Compiler-- Update--and some thoughts

Just felt like posting.

I seem to be recovering well from the gall bladder surgery in the sense of no apparent infection. It is nice to NOT have those constant fevers. But I find myself VERY tired at times. I never used to nap, but I have been falling asleep for a few hours each afternoon. A few times, I did not wake up refreshed at all, but the other times were better. I suspect this is just my body recovering from the surgery. Also, I haven't exercised much and that is probably counterproductive. I need to do more walking. The weather has been cold, rainy and just crappy, but let's face it, I could still go to the gym and do some treadmill work. I just seem to be lazy and maybe a tad depressed. I'm in a slight funk!

The big elephant in the room remains the PC. My PSA is continuing its 3-month doubling time. On Monday I consult with my Umich doctor and on Wednesday with Dr. Lam. I will ask if doing the PSA 5 days after surgery might have skewed the results upward. If yes, maybe we can retest in 4 weeks. If no, I will listen to their recommendations, which will probably be to do HT (with my short PSADT I don't think they will be in the wait until there is a problem camp).

There seems to be some evidence that starting HT BEFORE one sees mets is a good thing, leading to much lengthier survival (at a price, unfortunately). Dr. Myers and Dr. Scholz seem to indicate that in their books.

That is the argument for earlier HT.

Now, I keep reading the comment, "treat the patient, not the number." That makes a lot of sense. It is a "feel good" phrase. But it always seems to be a euphemism for "don't start HT until symptoms so warrant." But, if the evidence says you have better survival by treating the number (ie: HT), but at a SE cost, then it's not so simple. It is a TOUGH call.

We are all wrestling with this (well, those of us who have failed the standard therapies). What to do?

I can only repeat:

It's a tough call!

Mel

 

Glad you're feeling better after the gallbladder surgery
I think you might need a while longer to recover and feel less tired. (The liver plays an important role in how you feel, how much energy you have etc. and maybe your liver is not firing on all cylinders if it was pushed about by the surgery or annoyed by the nearby infection.)

I think HT sooner rather than later might be better. (But that said, I'm not in your shoes and I'm hoping I'm still a long way from having to think about HT)
Let's assume that mets are going to develop in a bone, if they do so then something starts to grow where it's not meant to and damages the bone (and causes bone pain). To my mind even if you use HT to shut down the cancer the bone has still been damaged. A premeptive strike would avoid the bone ever getting damaged. the price being side-effects of HT.

This is say like the root of a plant growing under the pavement (sorry sidewalk) and pushing the paving out of the way. Now you could chop down the plant and stop the roots growing, but that would still leave the damaged paving. Or you could look at your paving while it was in good shape and cover the area with weed killer to stop a plant growing. (The price being that nothing would grow, not even the plants you wanted to have)

Alf

Mel,

I hope you surgical recovery continues to progress positively. I think that once you can restart your exercise routine your energy will also start rebounding.

As to HT, I am a current sufferor of some 16 months now and will stay on at least another 6 months. I was high risk to begin with and couldn't find anyone in my initial reseach that suggested postponing HT. Since then, I have sided with the group that recommend to hit it early and with multiple approaches; rather than waiting to see what has happened and then use a sequential approach with treatments responding to changes in PSA. My docs are agressive and want to stay ahead of the progression they expect, rather than react to a progression after it is evident. I think that if you let this stuff get a foothold then it will be more difficult to control.

Obviously, I think the level of treatment agressiveness should be matched to the apparent aggressiveness of the cancer; and, as we know, with prostate cancer there is great variation from indolent to aggressive. Thus a "one size fits all" approach is certainly not proper. I have not known my doubling rate and can only guess what it may be if or when I suffer a recurrance based on my G7 score. I have made different projections of PSA doubling and estimates of relative tumor volume progression and it gets very significant very quickly. This is not meant to scare, as I presume you have done similar calculative projections based on your circumstances.

I first did this fifteen years ago when my wife was first treated for breast cancer. At that time the best the docs could estimate was that she was at a 90 day doubling time. They helped us work that backwards to show over what period of time the cancer had been developing. Then they projected it forward to show the tremendous risk of waiting on treatment as her lesion, which was the size of an almond, would be expected to become the size of a lemon and then an orange in a very short period of time. Additionally the metastatic risk was explained.

I know you are braced for HT given your current PSADT. It is not fun, but it can be managed fairly effectively.

I'm in 100% agreement with John here...

The problem is our inability to identify aggressive versus indolent types of the disease. It's still a "guesstimate".

But I think it's a good guess that 4+3=7 with positive margins is not indolent...

Tony

Mel, I am also a believer in early HT for aggressive desease. Although there clearly is a difference of opinion among medical oncologists. The first one I saw told me straighf out that HT would only be effective for a certain period of time regardless of when I started. It was his recommendation that I hold off on HT until symptoms presented themselves. I didn't like that answer and had second and third opiinions. The other two docs recommended SRT w/HT. I ended up doing a year of ADT3. BB

Mel,

I've got nothing to offer but good vibes. Hope you shake off the funk soon, and good luck with your upcoming treatment decision.

Hang in there, and let us know what happens next week.

Jonathan