I'm now in my 19th month , third round, eleventh year, of IADT3 (triple intermittent androgen deprivation therapy, aka hormonal blockade), and I got my ultrasensitive PSA result at my appointment this afternoon: 0.04. That's a fine result at this point, especially considering my starting point, but it is 0.01 higher than last time on 3/2/2010 (not reported here), and it persuaded my doctor and me that it would not be worthwhile to have another Lupron shot in order to continue to see if my PSA would drop below 0.01 as it had on my previous two cycles.
It really looks like my PSA has leveled off, and, since it's slightly higher than it was at the end of my previous two cycles, it's possible I've developed a little androgen independent prostate cancer - cancer that cannot be controlled by withdrawing androgens like testosterone and DHT. It's also possible the cancer hit a low point (0.03) and is already headed upward (0.04). It's also possible that the cancer has just mutated and is now using Casodex as fuel, but that seems highly unlikely for me at this point in view of the PSA pattern. On the other hand, the increase from the March result could be due just to day-to-day variation or lab testing variation. It could be due mainly to rounding (such as a "true" result of 0.034 rounded to 0.03 in March and a "true" result of 0.035 rounded to 0.04 in April, or something close to that. Not being able to reach <0.01 might be due in part to the fact that my lab is now using a Roche ECLIA ultrasensitive test instead of the Immulite 3rd Generation ultrasensitive test used the previous times. But the bottom line is that it now makes sense for me to take a vacation from the heavy duty drugs - the Lupron and the Casodex.
I'm greatly pleased that my DEXA bone mineral density scan showed that I was back in the normal range - no longer classified as having osteopenia. That's a real accomplishment after a year and a half of hormonal blockade involving Lupron.
I credit this success to Boniva, calcium and vitamin D supplements, and regular strength exercise. I'm going to take a vacation from Boniva too.
I'm delighted that my PSA has more or less plateaued below 0.05. I never would have believed this would be possible when I started on this journey slightly over ten years ago with a challenging case. I'm sure all of my doctors, even the experts I have followed (Myers, Strum, Scholz, Leibowitz, Lam, Tucker), would have considered this success extremely unlikely, even if I stuck closely to their recommendations, which I have done.
My main concern is that the impact of three cycles of Lupron totaling (34, 19 and 19 months) 72 months intermittently over the three on-therapy cycles has the potential to permanently shut down production of testicular testosterone, especially as I'm now 66 years old. I think the risk is reasonably low, especially as I'm taking countermeasures, but it is there. If it happens, I'll probably follow the advice of the experts and take some testosterone supplementation during the off-therapy periods.
I've updated my previous update from January in this fresh thread. The updated information is in green, and the rest is in black.
Here's how I have done from the last time I decided to resume full therapy. (This updates and includes some of the same information from my thread started 3/27/09, "Still so far so good - 3rd PSA test (6 months) third round, tenth year IADT3.)" My earliest thread on this board about my case was "Eighth year anniversary as a survivor - challenging case, today", started back on 12/7/2007.
September 3, 2008 PSA 9.53 (Last test before returning to triple therapy)
January 16, 2009....PSA---0.86
March 18, 2009.......PSA---0.46
May 4, 2009............PSA---0.28
December 24...........PSA---0.04 March 2, 2009.........PSA---0.03
April 2, 2009...........PSA---0.04
ALL SIGNIFICANT TESTS
September 3, 2008 PSA 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 (That's fine - the lower limit of the test.)
July 2 PSA 0.15
July 2 DHT <3
Cholesterol results are important for hormonal therapy patients too, and I was reassured by these fine results from my internal medicine doctor that my countermeasures were doing the job:
July 6 Total Cholesterol 198 (Once was in the 250s [before simvastatin]. )
July 6 HDL 87 (My internal medicine doc was clearly awed by this one! )
July 6 Ratio 2.3
July 6 LDL 101
July 6 Trigs 49
August 28 PSA 0.07
August 28 Testosterone <10 (Goal: <20; so that's fine.)
August 28 DHT <3 [In the current Prostate Forum newsletter, Dr. Charles Myers, one of our leading experts in hormonal therapy, said he likes this result to be below 10.]
August 28 25 hydroxy vitamin D: 53 (Would like it higher; but it's toward the lower end of the acceptable range of 50 - 80, or even 100, recommended as ideal for us by the experts I trust.) [In the latest Prostate Forum newsletter, Dr. Myers said he likes to see this value between 60 and 100. I've added an additional 1,000 IU of vitamin D3 per day, and my oncologist and I will be checking how I do with the 25-hydroxy vitamin D test. I once way overshot my target, hitting around 141, near what is called "vitamin D intoxication." I've been more cautious since then!]
October 28 PSA 0.05
December 24 PSA 0.04 March 2, 2010 PSA 0.03
Vitamin D 54
March 25 DEXA: "Normal", improved from osteopenia, remarkable after 19 months of hormonal blockade therapy
April 2,2010 PSA 0.04 Vitamin D 62 (I had increased the dose of Vitamin D3 by 1000 IU; would like to get the 25-hydroxy vitamin D level in the 80 to 100 range.)
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 was to stay on blockade for at least a year (done)and to get that PSA below 0.05 (done), 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 (not going to happen). (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 still 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. Our fellow prostate cancer survivor and highly respected medical oncologist Dr. Charles "Snuffy" Myers, MD, said recently again that the patients he knows who are doing very well despite challenging cases are the ones who are diligent about their supportive care, including diet/nutrition/supplements, exercise, and stress reduction; I'm in that group. (Many of the men in his practice, which is specialized in prostate cancer, have challenging cases, and he also repeated this year that most of these men who die earlier than other men with similar challenging circumstances are men who ignore supportive care lessons, eating whatever they want, being careless about exercise, and so on. )
I'm extremely grateful that I'm responding well to intermittent androgen deprivation therapy at virtually the ten year point since my diagnosis in December 1999. Back then I talked to several of the experts in hormonal blockade, and even they were doubtful that I would enjoy prolonged success. Now in 2009, quite a number of their patients with extra challenging cases similar to mine are also doing extraordinarily well, and all that I know in that group are diligent about supportive care (nutrition, exercise, etc.). Many of us are also spiritual and active church members who pray and invite prayer support. We don't talk about that much on the board, but I'm convinced that spiritual life and support also is key.
Good luck to all of us as we cope with this disease,