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Thread: Monitoring metabolic health while on ADT

  1. #1
    Senior User
    Join Date
    May 2017
    Posts
    205

    Monitoring metabolic health while on ADT

    My doc did not mention anything about monitoring lipids, minerals or bone density etc. while on ADT. The radiation tech where I get salvage radiation checks my vitals every Monday. My blood pressure is normally very low but is now borderline high. First time in my adult life I have seen this. I am thinking about ordering a Lipid Blood Test Panel Plus Hemoglobin (Hb) A1C from Lab Corp. From what I have read about ADT, it messes with your lipid levels and may produce insulin resistance and other metabolic problems. My total cholesterol bounces around between 85 and 95 so I'd be interested to see what it is now after two months of ADT. The A1C test should tell me if the ADT is messing with my blood sugar. I'm just wondering what else I should order, if anything. The next time I meet with the RO I can bring my test results. Anybody have any suggestions on what other tests would be good to order? For those of you who went through ADT, did your doc monitor you with lab work? I'm going to be proactive with this.
    DOB 1961
    2010-05 2.42
    2015-07 7.0
    2015-08 5.4
    2016-02 6.2
    2016-09 7.86
    2017-02 7.2
    2017-05 5.65
    2017-06 biopsy 7 of 13 cores G6
    2017-10 7.11
    2018-04 7.47
    2018-11 11.80

    2019-01 Da Vinci RALP
    Pathology report:
    Final stage pT2C
    Histologic type: Acinar adenocarcinoma with focal mucinous features
    Grade: 3+4=7 35% pattern 4
    23% of prostate involved
    EPE-
    BNI-
    SVI-
    PNI+
    LVI+
    Margins focally positive [1-3 mm] 4 locations
    Cribriform pattern noted

    Roche ECLIA uPSA
    2019-03 0.133
    2019-04 0.116
    2019-05 0.143
    2019-06 0.140
    2019-07 0.183
    2019-08 0.197
    2019-08 Start Lupron/Casodex
    2019-09 Decipher score .49
    2019-10 0.007
    2019-10-14 Start salvage radiation 39 treatments 70.2Gy
    2019-12-06 Completed radiation

  2. #2
    Quote Originally Posted by Busby View Post
    My doc did not mention anything about monitoring lipids, minerals or bone density etc. while on ADT. The radiation tech where I get salvage radiation checks my vitals every Monday. My blood pressure is normally very low but is now borderline high. First time in my adult life I have seen this. I am thinking about ordering a Lipid Blood Test Panel Plus Hemoglobin (Hb) A1C from Lab Corp. From what I have read about ADT, it messes with your lipid levels and may produce insulin resistance and other metabolic problems. My total cholesterol bounces around between 85 and 95 so I'd be interested to see what it is now after two months of ADT. The A1C test should tell me if the ADT is messing with my blood sugar. I'm just wondering what else I should order, if anything. The next time I meet with the RO I can bring my test results. Anybody have any suggestions on what other tests would be good to order? For those of you who went through ADT, did your doc monitor you with lab work? I'm going to be proactive with this.
    If they took you BP with one of those automated cuffs, I would not be concerned. My BP is all over the place with those things. Today I was 110/60, two weeks ago 185/80.

    My MO did do a bone density for a base line.
    YOB 1957

    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.

    3/6/19. Pathology - Grade Group 4 Intraductal Carcinoma
    T3aNO, 1 mm EPE, GS8, 21 mm uni-focal tumor involved 10% of prostate.

    7 Nodes, SV, SM, PNI, and BNI were negative.

    LVI and Cribriform pattern present.

    Decipher .86 High Risk.

    Post Surgery PSA
    3/25/19 .03. (<1 month)
    4/25/19 <.03. (2 months)
    5/25/19 <.02. (3 months)
    9/10/2019. <.02. (6 months)
    11/27/2019. <.02. T<3. (9 months)

    3 Part Modality Treatment

    2/25/19 Robotic Laparoendoscopic Single Site Surgery outpatient Cleveland Clinic,

    ADT - started 6/19, end date 6/21.

    ART - Completed 9/26/19. (78 Gy, yes, I glow in the dark)

  3. #3
    Experienced User
    Join Date
    Nov 2017
    Posts
    99
    I was on hormone therapy for six months and my MO ordered a complete panel at both the three and six month points, and three months after completion. It seems to me that monitoring is called for, for the reasons you mentioned and others. He also ordered a bone density study.

    Eric

  4. #4
    Hi Busby! Great job being proactive and monitoring your metabolic status while on ADT! It is surprising that there is not a standard monitoring protocol. Possibly you are only on a 6 month course of ADT. Regardless, I would think that before and after values would/should be monitored and assessed. You may want to contact your health insurer and ask for their accepted guidelines.

    FYI: Here is a related article of interest from UROToday (it addresses advanced PCa status which obviously is long term ADT):

    https://www.urotoday.com/journal/eve...te-cancer.html

    Keep in mind the recommendations for regular weight bearing exercises to help maintain muscle mass and bone density.

    Re "My total cholesterol bounces around between 85 and 95..:" That is impressive! Is this a result of good genes & lifestyles or a statin medication?

    Good luck crossing The SRT Finish Line with minimal effects. Stay focused on the fact that you have set the stage to make 2020 a Great Year!

    We are with you every "Zap" of the way!

    MF
    Last edited by Michael F; 10-30-2019 at 12:39 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 91 Months Post Op: Mean = 0.022 (22x uPSAs: Range 0.017 - 0.032) LabCorp: Ultrasensitive PSA: Roche ECLIA
    Continence = Very Good (≥ 99%)
    ED = present

  5. #5
    Senior User
    Join Date
    May 2017
    Posts
    205
    Michael F I'm on a four month ADT regimen, only long enough to complete salvage radiation. I'm wondering if the lack of monitoring is due to the short duration. I will ask doc about this next week. 25 years ago my doc told me I would never die of a heart attack but he also said there is a link between low cholesterol and certain cancers.
    DOB 1961
    2010-05 2.42
    2015-07 7.0
    2015-08 5.4
    2016-02 6.2
    2016-09 7.86
    2017-02 7.2
    2017-05 5.65
    2017-06 biopsy 7 of 13 cores G6
    2017-10 7.11
    2018-04 7.47
    2018-11 11.80

    2019-01 Da Vinci RALP
    Pathology report:
    Final stage pT2C
    Histologic type: Acinar adenocarcinoma with focal mucinous features
    Grade: 3+4=7 35% pattern 4
    23% of prostate involved
    EPE-
    BNI-
    SVI-
    PNI+
    LVI+
    Margins focally positive [1-3 mm] 4 locations
    Cribriform pattern noted

    Roche ECLIA uPSA
    2019-03 0.133
    2019-04 0.116
    2019-05 0.143
    2019-06 0.140
    2019-07 0.183
    2019-08 0.197
    2019-08 Start Lupron/Casodex
    2019-09 Decipher score .49
    2019-10 0.007
    2019-10-14 Start salvage radiation 39 treatments 70.2Gy
    2019-12-06 Completed radiation

  6. #6
    Busby, i was on a 6 month regimen of ADT, in conjunction with ADT. My total cholesterol which was always in the 80-90 range (with 10 mg crestor per day, i have atherosclerosis) went to 130. My Triglycerides, which were always a problem in the 200's went to 511 before my Cardiologist put me on meds and it is now down to 260 (my last lupron shot was Nov 201. I also grew a basketball for a stomach, which was pretty flat (for a 68 year old) before i started ADT. These are both signs of Metabolic syndrome.

    To answer your question, my RO, at MSKCC never monitored my lipids, except for the one time that i was getting bloodwork done for Testosterone and PSA and i asked him to do lipids also. I think the Drs are remiss to not talk about this issue with patients, its a big deal, especially when men already have heart diseaes.
    Best one can do is be disciplined about eating low carb low sugar and exercise. I didnt do that until i already had the symptoms.

    Good luck
    Diagnosed at age 64 (in November, 2014), PSA 4.3
    Nov 2014 BX 3 of 12 cores positive original pathology G8. Johns Hopkins second opinion, G6
    Surgery with Dr Ash Tewari Jan 6, 2015
    Post surgical pathology, stage T2c, bilateral disease, upstaged to G7(3+4)
    5% of Prostate involved in Tumor. Organ confined, Margins, SV, lymph nodes (9) all negative, PNI positive
    PSA <.02 until (uh-oh), 2/17 .02. Then 5/17-.033, 8/17-.033, 11/17-.046, 4/18-.060, 6/18-.068, 7/18- .082, 8/18-. 078.
    Decipher score low risk, .37
    ADT/Firmagon started August 2018. SRT SEPT 2018. Finished SRT November 2018, Finished ADT Feb 2019
    T=7, PSA <.05, 5/19 T=48 PSA <.05, 10/19 T=97 PSA=<.05

  7. #7
    Senior User
    Join Date
    May 2017
    Posts
    205
    Pratoman I actually saw the doc today and asked about this. He said he didn't think monitoring would be necessary based on these factors:

    1) I am on the lowest dose of bicalutamide
    2) Treatment time is limited to four months
    3) I am already fit and continuing to exercise

    I'm going to go ahead and get the lipid profile blood test to compare with my last annual physical. My overall weight has not changed by a single pound but that doesn't mean I haven't lost lean muscle mass and gained fat. My waist size has not changed . . . yet.
    DOB 1961
    2010-05 2.42
    2015-07 7.0
    2015-08 5.4
    2016-02 6.2
    2016-09 7.86
    2017-02 7.2
    2017-05 5.65
    2017-06 biopsy 7 of 13 cores G6
    2017-10 7.11
    2018-04 7.47
    2018-11 11.80

    2019-01 Da Vinci RALP
    Pathology report:
    Final stage pT2C
    Histologic type: Acinar adenocarcinoma with focal mucinous features
    Grade: 3+4=7 35% pattern 4
    23% of prostate involved
    EPE-
    BNI-
    SVI-
    PNI+
    LVI+
    Margins focally positive [1-3 mm] 4 locations
    Cribriform pattern noted

    Roche ECLIA uPSA
    2019-03 0.133
    2019-04 0.116
    2019-05 0.143
    2019-06 0.140
    2019-07 0.183
    2019-08 0.197
    2019-08 Start Lupron/Casodex
    2019-09 Decipher score .49
    2019-10 0.007
    2019-10-14 Start salvage radiation 39 treatments 70.2Gy
    2019-12-06 Completed radiation

  8. #8
    Senior User
    Join Date
    Feb 2017
    Posts
    182
    ADT is a slog. No doubt about it. I finished the two years last Spring. The frequency of testing obviously varies from case to case. I've been doing a CBC and a Metabolic Panel every 90 days since May of 2017. Joining those two has been both a PSA and a Testosterone level.
    2010-PSA 3.59; 2011-PSA 3.58; 2012-PSA 5.28, 4.26; 2013-PSA 5.98, 7.37; 2014-PSA 5.90, 4.70; 2015-PSA 5.18, 7.35
    RALP 16 March 17, Wesley Long, Greensboro, NC
    Pathology: pT3a, pN1 Gleason 4+5=9 adenocarcinoma with + surgical margin at bladder neck; 3 of 16 lymph nodes positive; neg seminal vesicles, vasa deferens
    Referral to Dr. Ken Pienta, Clinical Dir Research, Brady Center, Johns Hopkins
    Enrolled in Clinical Trial IRB002120414 “Phase II Study of definitive therapy for oligometastatic prostate cancer post surgery"
    Completed: Docetaxel 12 Jun 17, 3 Jul 17, 24 Jul 17, 14 Aug 17, 15 Sep 17
    Lupron every 90 days for two years. Completed March 2019
    Bone/Body Scans - 15 Sep 17 - neg; 15 Mar 18 - neg; 14 Sep 18 - neg; 17 Mar 19 - neg
    EBRT: 69 Gy total (46 to fossa, 23 boost to suspect areas) 1st treatment 28 Sep 17, last 22 Nov 17
    PSA: 25 May 17=0.2; 5 Sep 17=0.1; 18 Dec 17=0.1; 6 Mar 18=0.1; 29 May 18=0.1; 5 Sep 18=0.1; 17 Dec 18=0.1; 12 Mar 19=0.1; 15 Jul=0.1; 29 Oct 19=0.1

  9. #9
    Senior User
    Join Date
    May 2017
    Posts
    205
    Quote Originally Posted by BAB View Post
    ADT is a slog. No doubt about it. I finished the two years last Spring. The frequency of testing obviously varies from case to case. I've been doing a CBC and a Metabolic Panel every 90 days since May of 2017. Joining those two has been both a PSA and a Testosterone level.
    BAB, I can't even imagine doing two years of ADT. Did you have to take any action based on your metabolic panel results? If so, what was done if you don't mind me asking?
    DOB 1961
    2010-05 2.42
    2015-07 7.0
    2015-08 5.4
    2016-02 6.2
    2016-09 7.86
    2017-02 7.2
    2017-05 5.65
    2017-06 biopsy 7 of 13 cores G6
    2017-10 7.11
    2018-04 7.47
    2018-11 11.80

    2019-01 Da Vinci RALP
    Pathology report:
    Final stage pT2C
    Histologic type: Acinar adenocarcinoma with focal mucinous features
    Grade: 3+4=7 35% pattern 4
    23% of prostate involved
    EPE-
    BNI-
    SVI-
    PNI+
    LVI+
    Margins focally positive [1-3 mm] 4 locations
    Cribriform pattern noted

    Roche ECLIA uPSA
    2019-03 0.133
    2019-04 0.116
    2019-05 0.143
    2019-06 0.140
    2019-07 0.183
    2019-08 0.197
    2019-08 Start Lupron/Casodex
    2019-09 Decipher score .49
    2019-10 0.007
    2019-10-14 Start salvage radiation 39 treatments 70.2Gy
    2019-12-06 Completed radiation

  10. #10
    Quote Originally Posted by Busby View Post
    Pratoman I actually saw the doc today and asked about this. He said he didn't think monitoring would be necessary based on these factors:

    1) I am on the lowest dose of bicalutamide
    2) Treatment time is limited to four months
    3) I am already fit and continuing to exercise

    I'm going to go ahead and get the lipid profile blood test to compare with my last annual physical. My overall weight has not changed by a single pound but that doesn't mean I haven't lost lean muscle mass and gained fat. My waist size has not changed . . . yet.
    That is all great news busby. I would just have lipids monitored occasionally so if they do rise, which seems unlikely in your case, you can go on meds temporarily, if needed. But a 4 month course is probably going to end up having been relatively easy on you
    Diagnosed at age 64 (in November, 2014), PSA 4.3
    Nov 2014 BX 3 of 12 cores positive original pathology G8. Johns Hopkins second opinion, G6
    Surgery with Dr Ash Tewari Jan 6, 2015
    Post surgical pathology, stage T2c, bilateral disease, upstaged to G7(3+4)
    5% of Prostate involved in Tumor. Organ confined, Margins, SV, lymph nodes (9) all negative, PNI positive
    PSA <.02 until (uh-oh), 2/17 .02. Then 5/17-.033, 8/17-.033, 11/17-.046, 4/18-.060, 6/18-.068, 7/18- .082, 8/18-. 078.
    Decipher score low risk, .37
    ADT/Firmagon started August 2018. SRT SEPT 2018. Finished SRT November 2018, Finished ADT Feb 2019
    T=7, PSA <.05, 5/19 T=48 PSA <.05, 10/19 T=97 PSA=<.05

 

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