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PSA still rising
  1. #1
    [email protected] Guest

    Default PSA still rising

    I last posted in August as my husband's psa was on the rise. It was
    1.16 in August. He had another test last week and it was 1.56. He has
    seen an oncologist at Mount Sinai in Toronto who has confirmed that
    the cancer has metastisized and they recommend that he start hormone
    therapy when his PSA hits around 4. He could start now but they
    agreed with my husband that since he's feeling great right now and is
    still sexually active, he can wait a bit. They also said that the
    hormones wouldn't really prolong his life, just help control the
    pain. They predict that he will feel good for another 2 years or so
    and then will enter a slow decline. It sounds to me like he has 4-5
    years left.

    On a selfish note, it's all rather gloomy and depressing. I'm 49 and
    having chats about funerals and cemetary plots. At least, being in
    Canada, money for treatment won't be an issue. My husband seems to be
    somewhat depressed and I think both of us should probably seek out a
    support group. Anyway, that's the way it is for now.
    Cheers,
    Karen in Toronto

  2. #2
    [email protected] Guest

    Default Re: PSA still rising

    On Jan 16, 9:47 am, khildebra...@casselsbrock.com wrote:
    > I last posted in August as my husband's psa was on the rise. It was
    > 1.16 in August. He had another test last week and it was 1.56. He has
    > seen an oncologist at Mount Sinai in Toronto who has confirmed that
    > the cancer has metastisized and they recommend that he start hormone
    > therapy when his PSA hits around 4. He could start now but they
    > agreed with my husband that since he's feeling great right now and is
    > still sexually active, he can wait a bit. They also said that the
    > hormones wouldn't really prolong his life, just help control the
    > pain. They predict that he will feel good for another 2 years or so
    > and then will enter a slow decline. It sounds to me like he has 4-5
    > years left.
    >
    > On a selfish note, it's all rather gloomy and depressing. I'm 49 and
    > having chats about funerals and cemetary plots. At least, being in
    > Canada, money for treatment won't be an issue. My husband seems to be
    > somewhat depressed and I think both of us should probably seek out a
    > support group. Anyway, that's the way it is for now.
    > Cheers,
    > Karen in Toronto


    Dear Karen:

    Thank you for your honest post. There is a distinction between the
    posts on this site by men and those by women, generally. Yours is an
    example of the open and emotional impact cancer has on the lives of
    partners and family members. I believe there is a message of hope
    within your husband's case. With a doubling time of more than a year,
    by the two dates and psa numbers you give, your husband may have years
    to go before he must initiate hormone therapy. And when that time
    comes, the most common response time is years again, ten years or more
    is common. This suggests that he, and you, have much more time than
    you calculate. Certainly no one can promise tomorrow, but the numbers
    in his case offer opportunity for him to benefit from treatments
    coming in the research world which may extend life, with quality, yet
    again.
    I know how reluctant doctors are to discuss life expectancy, and when
    they do, how poorly and pessimistically they perform. Trust the
    research and experience of many men on this. If your medical team has
    provided the 4-5 years that you mention, they are wrong. As one who is
    farther down the line than your husband I submit life is for living.

  3. #3
    Alan Meyer Guest

    Default Re: PSA still rising

    <[email protected]> wrote in message
    news:[email protected]...
    >I last posted in August as my husband's psa was on the rise. It was
    > 1.16 in August. He had another test last week and it was 1.56. He has
    > seen an oncologist at Mount Sinai in Toronto who has confirmed that
    > the cancer has metastisized and they recommend that he start hormone
    > therapy when his PSA hits around 4. He could start now but they
    > agreed with my husband that since he's feeling great right now and is
    > still sexually active, he can wait a bit. They also said that the
    > hormones wouldn't really prolong his life, just help control the
    > pain. They predict that he will feel good for another 2 years or so
    > and then will enter a slow decline. It sounds to me like he has 4-5
    > years left.
    >
    > On a selfish note, it's all rather gloomy and depressing. I'm 49 and
    > having chats about funerals and cemetary plots. At least, being in
    > Canada, money for treatment won't be an issue. My husband seems to be
    > somewhat depressed and I think both of us should probably seek out a
    > support group. Anyway, that's the way it is for now.
    > Cheers,
    > Karen in Toronto


    Karen,

    I'm going to recommend something that is probably stupid, but I'm
    not sure there's anything to lose.

    What I suggest is that your husband begin a regimen of diet and
    supplements that are thought to be useful against cancer. I'm
    suggesting that for two reasons.

    One is that a friend of mine with very aggressive cancer was put
    on such a regimen by Charles "Snuffy" Myers, a leading prostate
    cancer oncologist. I don't know if it did any good. Myers is
    also treating him with very complicated hormone therapy, so it's
    impossible to separate the effects of the prescription drugs from
    the supplements. However, the fact that Dr. Myers thinks these
    things are worth doing says something to me. He is a nationally
    recognized expert.

    The other reason is that your husband's PSA is rising relatively
    slowly. I think that means that the rate of tumor cell growth is
    only a little higher than the rate of tumor cell death. If
    that's true, and if the supplements promote cancer cell death
    ("apoptosis" is the technical term), then maybe they can tip the
    balance a little the other way. Just slowing down the process a
    little may have a much more significant effect in a slow growing
    cancer than slowing it down a little in a fast growing cancer.

    Now the next question is what to take. Unfortunately, I don't
    know the answer. Dr. Myers had my friend (whose PSA reached 700
    by the way) on 5 pomegranate extract capsules each day from:

    http://www.lef.org/newshop/items/item00956.html

    I don't know if these are better than cheaper ones from other
    sources, but you can look at what they contain and compare them
    to others.

    He's also taking megadoses of vitamin C, but I don't know the
    specific dosage.

    Other things that people have suggested include: lycopene, EGCG
    (green tea), vitamin D, and maybe other things. A low fat diet,
    with lots of fruits and vegetables is also often recommended. If
    you search the archives of the newsgroup you'll see
    recommendations from others who know more than I do about this.

    I don't see how this can hurt.

    Finally, I'll make a few remarks about hormone therapy.

    The "two years" that the oncologist predicted may stretch
    considerably longer than that. Steve Kramer, a stalwart
    contributor to this group, began hormone therapy in July, 2003.
    Four and a half years later, his PSA is still undetectable.

    Steve started HT early, while his PSA was still below 1.0. But
    it's working well for him. Since your husband's PSA growth seems
    reasonably slow, HT may work very well for him too.

    Hormone therapy does eventually fail, but that's not quite yet
    the end of the line. There is "second line" hormone therapy
    (ketoconazole and/or estrogen patches) that works well for some
    men. Then there is chemotherapy. There are also a number of new
    therapies in clinical trials that may add more months or years
    and may be available by the time other therapies stop working for
    your husband.

    I know that, psychologically, all of this is very, very
    difficult. It's necessary to be realistic and not live on false
    hopes. But I think it's also important not to give up on life.
    There are at least a few very good years ahead, and a few years
    with problems. Even the years with problems can be good years.

    I was on a cruise to Alaska once and sat at dinner with a lady in
    a wheel chair and her husband. It turned out that she was dying
    of cancer and had only a short time to live, but she had always
    wanted to see Alaska. I was impressed by the lady's good
    spirits, by how much interest she took in the conversations at
    dinner, by how fine a relationship she enjoyed with her husband,
    and by how much she seemed to enjoy the scenery in Alaska. I
    learned something about how to live from her.

    Best of luck to you both.

    Alan



  4. #4
    Justin Thyme Guest

    Default Re: PSA still rising

    My comment at the bottom.


    <[email protected]> wrote in message
    news:[email protected]...
    >I last posted in August as my husband's psa was on the rise. It was
    > 1.16 in August. He had another test last week and it was 1.56. He has
    > seen an oncologist at Mount Sinai in Toronto who has confirmed that
    > the cancer has metastisized and they recommend that he start hormone
    > therapy when his PSA hits around 4. He could start now but they
    > agreed with my husband that since he's feeling great right now and is
    > still sexually active, he can wait a bit. They also said that the
    > hormones wouldn't really prolong his life, just help control the
    > pain. They predict that he will feel good for another 2 years or so
    > and then will enter a slow decline. It sounds to me like he has 4-5
    > years left.
    >
    > On a selfish note, it's all rather gloomy and depressing. I'm 49 and
    > having chats about funerals and cemetary plots. At least, being in
    > Canada, money for treatment won't be an issue. My husband seems to be
    > somewhat depressed and I think both of us should probably seek out a
    > support group. Anyway, that's the way it is for now.
    > Cheers,
    > Karen in Toronto


    You have chosen a great group for support, help, and encouragement. Your
    husband's condition and concern is probably mirrored by many people here,
    and they're a wonderful group, believe me.

    My PSA was much higher than your husbands and was detected and treated about
    six years ago. My urologist recommended surgery, and I trusted him. After
    that, I had a couple of hormone injections to reduce the PSA again, but only
    marginally effective. But then, I am maybe 20 years older than he is and
    worrying at his age (I assume at about your age) is absolutely
    counterproductive.

    All the best to both of you,

    Ken Bland



  5. #5
    [email protected] Guest

    Default Re: PSA still rising

    On Jan 16, 1:16*pm, "Alan Meyer" <amey...@yahoo.com> wrote:
    > <khildebra...@casselsbrock.com> wrote in message
    >
    > news:[email protected]...
    >
    >
    >
    >
    >
    > >I last posted in August as my husband's psa was on the rise. *It was
    > > 1.16 in August. *He had another test last week and it was 1.56. He has
    > > seen an oncologist at Mount Sinai in Toronto who has confirmed that
    > > the cancer has metastisized and they recommend that he start hormone
    > > therapy when his PSA hits around 4. *He could start now but they
    > > agreed with my husband that since he's feeling great right now and is
    > > still sexually active, he can wait a bit. They also said that the
    > > hormones wouldn't really prolong his life, just help control the
    > > pain. *They predict that he will feel good for another 2 years or so
    > > and then will enter a slow decline. It sounds to me like he has 4-5
    > > years left.

    >
    > > On a selfish note, it's all rather gloomy and depressing. I'm 49 and
    > > having chats about funerals and cemetary plots. At least, being in
    > > Canada, money for treatment won't be an issue. My husband seems to be
    > > somewhat depressed and I think both of us should probably seek out a
    > > support group. Anyway, that's the way it is for now.
    > > Cheers,
    > > Karen in Toronto

    >
    > Karen,
    >
    > I'm going to recommend something that is probably stupid, but I'm
    > not sure there's anything to lose.
    >
    > What I suggest is that your husband begin a regimen of diet and
    > supplements that are thought to be useful against cancer. *I'm
    > suggesting that for two reasons.
    >
    > One is that a friend of mine with very aggressive cancer was put
    > on such a regimen by Charles "Snuffy" Myers, a leading prostate
    > cancer oncologist. *I don't know if it did any good. *Myers is
    > also treating him with very complicated hormone therapy, so it's
    > impossible to separate the effects of the prescription drugs from
    > the supplements. *However, the fact that Dr. Myers thinks these
    > things are worth doing says something to me. *He is a nationally
    > recognized expert.
    >
    > The other reason is that your husband's PSA is rising relatively
    > slowly. *I think that means that the rate of tumor cell growth is
    > only a little higher than the rate of tumor cell death. *If
    > that's true, and if the supplements promote cancer cell death
    > ("apoptosis" is the technical term), then maybe they can tip the
    > balance a little the other way. *Just slowing down the process a
    > little may have a much more significant effect in a slow growing
    > cancer than slowing it down a little in a fast growing cancer.
    >
    > Now the next question is what to take. *Unfortunately, I don't
    > know the answer. *Dr. Myers had my friend (whose PSA reached 700
    > by the way) on 5 pomegranate extract capsules each day from:
    >
    > * *http://www.lef.org/newshop/items/item00956.html
    >
    > I don't know if these are better than cheaper ones from other
    > sources, but you can look at what they contain and compare them
    > to others.
    >
    > He's also taking megadoses of vitamin C, but I don't know the
    > specific dosage.
    >
    > Other things that people have suggested include: lycopene, EGCG
    > (green tea), vitamin D, and maybe other things. *A low fat diet,
    > with lots of fruits and vegetables is also often recommended. *If
    > you search the archives of the newsgroup you'll see
    > recommendations from others who know more than I do about this.
    >
    > I don't see how this can hurt.
    >
    > Finally, I'll make a few remarks about hormone therapy.
    >
    > The "two years" that the oncologist predicted may stretch
    > considerably longer than that. *Steve Kramer, a stalwart
    > contributor to this group, began hormone therapy in July, 2003.
    > Four and a half years later, his PSA is still undetectable.
    >
    > Steve started HT early, while his PSA was still below 1.0. *But
    > it's working well for him. *Since your husband's PSA growth seems
    > reasonably slow, HT may work very well for him too.
    >
    > Hormone therapy does eventually fail, but that's not quite yet
    > the end of the line. *There is "second line" hormone therapy
    > (ketoconazole and/or estrogen patches) that works well for some
    > men. *Then there is chemotherapy. *There are also a number of new
    > therapies in clinical trials that may add more months or years
    > and may be available by the time other therapies stop working for
    > your husband.
    >
    > I know that, psychologically, all of this is very, very
    > difficult. *It's necessary to be realistic and not live on false
    > hopes. *But I think it's also important not to give up on life.
    > There are at least a few very good years ahead, and a few years
    > with problems. *Even the years with problems can be good years.
    >
    > I was on a cruise to Alaska once and sat at dinner with a lady in
    > a wheel chair and her husband. *It turned out that she was dying
    > of cancer and had only a short time to live, but she had always
    > wanted to see Alaska. *I was impressed by the lady's good
    > spirits, by how much interest she took in the conversations at
    > dinner, by how fine a relationship she enjoyed with her husband,
    > and by how much she seemed to enjoy the scenery in Alaska. *I
    > learned something about how to live from her.
    >
    > Best of luck to you both.
    >
    > * * Alan- Hide quoted text -
    >
    > - Show quoted text -


    Thanks for your responses Alan - I should add that my husband has
    already had a Prostatectomy, Radiation and began seeing a nutritionist
    and taking supplements as soon as he found out he had prostate cancer,
    which was about 7 years ago(at age 41). I believe the doctors came to
    their conclusions because of his gleason 8 (3 +5) and path report.
    However, as you point out, there is always hope and new developments
    coming down the road...

  6. #6
    Alan Meyer Guest

    Default Re: PSA still rising



    <[email protected]> wrote in message
    news:[email protected]..
    ....
    > Thanks for your responses Alan - I should add that my husband
    > has already had a Prostatectomy, Radiation and began seeing a
    > nutritionist and taking supplements as soon as he found out he
    > had prostate cancer, which was about 7 years ago(at age 41). I
    > believe the doctors came to their conclusions because of his
    > gleason 8 (3 +5) and path report. However, as you point out,
    > there is always hope and new developments coming down the
    > road...


    41 is so young to have cancer. If he were 75 when he was
    diagnosed, his treatment, which controlled his cancer for 7
    years, would probably have been considered a success.

    If you want to see what kinds of experimental treatments are
    available, here are the primary U.S. websites for searching.
    I believe they include many trials offered in Canada.

    http://www.cancer.gov/clinicaltrials/search
    or
    http://clinicaltrials.gov

    Here's a website that might be a starting place in Canada:

    http://www.cancer.ca/ccs/internet/st...gId-en,00.html

    Again, I wish the best to you and your family.

    Alan



  7. #7
    Steve Kramer Guest

    Default Re: PSA still rising

    <[email protected]> wrote in message
    news:[email protected]...

    >I last posted in August as my husband's psa was on the rise. It was
    > 1.16 in August. He had another test last week and it was 1.56. He has
    > seen an oncologist at Mount Sinai in Toronto who has confirmed that
    > the cancer has metastisized and they recommend that he start hormone
    > therapy when his PSA hits around 4. He could start now but they
    > agreed with my husband that since he's feeling great right now and is
    > still sexually active, he can wait a bit. They also said that the
    > hormones wouldn't really prolong his life, just help control the
    > pain. They predict that he will feel good for another 2 years or so
    > and then will enter a slow decline. It sounds to me like he has 4-5
    > years left.
    >
    > On a selfish note, it's all rather gloomy and depressing. I'm 49 and
    > having chats about funerals and cemetary plots. At least, being in
    > Canada, money for treatment won't be an issue. My husband seems to be
    > somewhat depressed and I think both of us should probably seek out a
    > support group. Anyway, that's the way it is for now.


    I am so sorry, Karen. Your husband (you've never told us his name) and I
    were both diagnosed in 2000, both young (he 41 and me 46), both T3, and both
    with PSAs in the mid-teens (he 13 and me 16). We both went with RRP and
    both ended up doing radiation. For a long time, he did much better than me.
    I chose ADT in 2003 after my PSA registered 0.32. His didn't get that high
    until February 2007.

    Personally, I thought ADT should have started then. It has done me good so
    far. But, I have no mets.

    My prayers go out to you.



    --
    PSA 16 10/17/2000 @ 46
    Biopsy 11/01/2000 G7 (3+4), T2c
    RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins
    PSA <.1 <.1 <.1 .27 .37 .75 PSAD 0.19 years
    EBRT 05-07/2002 @ 47
    PSA .34 .22 .15 .21 .32 PSAD .056 years
    Lupron 07/03 (1 mo) 8/03 and every 4 months there after
    PSA .07 .05 .06 .09 .08 .132 .145 PSAD 1.4 years
    Casodex added daily 07/06
    PSA <0.04, <0.05, <0.04, <0.04 10/11/07
    Non Illegitimi Carborundum



  8. #8
    kh Guest

    Default Re: PSA still rising

    On Jan 16, 9:47 am, khildebra...@casselsbrock.com wrote:

    > ... They predict that he will feel good for another 2 years or so
    > and then will enter a slow decline. It sounds to me like he has 4-5
    > years left.


    My opinion is that opinion might be wrong. I straight out asked my
    docs and was told that no one knows.

    Their words, "we've tried to predict what will happen but have not
    been able to do that in individual cases."

    Find the most expert medical oncologists you can, work with them, live
    your life to the fullest.

    -kh you know what to do.


  9. #9
    callalily Guest

    Default Re: PSA still rising

    Dear Karen,

    I am so sorry you find yourself in this situation. I am about the
    same age as you, and it hurts when you are hit with this (relatively)
    young. The one thing I would do is add Vitamin D to your husband's
    diet. I am not big on supplements: all my husband takes is pom juice
    and pills. However, I've been following some of the research on
    Vitamin D, and I think it could have a positive impact without
    affecting your husband's QOL. There was an article in July in the
    NEJM, which I read. It verified the powerful benefits of Vitamin D
    for various conditions. And you can take very high levels without
    incurring toxicity.

    I had my husband's D3 levels tested by his internist recently, and he
    came up short: a "20" -- normal range is 20-100. A friend sent me Dr.
    Myers' recommended regimen. I am going to up his D3 intake from 1,000
    IU/day to 9,000 for starters. However, he will have to be monitored
    by a doctor periodically. And the next step is to find a doc who will
    do this. Maybe a med onc.

    Am happy to share any of this info with you.

    Also, I saw a post in PPML (PC group run by acor.org) where they are
    always talking about this subject. Somebody cited recommended levels
    of Vitamin D for men with PC, as stated by several oncologists. The
    fact that prestigious, mainstream oncs, like Donald Trump of Roswell
    Cancer Center, recommend higher intake of Vitamin D, makes me take
    this seriously,

    Best of luck.

    Leah


    On Jan 16, 2:16*pm, "Alan Meyer" <amey...@yahoo.com> wrote:
    > <khildebra...@casselsbrock.com> wrote in message
    >
    > news:[email protected]...
    >
    >
    >
    >
    >
    > >I last posted in August as my husband's psa was on the rise. *It was
    > > 1.16 in August. *He had another test last week and it was 1.56. He has
    > > seen an oncologist at Mount Sinai in Toronto who has confirmed that
    > > the cancer has metastisized and they recommend that he start hormone
    > > therapy when his PSA hits around 4. *He could start now but they
    > > agreed with my husband that since he's feeling great right now and is
    > > still sexually active, he can wait a bit. They also said that the
    > > hormones wouldn't really prolong his life, just help control the
    > > pain. *They predict that he will feel good for another 2 years or so
    > > and then will enter a slow decline. It sounds to me like he has 4-5
    > > years left.

    >
    > > On a selfish note, it's all rather gloomy and depressing. I'm 49 and
    > > having chats about funerals and cemetary plots. At least, being in
    > > Canada, money for treatment won't be an issue. My husband seems to be
    > > somewhat depressed and I think both of us should probably seek out a
    > > support group. Anyway, that's the way it is for now.
    > > Cheers,
    > > Karen in Toronto

    >
    > Karen,
    >
    > I'm going to recommend something that is probably stupid, but I'm
    > not sure there's anything to lose.
    >
    > What I suggest is that your husband begin a regimen of diet and
    > supplements that are thought to be useful against cancer. *I'm
    > suggesting that for two reasons.
    >
    > One is that a friend of mine with very aggressive cancer was put
    > on such a regimen by Charles "Snuffy" Myers, a leading prostate
    > cancer oncologist. *I don't know if it did any good. *Myers is
    > also treating him with very complicated hormone therapy, so it's
    > impossible to separate the effects of the prescription drugs from
    > the supplements. *However, the fact that Dr. Myers thinks these
    > things are worth doing says something to me. *He is a nationally
    > recognized expert.
    >
    > The other reason is that your husband's PSA is rising relatively
    > slowly. *I think that means that the rate of tumor cell growth is
    > only a little higher than the rate of tumor cell death. *If
    > that's true, and if the supplements promote cancer cell death
    > ("apoptosis" is the technical term), then maybe they can tip the
    > balance a little the other way. *Just slowing down the process a
    > little may have a much more significant effect in a slow growing
    > cancer than slowing it down a little in a fast growing cancer.
    >
    > Now the next question is what to take. *Unfortunately, I don't
    > know the answer. *Dr. Myers had my friend (whose PSA reached 700
    > by the way) on 5 pomegranate extract capsules each day from:
    >
    > * *http://www.lef.org/newshop/items/item00956.html
    >
    > I don't know if these are better than cheaper ones from other
    > sources, but you can look at what they contain and compare them
    > to others.
    >
    > He's also taking megadoses of vitamin C, but I don't know the
    > specific dosage.
    >
    > Other things that people have suggested include: lycopene, EGCG
    > (green tea), vitamin D, and maybe other things. *A low fat diet,
    > with lots of fruits and vegetables is also often recommended. *If
    > you search the archives of the newsgroup you'll see
    > recommendations from others who know more than I do about this.
    >
    > I don't see how this can hurt.
    >
    > Finally, I'll make a few remarks about hormone therapy.
    >
    > The "two years" that the oncologist predicted may stretch
    > considerably longer than that. *Steve Kramer, a stalwart
    > contributor to this group, began hormone therapy in July, 2003.
    > Four and a half years later, his PSA is still undetectable.
    >
    > Steve started HT early, while his PSA was still below 1.0. *But
    > it's working well for him. *Since your husband's PSA growth seems
    > reasonably slow, HT may work very well for him too.
    >
    > Hormone therapy does eventually fail, but that's not quite yet
    > the end of the line. *There is "second line" hormone therapy
    > (ketoconazole and/or estrogen patches) that works well for some
    > men. *Then there is chemotherapy. *There are also a number of new
    > therapies in clinical trials that may add more months or years
    > and may be available by the time other therapies stop working for
    > your husband.
    >
    > I know that, psychologically, all of this is very, very
    > difficult. *It's necessary to be realistic and not live on false
    > hopes. *But I think it's also important not to give up on life.
    > There are at least a few very good years ahead, and a few years
    > with problems. *Even the years with problems can be good years.
    >
    > I was on a cruise to Alaska once and sat at dinner with a lady in
    > a wheel chair and her husband. *It turned out that she was dying
    > of cancer and had only a short time to live, but she had always
    > wanted to see Alaska. *I was impressed by the lady's good
    > spirits, by how much interest she took in the conversations at
    > dinner, by how fine a relationship she enjoyed with her husband,
    > and by how much she seemed to enjoy the scenery in Alaska. *I
    > learned something about how to live from her.
    >
    > Best of luck to you both.
    >
    > * * Alan- Hide quoted text -
    >
    > - Show quoted text -



  10. #10
    Gourd Dancer Guest

    Default Re: PSA still rising

    Karen, I am not a Doctor, just a Patient. You might read the following as I
    started this trial in July 2004 two months after my first Lupron (PSA was at
    32.0 and start of chemo 3.0; plus I had two mets to the spine):

    Trial of Chemotherapy plus Hormonal Therapy as Initial Treatment for
    Unresectable / Metastatic Adenocarcinoma of the Prostate
    H. Henary, R.J. Amato; The Methodist Hospital/The Methodist Hospital
    Research Institute/Genitourinary Program, Houston, TX

    Background: Chemotherapy is a setting of hormone refractory prostate cancer
    has shown palliative benefit especially with substantial PSA decline
    strongly suggesting that disease modifying potential exists. Recently,
    chemotherapy is beginning to show a survival advantage. The stage is set for
    chemotherapy given earlier in a disease course. As a working hypothesis, we
    suspect that the transformation from an androgen-dependent to an
    androgen-independent phenotype is mediated by the expansion of an
    androgen-independent clone already present at the time of androgen
    deprivation. If this model is correct, then it would be desirable to bring
    treatment to bear on the androgen-independent component when the
    corresponding tumor burden is minimal. Thus, we view the
    androgen-independent component as analogous to "microscopic residual" or
    "micro-metastatic" disease for which adjuvant chemotherapy has shown to be
    effective in other contexts.

    Methods: Each course of chemotherapy lasts for 8 weeks. Patients were
    treated in weeks 1, 3, and 5 with doxorubicin 20 mg/m2 as a 24-hour
    intravenous infusion on the first day of every week in combination with
    ketoconazole 400 mg orally 3 times a day daily for 7 days. In weeks 2, 4,
    and 6, treatment consisted of paclitaxel 100 mg/m2 intravenously on the
    first day of every week in combination with estramustine 280 mg orally 3
    times a day for 7 days. After completion of 3 courses of chemotherapy,
    hormone management [medical castration plus casodex (at the completion of
    chemotherapy)] is initiated at the start of chemotherapy and for a total of
    24 months.

    Results: Nineteen men have been enrolled with a median age of 63 (48-76).
    Fifty percent of the men had no prior local therapy, while the other 50%
    either failed surgery, radiation therapy, or surgery plus radiation therapy.
    Fifty-nine percent of the men had Gleason 7, 12%/8, 24%/9, and 5%/10.
    Thirty-five patients presented with bone metastasis and 50% presented with
    nodal involvement. The median PSA reduction to date has been 95.6%.

    Conclusion: Enrollment is ongoing. Further information regarding PSA
    response, associated radiographic response, and toxicity will be presented.

    Karen, note that I am still undetectible and the two mets are gone.

    Gourd Dancer



    <[email protected]> wrote in message
    news:[email protected]...
    >I last posted in August as my husband's psa was on the rise. It was
    > 1.16 in August. He had another test last week and it was 1.56. He has
    > seen an oncologist at Mount Sinai in Toronto who has confirmed that
    > the cancer has metastisized and they recommend that he start hormone
    > therapy when his PSA hits around 4. He could start now but they
    > agreed with my husband that since he's feeling great right now and is
    > still sexually active, he can wait a bit. They also said that the
    > hormones wouldn't really prolong his life, just help control the
    > pain. They predict that he will feel good for another 2 years or so
    > and then will enter a slow decline. It sounds to me like he has 4-5
    > years left.
    >
    > On a selfish note, it's all rather gloomy and depressing. I'm 49 and
    > having chats about funerals and cemetary plots. At least, being in
    > Canada, money for treatment won't be an issue. My husband seems to be
    > somewhat depressed and I think both of us should probably seek out a
    > support group. Anyway, that's the way it is for now.
    > Cheers,
    > Karen in Toronto




  11. #11
    I.P. Freely Guest

    Default Re: PSA still rising


    > <[email protected]> wrote
    >> they recommend that he start hormone
    >> therapy when his PSA hits around 4. He could start now but they
    >> agreed with my husband that since he's feeling great right now and is
    >> still sexually active, he can wait a bit. They also said that the
    >> hormones wouldn't really prolong his life, just help control the
    >> pain.


    Support for that general position is widespread in the research and the
    books, and there's a lot to be said for higher QOL for several years vs
    a few months' extra heartbeat. I plan to delay ADT when my G-8 PC
    returns until some significant new evidence changes that paradigm and
    convinces me ADT will make my life significantly BETTER rather than
    significantly worse.

    I.P.

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