specialist looks at all the medical info up to that point and proceeds in the best way possible for me.

the next surgeon you talk to will recommend surgery. that's a given. While you are waiting I think ADT is very wise. but make no mistake about it: left untreated G9 cancer will come roaring back when ADT finally fails.

why do you think surgery is better than radiation?

You have a few misconceptions that need clarifying.

First, ADT generally will not cure the cancer or kill much of it. It most often will halt the activity by starving the cancer of testosterone and you are experiencing that with the lower PSA and smaller tumors, but once you stop the ADT or the cancer becomes refractory, it will be right back and often stronger. PCa, can go dormant, for long periods and not die. That is what much of it does when on ADT. Some will die, but ADT is not known to be curative in most situations. It is more for management. It does shock or make the PCa more sensitive and vulnerable to the effects of radiation and is most often used for a month or two before using radiation to help radiation be even more effective.

The “no surgery after radiation” is a myth many surgeons state. Radiation is an extremely effective initial treatment and covers an area larger than the surgeon can remove. Rarely does a man need salvage treatment to the prostate bed after radiation. But if they do there are other forms of salvage treatment like
HDR brachytherapy, HIFU, cryotherapy, etc. about 35% of men who have surgery will experience failure because the surgeron can not cut all the cancer out and then will need radiation in addition to the surgery. This is the worst combination for significant negative side effects and should be avoided. High risk, like you, often indicates a higher probability the surgery will be unsuccessful. You have a much higher probability of surgery failing than radiation failing. When surgery fails, most often it has to be followed by radiation. When radiation fails, it is usually because the cancer is already spread outside the radiation field. In that case neither surgery nor radiation would have been successful.

Cutting it out by surgery and killing the cancer by radiation both have the same effect on the cancer that can be treated. There is no advantage to surgery. Killed is equal to cut out. Radiation is routinely and safely used for most all non-blood cancer treatment. There is negligible risk to secondary cancers from radiation. A Swedish study of 350 men found only one such occurrence in 10 years after radiation for prostate cancer .03%. The occurrence of dying due to the complications of surgery is about 1%. Thus dying of the surgery is a greater risk than getting a radiation induced secondary cancer. The exposure to healthy cells is minimal with modern radiation techniques and the healthy cells repair the damage and go on living until they were to die anyway as all healthy cells do. The ones that can not self repair die more quickly and are replaced by healthy cells. There is no evidence that routine radiation used for prostate cancer has damaging effects to the immune system that are long term or permanent for people that are otherwise in good health.

Of course diet is important and can be effective in keeping you in a better state of health and can help you tolerate the treatments. But there is no evidence that there is any diet that will cure or control your cancer. Basically what your body needs for nourishment is what the cancer will feed on. After all the cancer is you. It is not something that has come in from the outside. It is your DNA and cells that have mutated in a way that makes them dangerous. The only way to kill the cancer by diet is to starve the host (you) to death. Then the cancer will die.

Best wishes and keep researching. Understand that surgeons prefer to do surgery. Do not listen to a surgeon about radiation as they are not the expert. Go to a radiation oncologist to be assessed for radiation. Then decide on the treatment method. I met with three surgeons and all said no to surgery due to my risk level. All said I would most likely need radiation on top of the surgery and they did not want to put me through that. I met with two different radiation oncologists that used different brachytherapy methods. I did this is a matter of a few weeks. I then used a combination of HDR brachytherapy, IMRT external beam radiation and ADT. That was more than eight years ago and my PSA has been undetectable ever since. Also, I am completely free of any negative treatment side effects. So the radiation has served me and hundreds of thousands like me very well with effective cancer control and minimal side effects.

JNF said...
You have a few misconceptions that need clarifying.

First, ADT generally will not cure the cancer or kill much of it. It most often will halt the activity by starving the cancer of testosterone and you are experiencing that with the lower PSA and smaller tumors, but once you stop the ADT or the cancer becomes refractory, it will be right back and often stronger. PCa, can go dormant, for long periods and not die. That is what much of it does when on ADT. Some will die, but ADT is not known to be curative in most situations. It is more for management. It does shock or make the PCa more sensitive and vulnerable to the effects of radiation and is most often used for a month or two before using radiation to help radiation be even more effective.

The “no surgery after radiation” is a myth many surgeons state. Radiation is an extremely effective initial treatment and covers an area larger than the surgeon can remove. Rarely does a man need salvage treatment to the prostate bed after radiation. But if they do there are other forms of salvage treatment like
HDR brachytherapy, HIFU, cryotherapy, etc. about 35% of men who have surgery will experience failure because the surgeron can not cut all the cancer out and then will need radiation in addition to the surgery. This is the worst combination for significant negative side effects and should be avoided. High risk, like you, often indicates a higher probability the surgery will be unsuccessful. You have a much higher probability of surgery failing than radiation failing. When surgery fails, most often it has to be followed by radiation. When radiation fails, it is usually because the cancer is already spread outside the radiation field. In that case neither surgery nor radiation would have been successful.

Cutting it out by surgery and killing the cancer by radiation both have the same effect on the cancer that can be treated. There is no advantage to surgery. Killed is equal to cut out. Radiation is routinely and safely used for most all non-blood cancer treatment. There is negligible risk to secondary cancers from radiation. A Swedish study of 350 men found only one such occurrence in 10 years after radiation for prostate cancer .03%. The occurrence of dying due to the complications of surgery is about 1%. Thus dying of the surgery is a greater risk than getting a radiation induced secondary cancer. The exposure to healthy cells is minimal with modern radiation techniques and the healthy cells repair the damage and go on living until they were to die anyway as all healthy cells do. The ones that can not self repair die more quickly and are replaced by healthy cells. There is no evidence that routine radiation used for prostate cancer has damaging effects to the immune system that are long term or permanent for people that are otherwise in good health.

Of course diet is important and can be effective in keeping you in a better state of health and can help you tolerate the treatments. But there is no evidence that there is any diet that will cure or control your cancer. Basically what your body needs for nourishment is what the cancer will feed on. After all the cancer is you. It is not something that has come in from the outside. It is your DNA and cells that have mutated in a way that makes them dangerous. The only way to kill the cancer by diet is to starve the host (you) to death. Then the cancer will die.

Best wishes and keep researching. Understand that surgeons prefer to do surgery. Do not listen to a surgeon about radiation as they are not the expert. Go to a radiation oncologist to be assessed for radiation. Then decide on the treatment method. I met with three surgeons and all said no to surgery due to my risk level. All said I would most likely need radiation on top of the surgery and they did not want to put me through that. I met with two different radiation oncologists that used different brachytherapy methods. I did this is a matter of a few weeks. I then used a combination of HDR brachytherapy, IMRT external beam radiation and ADT. That was more than eight years ago and my PSA has been undetectable ever since. Also, I am completely free of any negative treatment side effects. So the radiation has served me and hundreds of thousands like me very well with effective cancer control and minimal side effects.

Great information and I think I will phone to see how quickly I can get in to see a radiation oncologist for a second opinion but again in Canada things like this take time and I only have till Mar 4 when I see the surgeon to arrange the surgery so It may be a problem scheduling wise.
More information creates more indecision but I know enough to listen to people that have been there and done it. What I've also learned is every individual can be different and one stroke of the "brush" doesn't fix all.
My mistake for not looking at radiation earlier and getting a varied opinion from them. This is creating a little more angst and I'm feeling like it's a race against time, but I want the best treatment for my circumstances, so I will follow your advice in trying to get an appointment asap. Thanks for giving me such good info to think about.

thejam said...

F8 said...
you "just want it out". I get that. I think the majority of us felt that way in the beginning. I know I did at first until my surgeon explained to me that my cancer was most likely out of the capsule and that if I chose surgery I would most likely also need radiation which could lock in long term side effects.

I won't repeat anything JNF said but I think anyone needing treatment should very carefully try to understand what he is saying.

if you are committed to surgery just know there's a very good chance you will need further treatment. with what I know now I would be talking to a radiation oncologist and about thresholds for further treatment, and stick to them no matter what my mind is telling me should my PSA start rising post surgery.

I do believe those periods of indecision and denial when doing incremental treatment can make the difference between "cure" and metastatic disease, and I do believe I've witnessed it right here on this board during the years that I've been here.

good luck to you!

Thanks F8 for also helping me to make a decision on how to proceed, I'll get a 2nd opinion from a radiation oncologist hopefully before I meet with my surgeon Mar 4.

hey you're welcome! your diagnosis is very serious. I really don't see any option other than kitchen sink if you want to beat this, and the fact that you think that maybe a few lifestyle changes will take you out of the high risk category tells me there is some denial on your part!

you've got to nuke this beast now and frankly to me that means triple play (like I had) or surgery and MOST LIKELY adjuvant/SRT radiation and a continuation of ADT.

good luck man!