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Old 03-27-2009, 11:30 AM   #1
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Cool Still so far so good: 3rd PSA (6 months), third round, tenth year IADT3

I'm again delighted that my PSA has continued to drop, as it should, at this point; now at the sixth month since resuming full therapy, at 0.46, it is 50% lower than it was two months ago.

While the vast majority of men will have a much more rapid PSA decline on triple therapy - even those with intact prostates who have never had radiation, surgery or other radical therapy, my PSA drops more slowly. It did this during both my first and second cycles, so I am not too concerned about the rate of decline. (I never had radiation or surgery, and my prostate was packed rock-hard with fairly aggressive cancer at the start , so triple therapy is dealing with a pretty tough job here.)

The one concern I do have is that the testosterone is not at around 20 or below as it should be with Lupron. While some men do not respond adequately to Lupron, I have in the past. I'm thinking the shot may have been placed too high to make it fully effective. I'm looking into this problem. In a way it is good: my PSA should decline more rapidly when I get the testosterone down to where it should be. I'll probably call my doctor to arrange both testosterone and DHT (dihydrotestosterone) blood tests for next month - more monitoring than we normally do with the next Lupron still two months off.

Here's how I have done from the time I decided to resume full therapy.

September 3, 2008 9.53 (testosterone 631)

Decided to end vacation from major drugs and go back on triple hormonal blockade (continuing finasteride, 2 X 5 mg daily on vacation and on full therapy).

September 17 - last thalidomide, used to prolong vacation

September 18 - first Casodex, 50 mg

September 26 - first Lupron shot (getting four month shots)

November 2008 PSA 2.27

January 16, 2009 PSA .86

March 18, 2009 PSA .46
March 18, 2009 28 testosterone (too high)
March 18, 2009 75 vitamin D (nice!)


My triple hormonal blockade consists of Lupron (four month shot for me, = 30 mg), Casodex (50 mg/day for me), and finasteride (2 X 5 mg/day). Intermittent triple hormonal blockade is also known as Intermittent Androgen Deprivation Therapy 3; it's abbreviated as IADT3.

This is following up on the thread I started on January 22, 2009 entitled "So far so good, 2nd PSA, third round, tenth year IADT3," and a previous thread, November 27, 2008, entitled "So far so good - first PSA, third round/ninth year IADT." (I'm also on Boniva for bone density, simvastatin to lower the risk of lethal prostate cancer plus heart health benefit, and a supportive program of diet/nutrition/supplements, exercise, and stress reduction.)

My goal is to stay on blockade for at least a year and to get that PSA below 0.05, but based on what Dr. Charles "Snuffy" Myers has been saying and writing lately, I would really like to see the PSA again drop to below 0.01. (I think that 0.05 goal was established when we lacked ultrasensitive PSA tests that could reliably report PSA to as low as less than (<) 0.01.) Unlike many patients who get below 0.05 within a few months on triple blockade, it has taken me many months on the two previous cycles. But my PSA has declined to below 0.05 twice before (in fact, to <0.01 twice before), and that's most important. The unusually long time to get there is not surprising considering my highly challenging case.

I see this current continued decline as very good and encouraging progress, but, as in January, I am still somewhat concerned now in March that I was able to cover about the same ground in two and a half months during my second cycle of blockade, and it took me four months this time. As far as I know that is not a big deal, but it could be a clue that the cancer has become a bit more difficult to deal with; it could also be the result of departing from my routine over the Thanksgiving, Christmas, and New Year season. (It took me about six months to cover the same ground during my first cycle, but I was on only two drug blockade at that time - Lupron and Casodex without the finasteride.) I'm also thinking the slower decline may be due to inadequate suppression of testosterone. That's something we can deal with.

I'm really happy that IADT3 is still working for me at this time. Quite a few men run into a hitch at this point - around ten to eleven years, and have to switch to another line of defense. I'm happy with the one I know. I'll admit I was more concerned than usually while waiting for this PSA result. Whew!

Jim

 
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Old 03-28-2009, 06:34 AM   #2
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Re: Still so far so good: 3rd PSA (6 months), third round, tenth year IADT3

Jim- So glad to learn your progress continues so well. You've taken a route that few of us can even imagine, as we chat about issues that seem minor compared to yours.
You've been an inspiration and provide a wake-up call to many, that this disease can be treated and controlled, even if it's an extreme case, if dealt with intelligently and with a plan. Thanks for continuing to share and to provide so much helpful information to those who find this board.

 
Old 03-29-2009, 05:02 PM   #3
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Re: Still so far so good: 3rd PSA (6 months), third round, tenth year IADT3

That is great news Jim and I echo what Daff said. You have so much knowledge of this wicked disease and are so great to share your knowledge a nd experiences with other men tryfing to figure out what to do to treat their disease.

Things are going well at UFPTI after 12 of 39 treatments completed. No side effects yet so that is good news so far. Had to go with the balloon as my prostate moved too much to just use the saline injection method.
Again, congratulations and I hope the good news continues.

 
Old 05-17-2009, 04:38 PM   #4
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Smile Re: Still so far so good: 3rd PSA (now 8 months), third round, tenth year IADT3

I'm updating the title of this thread (should have said 4th PSA, but now can't edit that), at least for this post, but I'll keep a lot of the joyful text as I am continuing to do very well. I recently got my PSA, DHT, etc. results and had a physical check by my oncologist that went fine. I'll update this in green.

Also, thanks for your thoughts, Yanick. Jim


Quote:
Originally Posted by IADT3since2000 View Post
I'm again delighted that my PSA has continued to drop, as it should, at this point; now at the sixth month since resuming full therapy, at 0.46, it is 50% lower than it was two months ago.

At eight months, my PSA was 0.28, 39% lower than two months ago.

While the vast majority of men will have a much more rapid PSA decline on triple therapy - even those with intact prostates who have never had radiation, surgery or other radical therapy, my PSA drops more slowly. It did this during both my first and second cycles, so I am not too concerned about the rate of decline. (I never had radiation or surgery, and my prostate was packed rock-hard with fairly aggressive cancer at the start , so triple therapy is dealing with a pretty tough job here.)

The one concern I do have is that the testosterone is not at around 20 or below as it should be with Lupron. While some men do not respond adequately to Lupron, I have in the past.

My dihydrotestosterone (DHT) level was < (less than) 3, which was the lower limit of the test and highly satisfactory. I asked for a testosterone test also but did not get it; however, that very low DHT is a good sign that all is fine.

I'm thinking the shot may have been placed too high to make it fully effective. ...

I now think that that placement does not make a difference, except that getting the injection high in butt muscle has caused me virtually no discomfort in the days after the last two injections. That's not a major issue, but it's a nice improvement from soreness that used to wake me up when I would lie on that side at night. This time I was glad to see that the same nurse was giving the shot!

Here's how I have done from the time I decided to resume full therapy.

September 3, 2008 9.53 (testosterone 631)

Decided to end vacation from major drugs and go back on triple hormonal blockade (continuing finasteride, 2 X 5 mg daily on vacation and on full therapy).

September 17 - last thalidomide, used to prolong vacation

September 18 - first Casodex, 50 mg

September 26 - first Lupron shot (getting four month shots)

November 2008 PSA 2.27

January 16, 2009 PSA .86

March 18, 2009 PSA .46
March 18, 2009 28 testosterone (too high)
March 18, 2009 75 vitamin D (nice!)

May 4, 2009 PSA .28
May 4, 2009 DHT <3


My triple hormonal blockade consists of Lupron (four month shot for me, = 30 mg), Casodex (50 mg/day for me), and finasteride (2 X 5 mg/day). Intermittent triple hormonal blockade is also known as Intermittent Androgen Deprivation Therapy 3; it's abbreviated as IADT3.

This is following up on the thread I started on January 22, 2009 entitled "So far so good, 2nd PSA, third round, tenth year IADT3," and a previous thread, November 27, 2008, entitled "So far so good - first PSA, third round/ninth year IADT." (I'm also on Boniva for bone density, simvastatin to lower the risk of lethal prostate cancer plus heart health benefit, and a supportive program of diet/nutrition/supplements, exercise, and stress reduction.)

My goal is to stay on blockade for at least a year and to get that PSA below 0.05, but based on what Dr. Charles "Snuffy" Myers has been saying and writing lately, I would really like to see the PSA again drop to below 0.01. (I think that 0.05 goal was established when we lacked ultrasensitive PSA tests that could reliably report PSA to as low as less than (<) 0.01.) Unlike many patients who get below 0.05 within a few months on triple blockade, it has taken me many months on the two previous cycles. But my PSA has declined to below 0.05 twice before (in fact, to <0.01 twice before), and that's most important. The unusually long time to get there is not surprising considering my highly challenging case.

...

I'm really happy that IADT3 is still working for me at this time. Quite a few men run into a hitch at this point - around ten to eleven years, and have to switch to another line of defense. I'm happy with the one I know....

Jim

Last edited by IADT3since2000; 05-17-2009 at 04:41 PM. Reason: Noted that title should say 4th PSA instead of 3rd.

 
Old 05-17-2009, 06:35 PM   #5
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Re: Still so far so good: 3rd PSA (now 8 months), third round, tenth year IADT3

Jim-
Great to hear your continuing good news.
Just today I heard about someone I met while at Florida Proton whom I know would be a good person to read some of your posts, or buy the books you've often recommended. While he was there to get proton radiation, it was not possible since he had had a hip replacement, and somehow or other he was no longer a good candidate for the proton treatments. He did receive IMRT radiation- and I believe that his initial PSA had dropped from a pre-treatment level of 12 to 3, over a period of months. But it's been on the rise lately- apparently now up from 8 three months ago to 10. Seems to me that he needs to learn about the type of treatment(s) you've been having. (He's in his mid-70s I think.) I know he has an appointment at the treatment center in a couple weeks, so hopefully he'll get some good advice-- it just can't be a good sign to see the kind of increase he's seeing after IMRT. I know it would be good for him to take a look at your posts, or at least obtain the books you recommend, but he does not use a computer or want to figure things out for himself, so I hope he gets good info from his doctor. I'll follow up afterwards- maybe I should print some of the relevant material and mail it to him.
I learned about this person from someone who has had what seems to be a very effective course of action for his own case-- which was a Gleason 8 cancer. He received the proton radiation about 1 1/2 yrs ago followed by I think 6 months of Lupron. His PSA has been holding steady now for a nearly a year at 0.2.

 
Old 05-18-2009, 03:23 PM   #6
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Re: Still so far so good: 3rd PSA (now 8 months), third round, tenth year IADT3

Hi daff,

I'm interspersing some comments in green in an excerpt of your post. Jim


Quote:
Originally Posted by daff View Post
Jim-
Great to hear your continuing good news.

Thanks for your encouragement.

Just today I heard about someone ... [who received] IMRT radiation- and I believe that his initial PSA had dropped from a pre-treatment level of 12 to 3, over a period of months. But it's been on the rise lately- apparently now up from 8 three months ago to 10. Seems to me that he needs to learn about the type of treatment(s) you've been having. (He's in his mid-70s I think.) I know he has an appointment at the treatment center in a couple weeks, so hopefully he'll get some good advice-- it just can't be a good sign to see the kind of increase he's seeing after IMRT.

I hope he gets good advice too, but I'm concerned because so many doctors think they know how do manage hormonal blockade therapy but really only know what works if the patient responds in a straightforward way and to an adequate degree, which is often not the case.

I fully endorse Yanick's suggestion about the pomegranate juice, or a high quality extract, which is the way I get my pomegranate daily. I really like the juice, but it needs to be high quality - preferably refrigerated and shielded from light - because light and heat weakens the key elements in the juice. The research was done with the Pom Wonderful brand, which is refrigerated before sale, but 8 ounces a day of Pom Wonderful is not inexpensive and you get the usual amount of sugar for a fruit-based drink. But that said, many of us spend a lot more on daily coffee. Many of us are crossing our fingers that further research by other research teams will confirm the great findings from the UCLA group. If you want more detail for him, I started a thread about pomegranate way back on 12/7/2007 entitled "Pomegranate juice/capsules to combat ED and prostate cancer."


I know it would be good for him to take a look at your posts, or at least obtain the books you recommend, but he does not use a computer or want to figure things out for himself, so I hope he gets good info from his doctor.

You are describing a patient who could probably substantially improve his chances of doing well if he were to become empowered. This is no time for him to continue putting his care on automatic pilot. "A Primer on Prostate Cancer - The Empowered Patient's Guide" (Strum and Pogliano, rev. ed. 2005) has a great section on hormonal therapy, but Dr. Myers' book is easy to read and understand and might be better for him. Of course, it would be best if he had both.

I'm convinced that for better cancer control most patients should at the least be on combined blockade, and to me it makes perfect sense to use triple blockade from the get-go. The unfortunate fact is that many doctors managing hormonal blockade still use only a single drug, usually Lupron or Zoladex as a shot, in the mistaken belief that the additional drugs don't help. (I believe the evidence is there that establishes the superiority of combined blockade to single-drug blockade, and I've seen enough and heard enough from leading doctors to believe that the three drug approach is usually the best.

However, the patient you describe has at least one other health issue (the hip replacement), and in view of his age, going with just an antiandrogen like Casodex plus Avodart (or finasteride instead of the Avodart) and not the drug class that includes Lupron) might be best. Dr. Mark Scholz, an expert in hormonal therapy, has observed that the latter approach often gives 80% of the benefit with just 20% of the side effects you get if a Lupron type drug is involved.

He should also be on a bisphosphonate with supplements for bone density, in my layman's opinion - based on what I've heard from experts, especially in view of his hip issues. I suspect he already is on a bisphosphonate program. If not, to me that is a red flag about his treatment; I would want to know why, and I would not hesitate to get a second opinion if the doctor was unaware of the threat to bone density and how to handle it.


I'll follow up afterwards- maybe I should print some of the relevant material and mail it to him.
I learned about this person from someone who has had what seems to be a very effective course of action for his own case-- which was a Gleason 8 cancer. He received the proton radiation about 1 1/2 yrs ago followed by I think 6 months of Lupron. His PSA has been holding steady now for a nearly a year at 0.2.
That's good to read. Looks promising!

Take care,

Jim

 
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