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I saw Dr. Lam today

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Prostate Cancer
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Posted 6/25/2014 12:53 AM (GMT 0)
It was a good appointment.

For any newbies or those who can't remember everyone else's stats, I
failed surgery and SRT. HT and Casodex resulted in a great response,
with my PSA going from 17.55 to < 0.02. which is undetectable. He
then took me off HT. I am only on avodart and metformin.

Last week, after 3 1/2 months on HT vacation, my PSA jumped to 0.04,

Basically, he considers anything under 0.05 undetectable, so my 0.04
is that.

Also, with my T climbing sharply from 10 to 140, the little PSA increase
is actually just fine. He said I can expect continued PSA INCREASES, but
it will be hopefully a year or two or three before it gets to where
we have to do something.

So, when it gets to 2.0, we will look at the C11 Scan at Mayo.

So. it looks like my PSA is extremely hormone sensitive.
He does NOT advocate a chemo/HT COMBINATION in my situation, since I am a G7. He feels when my PSA goes up, we can knock it down again with HT.

Right now, I can continue my HT vacation and retest in 3-6 months!

Mel
Posted 6/25/2014 1:21 AM (GMT 0)
Mel,

I think that is a great report.    Time to relax and get back and get back to the excitement of.....mathematics!!!!

It looks like you are on the road to long term control.   Hope you have a great summer,

Jack.

Posted 6/25/2014 2:05 AM (GMT 0)
Mel, just missed you again as I am going to stop in at Marina Thursday at 9 AM for Prolia shot as I am in LA Wed to meet with RO Chris King at UCLA.

One of these days we will meet face to face, perhaps GFMPH Rochester last week of Sept.

LupronJim
Posted 6/25/2014 2:17 AM (GMT 0)
Mel,
Celebrate the positive! You are in the Zero Club and in California!
Have fun, have some prawns and avocados.

LupronJim,
Mel may me a Florida snowbird this winter! If he is, you can come down here to W Palm Beach and we can have a little GFMPH So. Florida Style!

Bill from Florida cool
Posted 6/25/2014 2:35 AM (GMT 0)
Sounds like a good plan, Mel...

Now get out there and enjoy the summer...

Jerry
Posted 6/25/2014 4:33 AM (GMT 0)
I like that plan.

Enjoy your vacation.
Andrew
Posted 6/25/2014 5:09 AM (GMT 0)
Sorry, Jim, will not be in Rochester. Still working.

Heading out to Palm Desert tomorrow.

Will be back in Santa Monica Fri -Tues.

Will you be around?

Mel
Posted 6/25/2014 11:19 AM (GMT 0)
Mel, this sounds really good. You are dealing with the best so you should take comfort. Now enjoy the rest of your visit in Cali.

Jim
Posted 6/25/2014 1:23 PM (GMT 0)
Mel -

Great to hear that the treatment plan is becoming a success.

As a mathematician, possibly you are someone who has a special appreciation for a PSA going from a 17.55 to a <0.02 value. (BTW, I have always found math to be a fascinating subject, it has such a purity to it).

Anyway, do as the others have suggested, enjoy your vacation!
Posted 6/25/2014 2:52 PM (GMT 0)
great news my friend. Yippee cool

ed
Posted 6/25/2014 4:49 PM (GMT 0)
Mel,

Great news. Hopefully that reduces your stress level a bit.


Goodlife
Posted 6/25/2014 5:14 PM (GMT 0)
Yep, another reprieve. I might add that even if Mets show up on a scan, which hopefully is a year or two down the road, he still is not in favor of the chemo/HT COMBO IN MY CASE.


Lupron Jim, will you still be in this area late Friday?

Mel
Posted 6/25/2014 5:21 PM (GMT 0)
sounds like great news to me. You deserve it.
Posted 6/26/2014 4:45 AM (GMT 0)

compiler said...
Sorry, Jim, will not be in Rochester. Still working.

Heading out to Palm Desert tomorrow.

Will be back in Santa Monica Fri -Tues.

Will you be around?

Mel

No, was in Santa Monica today to meet wit Dr Chris KIng RO and plan the 5 session SBRT with Tall Allen's help.

In Marina del Rey CA Thursday but Friday I am in SF to seek a second opinion from Mack Roach at UCSF.

Third opinion is with Brian Moran in Chicago July 3.

One of these days, Mel to coin a Jackie Gleason phrase changing Alice to Mel.

Not likely I get to Michigan and you were just in FL, so may be a while.
Posted 6/26/2014 6:18 PM (GMT 0)
Good update.

You wrote, "He does NOT advocate a chemo/HT COMBINATION in my situation, since I am a G7. He feels when my PSA goes up, we can knock it down again with HT."

Do you know why the gleason is relevant? Also, can I ask if you are older or younger? I ask because my husband is very young and the doctor has suggested when it is time we may want that combination for a G7. I don't know if it's due to age or just varying philosophies.
Posted 6/26/2014 10:49 PM (GMT 0)
Melg

Good question.
I am 68,

Lam seemed to indicate that the combo was pretty rough. He felt most of the patients had a higher G score and a much higher PSA. He wants to prevent the PSA from getting there. But I think implicit in his opinion is that we might know more by the time I get to that point. He made it clear that the combo choice is on the table, but in my case he would be leaning towards HT only.

Mel
Posted 6/27/2014 12:27 AM (GMT 0)
Melg,

The survival benefit for low volume guys is still not known. Huge survival difference for high volume (many mets) guys, but jury still out for the low volume (less than 5 mets).
Posted 6/27/2014 1:30 PM (GMT 0)
Thanks for the feedback Mel and Jerry. It's tricky to know how aggressive to be. On the one hand, if it is not a desperate situation, one is inclined to not be aggressive. But it seems like the earlier something is attacked, the more likely the treatment might be successful longer term. And with someone who would have a long life expectancy without the prostate cancer, that is certainly the goal.
Posted 6/27/2014 2:13 PM (GMT 0)
Melg,

Do you know if your husband is a Gleason 7(3+4) or a 7(4+3)? The (4+3) would be higher risk and might affect the two doctors' evaluations. On the other hand the HT/Chemo combo is an emerging area for non-hormone-resistant PCa and some doctors are more conservative than others.
Posted 6/27/2014 3:23 PM (GMT 0)
I have talked to my docs (uro, rad-onc, and med-onc) several times about throwing chemo in the initial mix. They all agree if my G was higher they probably would have. My G is pretty equal 3s and 4s with a determination of 7 the hard way as it is the most advanced, but not most prevelant. My docs treat the highest combo. Another HW brother, Southern Comfort, had chemo upfront but he was G9 as I recall. He goes to Scholz.
Posted 6/27/2014 4:16 PM (GMT 0)
Adding chemo to HT will certainly be something my docs and I will consider when I come off my HT vacation.

 

Posted 6/27/2014 5:28 PM (GMT 0)
I see Dr. Lam. I was a t3b G9 (5+4) with a pre-op PSA of 54.9. Dr Lam recommended adding chemo given my stats. This was back in 2012. I recall asking him about how many he had treated with my stats. I vaguely recall him saying something like 50 or so men in 11 years any maybe 30 or 35 had done the chemo -- fuzzy on the numbers.

Southern Comfort
Posted 6/27/2014 6:40 PM (GMT 0)
Mel, I have been away from the board for a while and was very happy to see your post and good news. Maybe now you can lay this crap down for a little while and go on enjoying life. I am still waiting for the news that you plan to winter in Florida.

Best to you,

Sonny
Posted 6/28/2014 12:50 AM (GMT 0)
Sonny and Bill and Lupron Jim

We have certainly discussed wintering in Florida.

I still want to teach. So, we will see how the schedule shapes up. That will happen in mid-October.

I will even consider going to part time if that will make it happen!

We definitely want to escape the Michigan deep freeze, especially after last winter, where the temps were negative double digits consistently for about two months.

Got us once. Will not get us twice!

Mel
Posted 6/29/2014 5:42 AM (GMT 0)
Just checking in and I'm very happy to hear this news, Mel. Now relax and enjoy the summer!
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