Post-Treatment update for HDR & EBRT

Well done, great report. It looks like the treatment is very effective with little lasting side effects. I am five and one-half years after HDR, IMRT and HT and doing well. You will continue to improve.

Good Update Dolphin07. Looks like the numbers are going in the right direction. Your cialis plan seems to be the best advice now a days. Hope it works for me too as I am on the same plan. HT till May of next year so I am still slogging through that. Take care. -JR

Great news and thanks for posting Dolphin.
I have another mentor to add to my list.

Hi all, it's been almost a year - I have yet to do any HBOT (Hyperbaric Oxygen Therapy) treatments. My PSA has been rising at the rate of .1 per month from a nadir of 0.5. I now stand at 1.5 with an upcoming blood test this week. I've tightened up on my diet, and have been plant-based for the past 4 months (I was less careful about diet the first year after treatment and stayed around a plant-based diet but did eat some goat cheese, butter, poultry and fish). I can tighten up further and eliminate bread (even the organic kind I eat) and the occasional baked treat I eat with coffee on Sundays. I'm not scared and contemplate no further conventional treatments.

Tall Allen: Thank you for the advice; I will keep it in mind as I go forward. As I understand it, biochemical failure is nadir plus 2.0 (meaning a PSA of 2.5 for me), and biochemical failure does not always mean disease progression. In any event, it's good to know there is some hope. Thanks again...

Tall Allen

I have no history of prostatitis - but I did have a bad infection after my 12-core biopsy. My PSA went up over 20, and after a 2-week course of antibiotics, it went down to 11.1. I had one 3-month shot of lupron that took my PSA down from 11.1 to 0.7.

There was a 3-month gap between that shot and my HDR because I decided against HT and EBRT. I live in San Simeon and have Kaiser as a retiree benefit. There are no Kaiser facilities in San Luis Obispo County. I would have had to rent a hotel room in the dead of summer in Bakersfield to do HT and EBRT. I had a very bad reaction to HT and was warned by doctors in Kaiser North not to use it again after I decided not to do HT and EBRT.

One month after treatment, my PSA was 1.0. I will contact my radiation oncologists after I get the results of my next blood test (early September). I will also contact my urologist and try to get some action up on a PET Scan. Thank you for being helpful.

Glad to hear it!

Turboz-

I could address my answer specifically to you if you would create a signature with details of your diagnosis and treatment history.

Your question is "If not is the conclusion there was metastis( table claims 47% mortality at 8 yrs if PSA nadir was greater than 0.5) or some other reason, the RT itself was not succesful? "

I can only repeat what I wrote there:

A nadir of only 0.5 ng/ml among those taking ADT in this clinical trial suggests that the ADT was not working completely. I assume that ADT was begun 2 months before the EBRT, continued during the 2 months of EBRT, and was continued for 2 months after that (6 months total). If the first PSA was taken 3 months after EBRT completion, the effect of the ADT had not worn off yet. Some of the cancer must already have been castration resistant. Patients received a bone scan, but some must have already had metastases that were too small to be detected by it. We see this reflected in how quickly the metric predicted mortality. In as quickly as one year from the start of treatment, mortality was 20% among those who had already reached a nadir, and it was over 0.5 ng/ml vs. 0% in those who hadn't reached it. At year one, the percent who had met the endpoint was negligible for the other endpoints. Clearly, patients with a PSA that never goes down below 0.5 ng/ml after radiation +ADT are at greater risk.

Is there anything I can further clarify?

You also asked: " is another PSA done at some point prior to commencing the RT, perhaps just prior to show the 2 month effect of the ADT on the PSA? would that be a good date point to have."

Yes. That is standard of care. Testosterone level should be measured prior to commencing RT to assure that castration has been achieved, and the PSA has responded. If not, an alternative hormone therapy may be employed.