Prognosis for T3, Gleason 9, recurrent PSA 19?

solunetta · New User Joined: 04 Mar 2008 Posts: 2

In 2004 at age 54 with a PSA of 8.5 my other half was diagnosed with advanced prostate cancer which was deemed aggressive. Since it had spread locally (lymph nodes, etc.), no prostatectomy was performed, and instead received pelvic radiation and chemotherapy (5 sessions). He was also put on CAB for 2 yrs. However, after being off CAB for 1 year, in a 6 month period his PSA went from 0.3 to 19. He is now back on CAB. Recent bone and CT scans were negative.

Could anyone please tell me what I may expect in the future. How long might he expect to be symptom-free? Unfortunately he doesn't practice a very healthy lifestyle (too much stress and sometimes also excess alcohol; he has however, increased vegetable intake and decreased meat consumption, although I don't know if at this stage it makes any difference.). I welcome any and all comments... Thank you...

Replicant · Moderator Joined: 01 Nov 2006 Posts: 860

Solunetta, you asked how long he can expect to be cancer free. He's not cancer-free. He is free of symptoms. Just a technicality, but I wanted to be clear about this.

I think I know what you meant by your question. Unfortunately, it's impossible for anyone to ascertain this for you, especially over the Internet.

For some men, androgen deprivation (the CAB, or complete androgen blockade you write of) will only help for a few years. For others, it may be over a decade. The majority of men will fall somewhere in between.

Urologist Patrick Walsh would tell you that while the CAB is kicking the daylights out of most of the cancerous cells right now, there are a minority of cells that aren't bothered by CAB. Eventually, as those cells multiply, they will become the majority. PSA will no longer be controlled by androgen deprivation, and the cancer will become hormone refractory. (Whether or not that scenario is correct, the end result is the same.)

It's not the end of the road at that point. A skilled oncologist may be able to continue to stall and delay disease progression with chemotherapy. More chemo meds are being developed all the time. Not long ago, chemo was for PCa was highly experimental.

I don't think (but I'm not an MD) it's possible to predict the course of an individual's prostate cancer in such a situation.

Don't despair. There is reason for hope. Take a look at the link chas036 posted not long ago--the story of a man who has had advanced PCa for 14 years: http://www.ustoowichita.org/cmaackprostatecancerstats.cfm

It's my hope that there are men now living with advanced PCa that will live long enough for science to find a cure. There have been exciting developments in immune-based therapies (vaccines like GVAX and Provenge) and I'm sure there will be more developments to come.

Before I forget, how's the PSA now? Has it been tested since he went back on CAB?

Best wishes.
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T2c, NXMX, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 (and thereafter) <0.1
http://pcabefore50.blogspot.com

johnw100

For anyone on hormone treatment, I always strongly suggest they read the book on hormone therapy and diet by Dr Myers.
Dr Myers used radiation and hormone treatment for his own high risk PC 8 yeras ago and has used it successively for many of his patients.

As suggested it's worth consulting an expert in that field.

Yes, it is impossible to know how long a treatment will be effective for: in Dr Myers view, most men diagnosed as being hormone resistant are not.

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