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Thread: Please educate me

  1. #1
    Experienced User
    Join Date
    Feb 2019

    Please educate me

    I am wondering about my possible options since my first post surgery PSA was .74 and the question comes to mind about ADT HT. It, to me only reduces the PSA and gives lots of side effects, so as far as eliminating the cancer if still present, does it? Also radiation scares me as far as creating more issues further down the road. I know these will be questions for the dr but I was , just wondering out loud on a forum, getting opinions.
    DOB 9/6/59
    1/21/19 PSA 7.5.
    Bx 2/8/19
    G7 (4+3), 60% pattern 4
    Reffered to Mayo Clinic Rochester, MN
    RALP 4/3/19 Igor Frank
    Adenocarcinoma G8 (4+4)
    Mass (3 x 1.5 x 1.2 cm)
    Tumor involves both seminal vesicles.
    Extraprostatic soft tissues, SM, EPE, BNI, LNI (24): neg., SVI+
    pT3b pN0 Mx
    7/19 3mo PSA 0.74
    7/24 retest PSA 0.78
    8/14 3 mo. Lupron inj.

  2. #2
    Senior User
    Join Date
    Jan 2019
    Your age is 60. Your life expectancy is about 25 years. ADT and SRT are the primary treatments for prostate cancer used to try to get you to your normal life expectancy. Your condition will qualify you for some clinical trials
    DOB 5/1957

    PSA - 11/2010=1.9, 6/12=2.3, 12/13=2.19, 12/14=2.64, 3/17=5.29, 3/17=3.91, 6/17=3.47, 12/17=4.50, 12/17=3.80, free PSA low risk (local (Uro, “My opinion you don’t have cancer), 8/18=5.13, 10/18=5.1, 10/19 ISO PSA 56% risk cancer. All DREs negative.

    DX 12/18, GS 8, 4+4 6/12 cores, LL Apex 100%, LM Apex 60%, LL Mid 50%, LMM 40%, LL Base 5%, LM <5%, Right side negative, (Uro opinion “This has been going on for a year”.... ah, more like 2 years ). Bone scan/CT negative

    2/25/19 R-LESS (Robotic Laparoendoscopic Single Site Surgery) outpatient Cleveland Clinic,

    3/6/19. Pathology - Grade Group 4 with Intraductal Carinoma
    T3aNO, GS8, 21 mm unifocal tumor 10%. -7 Nodes, - SV, - Margins, - PNI,
    - bladder neck neg., +LVI, + EPE non focal apex/mid lateral 1mm max extension, Cribriform pattern present. Decipher .86 High Risk.

    PSA 3/27/19 .03. (29 days)
    4/25/19 <.03. (58 days)
    5/25/19 <.02. (88 days)

    ADT - 6/3/19
    ART - 8/5/19

  3. #3
    I received a 6 month ADT shot (Lupron) in December 2018 in preparation for salvage radiation starting in January. I completed the SRT in March and had no side effects from radiation and no side effects from the Lupron. There are several others on this forum who went through the same and suffered no side effects.
    There is no right or wrong decision for treatment. Make the decision you are comfortable with and can live with and not second guess if all does not go optimally.

    6/2016 PSA 5.1, negative DRE
    6/2016 Urologist PSA 6.0, %free = <10% chance cancer, negative DRE
    12/2016 PSA 7.7, %free = 50% chance cancer, negative DRE
    2/2017 biopsy Bostwick 5/12 3+3, perineural invasion. Hopkins 5/12, 4 3+3, 1 3+4 (5% 4), perineural invasion
    5/17/2017 Open RP by Dr Alan Partin - Hopkins (5500+ prostate cancer surgeries, open & robotic)
    5/2017 Pathology 3+4, T2x, +margin (6mm, 3+3), organ contained except unevaluable at +margin, moderate tumor extent
    seminal vesicles, lymph nodes all neg
    Age: 62 @ surgery
    8/2017 PSA < .1
    11/2017 PSA <.1
    5/2018 uPSA .06, standard .1
    8/2018 uPSA .07, standard .1
    11/2018 uPSA .10, standard .1
    12/29/2018 6 month Lupron shot
    1/22/2019 start SRT, 39 treatments, 5 days per week
    3/15/19 ended SRT with no significant side effects

  4. #4
    Mostth, you are very fortunate in getting your care at the Mayo. You can ask about SOC (Standard Of Care) treatments and experimental ones. If your persistent PSA is confirmed, you can have consults with different specialists there before deciding.

    HT is used as a main weapon to control metastatic PCa. But it also plays a role in conjunction with, or prior to, RT to the prostate bed. It both shrinks lesions and makes tumor cells more sensitive to RT, sometimes making it more effective. Talk to your docs about it and other neoadjuvant treatments that can be given before and/or with radiation.

    I would ask about genomic testing to see an estimate of your risk category for metastases.

    Radiation can kill cancer cells in place. Yes there is a risk of toxicities, but we're not dealing with bronchitis or poison ivy. Keeping things in perspective is very important.

    Your docs will give you details about if, when, and why they advise ADT and what the alternatives are.

    Have you had a bone scan? if not, that and/or other scans (auxim or Ga-PSMA-PET) may be able to identify the sources/location of your remaining PSA.

    Read what other Brothers suggest, ask questions here, and start a list of questions for your docs.

    Last edited by DjinTonic; 07-17-2019 at 02:27 AM.

  5. #5
    Top User garyi's Avatar
    Join Date
    Apr 2017
    <<<mostth;385202]I am wondering about my possible options since my first post surgery PSA was .74 and the question comes to mind about ADT HT.......>>>

    You're being treated at Mayo Clinic Rochester...your options won't get better than what they tell you.

    You have persistent PSA. Basically surgery missed something. Given your age and pathology they probably will tell you to have SRT and the sooner the better. ADT should also be considered. Radiation and hormones are no picnic, but they sure beat your cancer metastasizing.

    Based on my history and research, I suggest you stop worrying about it, looking for our non-professional abstract advise, and get your butt back to Mayo, ASAP. Good luck!!
    72...LUTS for the past 7 years
    TURP 2/16,
    G3+4 discovered
    3T MRI 5/16
    MRI fusion guided biopsy 6/16
    14 cores; four G 3+3, one G3+4,
    CIPRO antibiotic = C. Diff infection 7/16
    Cured with Vanco for 14 days
    Second 3T MRI 1/17
    Worsened bulging of posterior capsule
    Oncotype DX GPS 3/17, LFP risk 63%, Likelihood of Low
    Grade Disease 81%, Likelihood of Organ Confined 80%
    RALP 7/13/17 Dr. Gonzaglo @ Univ of Miami
    G3+4 Confirmed, Organ confined
    pT2 pNO pMn/a Grade Group 2
    PSA 0.32 to .54 over 3 months
    DCFPyl PET & ercMRI Scans - 11/17
    A one inch tumor still in prostate bed = failed surgery
    All met scans clear
    SRT, 2ADT, IMGT 70.2 Gys @1.8 per, completed 5/18
    Radiation Procitis, and Ulcerative Colitis flaired after 20 years
    PSA <.006 9/18, .054 11/18, .070 12/18, .067 2/19, .078 5/19, .074 7/19
    We'll see....what is not known dwarfs what is thought to be fact

  6. #6
    One correction to what might be a misconception about PSA on your part. ADT can keep metastatic PCa at bay and prolong life. Low and lowered PSA are a sign that ADT is (still) working. The purpose of ADT isn't to lower PSA per se, just so the patient can wave a lab report with pride, but rather the low PSA is the direct result of the cancer cells "gasping" for testosterone, not finding it, and not being able to proliferate. Proliferation is reflected in rising PSA. PSA measurements after primary treatment are like the indicator needle on a sensitive cancer-monitoring instrument.

    Unfortunately, the cancer can outsmart the ADT by becoming resistant to it. We now have a comeback to that in the form of 2nd generation ADT medications. The fight goes on.

    But once you understand the significance of post-treatment PSA, it's fine to wave your lab result and celebrate

    Last edited by DjinTonic; 07-17-2019 at 10:53 AM.

  7. #7
    Experienced User
    Join Date
    Nov 2017
    I just finished six months of hormone therapy and salvage radiation. Other than fatigue, the side effects are minimal. You have cancer remaining after surgery. Hit it hard, and go for the cure without fear.


  8. #8
    Newbie New User
    Join Date
    Mar 2019
    I had the surgery end of Jan 2019 and the post RP PSA was at 1.6. The MO asked for the Axumin PET scan which showed a lymph node to be the problem. The bad news was that a 1 lymph node was affected and the good news was only 1 lypmh node was affected.

    The treatment included 2 weeks of Casodex and the the Lupron shot. The Lupron shot was given on April 16. Jun 3rd PSA test showed PSA at <0.1. So the Lupron treatment immidiately showed good results. I also started the radiation treatment Jun 24th. A total of 40 treatments are scheduled. I have completed 16 of them as of yesterday.

    THe main side effects of Lupron have been hot flashes and fatigue. The doctors have given me Venlafaxine for hot flashes and it is helping. The side effects due to radiation have been fatigue and upset stomach.

    I am not going to minimize the side effects but the bottom line is that the side effects are manageable. And the lab results like Djin has said, are significantly positive.
    PSA 11/16 - 2.5; PSA 03/17 - 2.4; PSA 08/18 - 4.6; PSA 09/18 - 4.9;
    TISSUE PATHOLOGY 10/04/2018:12 samples - 4 with (4+4), 2 with (4+3), 6 benign

    BONE SCAN WHOLE BODY 10/15/2018: degenerative changes. No other findings
    CT ABDOMEN PELVIS W/ (ORAL/IV) CONTRAST 10/16/2018:no evidence of metastatic disease
    MRI PROSTATE WO/W CONTRAST 11/08/2018: suspicious for malignancy; Findings suspicious for a PI-RADS 5 lesion
    MRI THORACIC SPINE WO/W CONT 11/10/2018:no evidence of metastatic disease

    Surgery da Vinci Robotic Laparoscopic - 01/25/2019

    Post surgery Report:
    EPE - Present, non-focal
    Margins - Involved by tumor at posterior mid and right anterior
    PNI - present
    No of lymph nodes examined 3; involved 0
    Total Gleason score 4+4 = 8
    Tertiary Gleason pattern 5(1%)

    PSA Post RP - 03/08/2019 - 1.6
    PSA - 03/22/2019 - 1.6
    Axumin PET Scan - 04/03/2019 - one positive lymph node

  9. #9
    Experienced User
    Join Date
    Feb 2019
    Yes I am , was treated at Mayo, but that was at the recommendation of my local uro. Mayo is 6.5 hours away and when we had my first checkup with the local uro(catheter removal and discussion about the pathology from surgery) he was quick to say that if I had any issues when the 3 mo. blood draw was taken "it would be back to Mayo". He was the one who recommended that I go there and that he would work with me when I got back, but it clearly seemed to me by his attitude that he was not happy that I did not choose him for the surgery.
    DOB 9/6/59
    1/21/19 PSA 7.5.
    Bx 2/8/19
    G7 (4+3), 60% pattern 4
    Reffered to Mayo Clinic Rochester, MN
    RALP 4/3/19 Igor Frank
    Adenocarcinoma G8 (4+4)
    Mass (3 x 1.5 x 1.2 cm)
    Tumor involves both seminal vesicles.
    Extraprostatic soft tissues, SM, EPE, BNI, LNI (24): neg., SVI+
    pT3b pN0 Mx
    7/19 3mo PSA 0.74
    7/24 retest PSA 0.78
    8/14 3 mo. Lupron inj.

  10. #10
    Hi mostth! You are asking excellent questions and receiving excellent feedback form your FBs in advance of your next Mayo Clinic appointment.

    Keep in mind that your "0.74" still needs to be confirmed. Good luck this week!

    In the event of remnant PCa, IMO it is essential to know the exact locations(s). FB vjbaba (Post #8 ) is a case in point. IF his RO put him in a standard ART protocol, would the (+) Lymph node be eradicated? I do not know the answer. However, I lost a close friend/relative to PCa for this exact reason (he was being treated at one of the Apex Ca Centers in the world. When discovered at a PSA = 5, they put him on some insane protocol that called for a series of CT guided biopsies of the (+) LN over the course of the protocol. They should have surgically retrieved the LN as soon as it was identified. He would be with us today!)

    Definitely communicate with vjbaba.

    Your experienced FBs will provide HT/ADT guidance. I have no experience with HT/ADT but if ever needed, I would not hesitate to incorporate with SRT. This will be temporary. Your goal remains: Permanent Cure!

    Try to relax and remain calm. The Mayo Clinic has seen it all and will successfully navigate you through this.

    We are all "mostth" hoping for a better PSA redo this week!

    Last edited by Michael F; 07-17-2019 at 07:24 PM.
    PSA: Oct '09 = 1.91, Oct '11 = 2.79, Dec '11 = 2.98 (PSA, Free = 0.39ng/ml, % PSA Free = 13%)
    Referred to URO MD
    Jan '12: DRE = Positive: "Left induration"
    Jan '12: Biopsy = 6 of 12 Cores were Positive: 1 = G7 (3+4) and 5 = Gleason 6
    Referred to URO Surgeon
    March '12: Robotic RP: Left: PM + EPE. MD waited in surgery for preliminary Path Report then excised substantial left adjacent tissue(s) down to negative margins and placed 2 Ti clips for SR guidance, if needed in future.
    Pathology: Gleason (3+4) pT3a pNO pMX pRO c tertiary pattern 5 / Prostate Size = 32 grams / Tumor = Bilateral: 20% / PNI: present
    3 month Post Op standard PSA = <0.1 ng/ml
    1st uPSA at 7 months Post Op = 0.018 ng/ml
    uPSA remains "stable" at 84 Months Post Op: Mean = 0.021 (20x uPSAs: Range 0.017 - 0.026) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present


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