iam appx 18months after rp on a pc with postive bladder margin but not positive lymph node involvment- i have gone thru with radiation treatment there after and chemotherapy -6 treatments with taxotere and has gone thru with 18 months of lupron (hormone treatement ) iam also taking calutide(casodex 50 mg) for last 12 months -- i had a psa of 55 at 1st diagnosis and my biopsy showed 5 and 4 for a total of 9

what are my chances -- iam 48 year old asian male

You've had a rough trip so far, but the good news is that you've actively pursued the different forms of treatment. You didn't mention what your recent PSA results have been- from what I've read, if this reading stays low, and you stay on hormone therapy, you could be ok for a long time. But obviously, a doctor is a better person to ask, since he or she would have the benefit of your progression and the various tests (MRI, bone scan, etc).

I spent some time yesterday with a neighbor who had positive margins after surgery a number of years ago- and when his PSA started rising, he went on a series of hormone treatments, and is still on those. Everything seems to be fine for him- and he's adapted well to the hormones.

iam appx 18months after rp on a pc with postive bladder margin but not positive lymph node involvment- i have gone thru with radiation treatment there after and chemotherapy -6 treatments with taxotere and has gone thru with 18 months of lupron (hormone treatement ) iam also taking calutide(casodex 50 mg) for last 12 months -- i had a psa of 55 at 1st diagnosis and my biopsy showed 5 and 4 for a total of 9

what are my chances -- iam 48 year old asian male

I'm with daff in thinking you have a good shot at many good years of living ahead of you. :)

You have had aggressive treatment, as you no doubt know, for your challenging case. The two things you could add are a 5-alpha reductase drug, either finasteride or Avodart (probably the latter as it is better on paper but with a much shorter track record) and a bisphosphonate to protect bone density while on hormonal blockde and reduce the likelihood of bone metastases.

It appears you are aiming for intermittent hormonal blockade (or, if you are lucky in achieving great and long-lasting cancer control after just one cycle, then once cycle of blockade with Lupron and Casodex plus the 5-ARI drug continuously for maintenance). One study published in the prestigious Journal of Urology in May 1996 (major authors: Scholz, Lam, Strum) indicates that adding the 5-ARI drug doubles the "off-therapy" (that is, off the Lupron and Casodex) period. :)

I have not had surgery, radiation or chemo, but I have been on intermittent triple hormonal blockade (Lupron, Casodex and finasteride, plus Fosamax until a year ago when I switched to Boniva). My case is also challenging: baseline PSA 113.6, GS 4+3=7, stage 3, but no detectable metastases. I am nearly at my eight year anniversary as a survivor and am doing very well. :cool: I posted more details under the thread "My story" on 11/20.

Medical research also suggests that certain supplements, nutrition, diet, exercise and stress reduction also support superior outcomes. :) There are several good books on these tactics, but there is one recent book that links these with hormonal therapy: "Beating Prostate Cancer: Hormonal Therapy & Diet," by Dr. Charles Myers.

Are you monitoring PSA with an ultrasensitive PSA test? If you do, you can compare your results to the results discussed by the authors in the above study and in other publications. Basically, if you get the PSA below 0.05, especially if you maintain it below that level for a year, it is an excellent indication that you have no or minimal androgen independent prostate cancer. If you do not get it to 0.05, some doctors I consider leaders believe it is a signal to add additional therapy or shift therapy. I've been able to get my PSA to <0.01 toward the end of the two cycles of full blockade I've had.

If you don't mind sharing your experience, I'm sure many of us would like to know what your experience with chemo was like. A number of doctors are now using a fairly short course of chemo at the start of hormonal blockade, and that appears to be what you had.

Take care and good luck,

Jim

thanks for your posting- sorry i was out of country-- psa level is at .05 for last 18 months -- chemo is not that difficult but loss of hair and some weakness would be there - i only took taxotere but doctors recommend irinotecan with taxotere which can be more effective but demanding on the body
i would like to know how you are doing -- and i am going to ck with my doctor about finastride/avodart and biphosnate for bones

thanks again
pk

Are stories are very semiular but your doctors seem to be treating you much more aggresively than mine own. You can read my story under " when it comes back" If you dont mind me asking where are you being treated. I am not 100% sure that I agree with my doctors next steps for me and would love to get more opinions. As you most likely know that there are not alot of doctors in the Daytona Beach area. I have been to the Lee Mofffit center in Tampa and the Md Anderson center in Orlando. Most of the men in my cancer support group have been treated locally so I would be interested in other facilities.

thanks for your posting- sorry i was out of country-- psa level is at .05 for last 18 months -- chemo is not that difficult but loss of hair and some weakness would be there - i only took taxotere but doctors recommend irinotecan with taxotere which can be more effective but demanding on the body
i would like to know how you are doing -- and i am going to ck with my doctor about finastride/avodart and biphosnate for bones

thanks again
pk

Thanks for your first hand report on chemo. It is encouraging to hear that you found it not that difficult. I hope that chemo for me is years into the future, if ever, but it helps to be prepared. I came very close to going on chemo in 2000 in addition to hormonal blockade, but before I started, my PSA responded well to the blockade drugs.

I also find your ability to keep the PSA at 0.05 (or lower perhaps, if that was the lower limit of the test, as I suspect) for 18 months highly encouraging. It's strong evidence you have little if any "androgen independent prostate cancer," judging from what I have read and talks I have heard. Doctors associated with the Prostate Cancer Research Institute have researched and documented that, and I believe that some of their evidence has been published in prestigious medical journals.

I have done very well both with control of the cancer and with quality of life. Cancer wise, I went straight to hormonal blockade, though I had planned both surgery (was rejected) and then radiation, but switched to reliance on hormonal when I learned more about it. I was on mostly triple blockade (Lupron, adding Casodex, later adding Proscar) for 31 months, achieving a nadir of <0.01 and staying below 0.05 for a year, then went off-therapy (maintaining only with Proscar and the bisphosphonate Fosamax) for 28 months until my PSA was around 10. I then was on low-dose thalidomide (plus 300 mg daily vitamin B6) for six months (plus the maintenance drugs), which halted my PSA rise, then knocked it down, but then the rise resumed. I restarted full blockade around a PSA of 10, as I recall it, and was on full therapy for 19 months, again achieving a nadir of < 0.01 (below 0.05 for only a month or so). I went off therapy in December 2006, maintaining with finasteride (generic Proscar) 5 mg X2 daily and monthly Boniva. My PSA has been rising again, and most recently was at 4.68 on 11/30/2007, up from 3.36 on 10/16/2007. I recently started two pomegranate extract pills a day to try to slow the rise, and I'll get a PSA test tomorrow that will tell me how I'm doing. While I'm hoping for the best, my doctor and I are anticipating that I will be going back on thalidomide soon to try to knock the PSA back down and extend my off therapy period. (Thalidomide is not a drug you take casually. It is very tightly controlled, and it has a risk of side effects that you have to balance against the expected benefits and countermeasures to try to limit or prevent the side effects and complications.)

My quality of life during the off-therapy periods is great. I recover from most of the effects of blockade in several months and fully by the six month point. (That's a fairly typical recovery for someone who has had only triple therapy for less than two years, or somewhat longer if younger than around 70.) Right now I feel as good as I did in the years before I was diagnosed and I'm fully functional - no problems. I felt the same during the last off therapy period. :)

Many doctors, even good ones, are not up to speed on finasteride and Avodart, though my impression is that word is getting out. I suggest you call your doctor to ask, and if he needs some backup information; there is some you can give him. For instance, Dr. Stephen Strum, medical co-author of "A Primer on Prostate Cancer -- The Empowered Patient's Guide," is one of the first doctors to use finasteride as a part of hormonal blockade therapy in addition to drugs like Lupron/Zoladex and Casodex/flutamide. I had the good fortune to be at a national conference on prostate cancer in 2000 that he moderated, and he gave a talk on triple blockade using finasteride (then sold as Proscar) as the third element. He and his then partner, Dr. Mark Scholz, and a pharmaceutical expert working with them, Dr. Jon McDermed, had just analyzed their results comparing triple blockade to double blockade. Dr. Strum was obviously excited by the success they had just observed.

Dr. Strum described some of their results in the Primer, which was first published in 2002. On page 148 he has a table showing men on double versus triple blockade who had recurred following a previous RP, RT or both, and how long they were able to stay off therapy before resuming. In simple terms, half the men on double blockade (without finasteride) had had to resume blockade at 24 months (using a PSA of 5.0 as the trigger to resume), while more than half the men on triple blockade (including finasteride), had not had to resume yet by the five year point (60 months, more than double the time off therapy, and still counting, and using a PSA of only 2.5 as the trigger to resume, making these results even more impressive). :angel: These results are particularly stunning when you realize that all these men had higher risk cases since they had all recurred, some after both surgery and radiation. :)

Jim

i have been treated for all the therapies at mayo jax and local medical onco- Dr dodd in ormond beach . please keep my name confidential if you speak to the office