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Rising psa, question on HT

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Posted 4/22/2015 12:18 AM (GMT 0)
I had the da vinci surgery (2013)and 38 radiation treatments (2014) my psa has gone up every time from .3 to the current 2.5 as of today. The doc wants to start HT now; I'm not convinced it's a good time to start via all the side effects; I've read a lot about it and lots of dr.'s don't recommend starting this soon; I don't know what to do. I've read to wait until I have pain and when a tumor is found, then start therapy; studies show that I won't die any sooner than someone who starts HT sooner. Any thought or opinions are welcome; this website has helped my a lot in the past. What is the cost of HT, does Medicare cover it??
steve in maine
Posted 4/22/2015 12:20 AM (GMT 0)
65 yrs old, - diagnosed with PCa April '13 PSA 8.

Biopsy 4/13
7 of 12 Gleason scores: 6,6,8,9,9,9 and 10
Radical Prostate removal Divinci Robotic May 15, 2013
3 mo PSA 8/28/13 0.3
38 Radiation Treatments, completed Nov.15, 2013
Next PSA test Feb. 2013
Feb. 27,2014 PSA .4
May 2014 PSA .6
Sept 2014 PSA .8
Dec. 2014 PSA 1.2
April 2015 2.5
Posted 4/22/2015 12:47 AM (GMT 0)
You appear to be systemic and very high risk with the G8-10. That means mets are already developing. I would be looking at the combination of chemotherapy and Hormone therapy. Probably the cancer you have that escaped surgery and radiation is the most aggressive and could give off very little PSA. Side effects of HT aren't so bad, I did three years of it. Cost isn't a problem and yes Medicare covers it along with your supplement. I hope you are using a top flight prostate cancer specialist medical oncologist that has demonstrated great results with high risk disease like yours. If not, I would be seeking one.
Posted 4/22/2015 3:18 AM (GMT 0)
I would second JNF's recommendation for aggressive treatment. The options depend on your preferences and your oncologist (regarding chemo + HT), but at the very least you should consider hitting your cancer with HT soon, plus various scans to rule out lymph node and or other involvement.

Your PSA is low, but rising, so there's a good opportunity to really kick those PC cells in the chin, while there's still a relatively small amount of them.

My Dad's latest scan showed bone mets and his PSA was around 14, so it's better to be aggressive as early as possible and bring it back to undetectable range.

Arthur
Posted 4/22/2015 6:04 AM (GMT 0)
Steve,

I agree with you. There is no evidence that HT, if started sooner, has any benefit for survival. I'm not saying it can't have any benefit, I'm just saying there is no evidence yet of that. Why not enjoy symptom-free living until mets are discovered? I'm not sure if you want to wait for bone pain -- you may want surveillance for mets, and begin chemohormonal therapy when there are multiple mets found.

That's where I disagree with the above two posters. There is no evidence that chemohormonal therapy has any benefit unless there are multiple mets found. In fact, there is evidence that it is of no benefit before then.

- Allen
Posted 4/22/2015 12:07 PM (GMT 0)
Steve,

My situation is similar to yours. Unfortunately, I have more questions than answers. Allen mentioned surveillance for mets. Is this something readily available at the local imaging center or does one have to travel all over the country. Does Medicare cover this type of imaging? I have found that Medicare is very selective about paying for imaging. I would also like to know what some of the oncologists that specialize in PCa say about when to start HT. It seems that Dr. Myers is on the sooner rather than later side. Doing nothing may well be the best option but it just seems counterintuitive.

Please keep us posted on your progress.

Carlos
Posted 4/22/2015 12:36 PM (GMT 0)
Steve, this is a quandary indeed. I don't have enough knowledge or experience to give you an educated opinion on this. However I'll just suggest that you make sure your team is now led by an experienced oncologist who is a prostate cancer expert. The decisions now are really critical.

Good luck.

Jim
Posted 4/22/2015 2:40 PM (GMT 0)
I'm in a very similar situation, but further along.

I am on HT (intermittant -- was able to do a 9-month vacation but now back on).

Dr. Lam, a well-renowned PC expert, advocated getting on HT (mine was in the teens when I finally got on it).

Dr. Hussain, a world class researcher, stated that there is no survival advantage. She said if I could stomach a fast rising PSA, I could wait until Mets/symptoms. Given my psyche, I opted to do the HT.

There is clearly...no real clear answer

Mel
Posted 4/22/2015 3:09 PM (GMT 0)
I have a 45 day doubling time so I would be in the teens with my PSA within a very short period of time. I opted to begin HT after the third rise in my PSA.
Posted 4/22/2015 6:02 PM (GMT 0)
Carlos, one can get bone scans anywhere, and I believe Medicare fully covers them. I don't think that any more specialized scans than that are necessary if one is just looking for a multiple met (5 or more) trigger point to begin chemohormonal therapy.

- Allen
Posted 4/22/2015 6:19 PM (GMT 0)
Shutterbug you should call Mayo in Rochester Mn for a C-11 Choline scan like Compiler did. Maybe the can locate a focal area and treat that before hormones.
Posted 4/30/2015 4:12 AM (GMT 0)
Steve:
Like you, I have high risk disease. For guys in our category, the best advice is to get a world class medical oncologist who can help you steer your way through the available and appropriate treatments for your particular case. Be careful of any definitive advice you get on this site concerning which option to pursue. Several of the contributors have very fixed notions and biases that may or may not be appropriate for you. When I moved my care to a world class cancer center (MD Anderson in Houston), I got totally different advice than my local oncologist and urologist gave. I have a high degree of confidence now that I am getting treated by the best and that my treatment is individualized to my case.
Posted 4/30/2015 9:50 PM (GMT 0)
HT suppresses prostate cancer so it makes no sense to wait. You won't know what SE's you'll enjoy until you've been on it a while. It effects different people in different ways.
Posted 5/4/2015 1:48 AM (GMT 0)
Compiler/Mel,
I sure don't agree with Dr. Hussain, I've been on Ht for 8 years so I'd say that that shows a good survivability rate. I started it immediately after Dx in 2007 and am still on it. Please include your signature so that I can compare some notes . . . Q
Posted 5/4/2015 3:54 AM (GMT 0)
JNF, how can you say that mets are forming now. Easy I guess, just form the words. Pass on your secrets to the medical oncologists in Pca. Systemic is not a synonym for Mets. I could go on but to what purpose. Again newbies and vets everywhere…beware of internet forums. There is a saying in ATC" Military ATC is to ATC as military music is to music". The same could be said for internet "knowledge" tho at least military music is not disharmonious. nono

Post Edited (logoslidat) : 5/3/2015 9:58:58 PM (GMT-6)

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