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Old 08-23-2010, 08:37 AM   #1
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PSA Relapse Following Salvage Radiotherapy, can you help?

I am looking for information related to issues of PC diagnostic and treatment after Salvage Radiotherapy.
In accordance to a report by R. Choo M.D. from Mayo Clinic, researches have been few, uncompleted or null to identify the best practice to treat cases of patients experiencing a relapse after major treatments. In my case (ten years of survival), I had RP followed by SRT and now I expect to continue the “standard protocol” with ADT, however, the only indication of recurrence is a rise of the PSA (I have no prostate). My doctor told me that his cutoff (level) for starting the ADT is a PSA=1.0.

A resent MIR was negative for metastasis and I am asymptomatic, surely the rise in PSA (0.05 to 0.79) validates the presence of prostatic cells but not recurrence of the cancer. Never the less I am skeptical to accept the idea of treating a “number” rather than a symptom.

I would like to receive opinions and accounts of cases with similar conditions. Can anyone in this forum help me?

Appreciated for any available information,
Baptista

 
Old 08-24-2010, 04:46 AM   #2
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi again Baptista,

I'll insert some thoughts in green.


Quote:
Originally Posted by Baptista View Post
I am looking for information related to issues of PC diagnostic and treatment after Salvage Radiotherapy.
In accordance to a report by R. Choo M.D. from Mayo Clinic, researches have been few, uncompleted or null to identify the best practice to treat cases of patients experiencing a relapse after major treatments.

The Mayo Clinic has been a leader in so much of medicine, and their work has included major contributions to prostate cancer. However, I'm rather surprised that your doctor would make that statement, especially as the Mayo Clinic has been quite involved in hormonal blockade therapy through the work of Dr. Horst Zincke (initial combo surgery plus blockade for higher risk cases).

Hormonal blockade IS and has for a long time been established as the standard treatment after surgery and/or radiation, or other local treatment has failed. There has been an abundance of research published on hormonal blockade therapy as well as other forms of hormonal therapy for prostate cancer. Moreover, there has been work on triple androgen deprivation (triple hormonal blockade) that has documented impressive success; some of it has been published, but some of it has been only informally published. My impression is that the team that has taken the lead here is the Scholz, Strum, Lam group. Dr. Charles "Snuffy" Myers' book "Beating Prostate Cancer: Hormonal Therapy & Diet," is precisely on your topic. Dr. Strum's book "A Primer on Prostate Cancer - The Empowered Patient's Guide, has a long and expert section on hormonal therapy, including a table showing impressive results from his practice using triple blockade after surgery, radiation, or both.

The National Comprehensive Cancer Network updated its guidelines last year for all kinds of situations involving prostate cancer. I haven't checked their update on your situation, but I'm confident it will feature hormonal therapy. If you check and find that's not so, please let us know on the board.


In my case (ten years of survival), I had RP followed by SRT and now I expect to continue the “standard protocol” with ADT, however, the only indication of recurrence is a rise of the PSA (I have no prostate). My doctor told me that his cutoff (level) for starting the ADT is a PSA=1.0.

A resent MIR was negative for metastasis and I am asymptomatic, surely the rise in PSA (0.05 to 0.79) validates the presence of prostatic cells but not recurrence of the cancer. Never the less I am skeptical to accept the idea of treating a “number” rather than a symptom.

I too would try to figure that out, but to me the key clue would be whether the PSA is rising at that tell-tale exponential rate, in other words, doubling in a period of time that was the same: for example, from .1 doubling to .2 in, let's say, five months; then .2 doubling to .4 in about another five months; then doubling from .4 to .8 in another five months; and so on. In contrast, some up and down PSA activity, or substantially inconsistent doubling times, would raise doubts about cancer recurrence, as I understand this as a layman.

I went through this with my own case, hoping that my very high-risk might still respond to a single round of triple hormonal blockade (31 months for me) like virtually all the low-risk cases - indefinitely long cancer control with the aid of finasteride or Avodart maintenance, at least in the practices of a couple of doctors. Their trigger point for restarting blockade was a PSA around 10 - a trigger that was higher than used by some of their expert peers. What was not clear to me was that the steady exponential rise in my PSA was a solid sign of recurrence.


I would like to receive opinions and accounts of cases with similar conditions. Can anyone in this forum help me?

Appreciated for any available information,
Baptista

I hope you get some helpful responses.

Take care,

Jim

 
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Old 08-31-2010, 01:29 PM   #3
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi Jim,

I appreciate your post above. I did my investigation at NCCN as you advised and got an insight of their recommendations for cases like mine. Surely the guidelines confirm HT as my next treatment. However, there is no recommendation on a “trigger” for starting the treatment in asymptomatic cases, neither on a decisive methodology (continuous vz intermittent). It seems that individual cases will require different decisions. That may be the reason for Dr. Choo’s report in insufficiency of trials and data to best treat cases of relapse after major treatments..

In regards to the timing, I quote here a summary of the text, for any one that might be interested in knowing its contents;
(NCCN Guidelines "Prostate Cancer" V.3.2010)
Timing of ADT for Advanced Disease (PSA recurrence or metastatic disease)
1) The timing of ADT for patients whose only evidence of cancer is rising PSA is influenced by PSA velocity, patient anxiety, and the short and long-term side effects of ADT.
2) A significant proportion of these patients will ultimately die of their disease; their prognosis is best approximated by the absolute level of PSA, the rate of change in the PSA level(PSA "doubling time"), and the initial stage, grade, and PSA level at the time of definitive therapy.
3) Earlier ADT may be better than delayed ADT, although the definitions of early and late (what level of PSA) are controversial. Since the benefit of earlier ADT is not clear, treatment should be individualized until definite studies are done. Patients with an elevated PSA (>50 ng/ml) and/or a shorter PSA doubling time (or a rapid PSA velocity) and an otherwise long life expectancy should be encouraged to consider ADT earlier.
4) Treatment should begin immediately in the presence of tumors-related symptoms or overt metastases (category 1). Earlier ADT will delay the appearance of symptoms and of metastases, but it is not clear whether earlier ADT will prolong survival. The complications of long-term ADT have not been adequately documented.

In regards to Optimal ADT, it says;
5) No clinical data supports the use of triple androgen blockade (finasteride or dutasteride with combined androgen blockade).
6) Intermittent ADT may reduce side effects without altering survival compared to continuous ADT but the long term efficacy of intermittent ADT remains unproven.

(Your case proves that intermittent ADT works very well)

Accordingly, in a setting of low PSA velocity<0.75, PSADT>8 moths and asymptomatic, the only trigger would be to soften patients’ anxiety and/or to accept ADT’s side effects. This leads to the consideration of a “long life expectancy”.
I am 61 so I would like to try the earlier ADT, triple blockade.

I have also searched other forums on prostate cancer to get answers for similar third-line treatment cases, but couldn’t find posts related to experienced cases. I got the impression that I should keep posting about my experience so that it may help others on the same boat.

Thanks for the help and interest.
Baptista

 
Old 08-31-2010, 07:07 PM   #4
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi Baptista,

I'm glad you were able to get the NCCN guidelines, and I'll insert some comments in blue, for contrast with your text and quotation.


[QUOTE=Baptista;4318573]Hi Jim,

I appreciate your post above. I did my investigation at NCCN as you advised and got an insight of their recommendations for cases like mine. Surely the guidelines confirm HT as my next treatment. However, there is no recommendation on a “trigger” for starting the treatment in asymptomatic cases, neither on a decisive methodology (continuous vz intermittent).

The experts in blockade whom I follow closely all believe that intermittent blockade is clearly superior to continuous blockade. There is a mound of clinical experience that indicates that, but there is not an abundance of studies.

It seems that individual cases will require different decisions. That may be the reason for Dr. Choo’s report in insufficiency of trials and data to best treat cases of relapse after major treatments..

In regards to the timing, I quote here a summary of the text, for any one that might be interested in knowing its contents;
(NCCN Guidelines "Prostate Cancer" V.3.2010)
Timing of ADT for Advanced Disease (PSA recurrence or metastatic disease)
1) The timing of ADT for patients whose only evidence of cancer is rising PSA is influenced by PSA velocity, patient anxiety, and the short and long-term side effects of ADT.
2) A significant proportion of these patients will ultimately die of their disease; their prognosis is best approximated by the absolute level of PSA, the rate of change in the PSA level(PSA "doubling time"), and the initial stage, grade, and PSA level at the time of definitive therapy.
3) Earlier ADT may be better than delayed ADT, although the definitions of early and late (what level of PSA) are controversial. Since the benefit of earlier ADT is not clear, treatment should be individualized until definite studies are done. Patients with an elevated PSA (>50 ng/ml)

I am really surprised the NCCN would mention such a high PSA as a trigger point. While there are debates about trigger point considerations, I'm thinking that the experts would want hormonal therapy started at least at a PSA of 10 or lower.

and/or a shorter PSA doubling time (or a rapid PSA velocity) and an otherwise long life expectancy should be encouraged to consider ADT earlier.
4) Treatment should begin immediately in the presence of tumors-related symptoms or overt metastases (category 1). Earlier ADT will delay the appearance of symptoms and of metastases, but it is not clear whether earlier ADT will prolong survival.

The experts I follow are all convinced that it does, and I'm convinced they are right. The problem here is that NCCN is dedicated to "evidence based medicine," and they prefer evidence from randomized "well-designed" trials, or ideally from double-blind, large, long-term, placebo controlled clinical trials. That kind of evidence is extremely hard to get due to ethical constraints, practicalities of trial design, and logistics. However, the evidence-based-medicine establishment has great difficulty appreciating this, probably because prostate cancer has such long survival, unlike almost all other cancers.

The complications of long-term ADT have not been adequately documented.


The experts know a great deal about these side effects and how to avoid or mitigate them. They have published a lot about this. Dr. Mark Scholz, one of the foremost experts in side effects of hormonal blockade, has a new book out - "Invasion of the Prostate Snatchers." I suspect he spends a lot of time on side effects and avoiding them. Conversely, the vast majority of non-expert doctors seem to me to be surprisingly ignorant about not only the side effects but how to deal with them.

In regards to Optimal ADT, it says;
5) No clinical data supports the use of triple androgen blockade (finasteride or dutasteride with combined androgen blockade).

That is actually a false statement, very likely based on ignorance rather than bad intent. Clinical data has been collected that supports triple blockade in several practices. Some of it has even been published in prestigious medical journals. However, while the statement is false, there have only been a few formal publications in peer reviewed journals on triple blockade, so the basis for the NCCN's impression is understandable.

6) Intermittent ADT may reduce side effects without altering survival compared to continuous ADT but the long term efficacy of intermittent ADT remains unproven.

(Your case proves that intermittent ADT works very well)

Again, proof is difficult to come by as mentioned above. However, a number of studies have been done that strongly suggest intermittent ADT works at least as well as continuous ADT.

Accordingly, in a setting of low PSA velocity<0.75, PSADT>8 moths and asymptomatic, the only trigger would be to soften patients’ anxiety and/or to accept ADT’s side effects. This leads to the consideration of a “long life expectancy”.
I am 61 so I would like to try the earlier ADT, triple blockade.

I have also searched other forums on prostate cancer to get answers for similar third-line treatment cases, but couldn’t find posts related to experienced cases. I got the impression that I should keep posting about my experience so that it may help others on the same boat.

There are some areas that you would find interesting. Also, several of the experts in triple blockade will be presenting in September at the National Conference on Prostate Cancer in Los Angeles, as they have in prior years.

Thanks for the help and interest.
Baptista

I'm glad to help. Take care,
Jim

 
Old 09-01-2010, 03:16 AM   #5
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi, although my case is not the same as yours I thought I would post a response since my therapy is now intermittent triple blockade. After RP and follow up radiation and single blockade my PSA dropped to .1. I was taken off single blockade and my PSA was at 1.2 approximately a year and a half later. I was placed on lupron again and six months later casodex, PSA dropped to .08. I swiched to dr Myers at this point and he placed me on triple blockade. My PSA dropped to <.01 and held there, a level I had not achieved on either single or double blockade.

I had my last lupron shot in March this year and came off casodex when I met with Dr Myers in June. We will see how it goes with just avodart. I am going for monthly Ultra Sensitive but have only completed one so far, PSA was still <.01.

BTW my original PSA was +45 in 2005 at time of RP and post RP Pathology was Gleason 4+5. Diagnosis of PC was made Feb 2005


John

 
Old 09-01-2010, 09:10 AM   #6
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Babtista,
Everthing I have read about HT says the earlier you start the better. It works much better when the tumor burden is low. This is a principal that oncologists use in all cancers and it would also make sense for PC. The old theory was not to use it until bone mets.
The biology of your individual cancer will dictate how it will respond to HT. Some patients do very well on just low dose Casodex while others need a triple blockade.
The key is to find an oncologist that will monitor you and work out which works best for you, and not just give you a shot of lupron and see you in 4 months. The Scholz book goes into some of this and also how to minimize the side affects you will incurr.
JohnT

 
Old 09-06-2010, 05:25 AM   #7
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Jim,
GuamJohn,
JohnT

Thank you for the comments on my post. I am relying very much on your insights and material from the net. < edited > has not sent me yet a copy of Myers’ BIBLE so I have many question marks to clarify. Could you please give me an insight on the following, if possible?

Am I wrong in thinking that practitioners of HT follow protocols, and that such is set at the beginning of the treatment? Or is HT fixed on the basis of “trial & error” along the period of treatment?

What kind of Monitoring is used by practitioners to certify If a cancer (biology) is responding to “protocol A”? And how long does it take to change protocols (A to B)?

I understand that HT is applied on a Single, Dual and Triple drugs each directed to different purposes. The classical ADT3 seems to be a combination of an Anti-androgen + a LHRH agonist + a 5α blocker. Why is a LHRH agonist used on single protocols if it is known that it causes “flare”?
Being from the same group, is there a drug that can be considered better than the other?

Very little is written about cases using estrogens (DES) and orchiectomy surgery. It may be because most materials on the net are posted in the United States where those treatments are less common. Do you know of protocols incorporating these kinds of treatments? Are they included in the same scenario as on a Single, Dual and Triple Blockage?

I believe that the behavior of cancer cells is influenced on the principle of adaptation to newer situations. They have the power of changing their way on how to survive, once supplies of testosterone are cutoff. Albeit the release from the side effects, to trick the cells into believing that “testosterone is going to be there always” may be the positive approach of the intermittent application (now you have it, now you don’t). Have you came a cross of any report on this basis? If such, orchiectomy should not qualify for an intermittent methodology? What about estrogens, are they proper for an intermittent approach?

Androgen deprivation by surgery or medication gives differ results in terms of Erection Dysfunction. In surgery ED is permanent. Is there any other aspect or side effect one should consider as important when deciding between both treatments?

My doctor is a urologist and belongs to a team of surgical oncologists experienced in the diagnose, and treatment of cancer. They practice in Lisbon biggest hospital. I think that I am in good hands. However, if unsatisfied I would not mind in changing “clubs”. Do you think that it would be possible to have a treatment applied on the “other side of the globe” far from where you live? And could the monitoring job be done by a third party?

I read that HT drugs ‘side effects are nasty. Most of them require medication to counter the symptoms and many of the drugs require previous health fitness, as a condition for its application. In this regard, what kind of questionnaire was given to you at the beginning of your treatment? And in your experience what could you suggest to patients on HT, apart from what it is written on the BIBLES (Myers and Scholz)?

Thank you in advance for the help and interest in my case.

Best Regards,
Baptista

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Old 09-06-2010, 06:43 AM   #8
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi Jim,

Forgot to ask you a favor. Could you get me some information/conclusions from the next (Sep) National Conference on Prostate Cancer, in Los Angeles.

Appreciated,
Baptista

 
Old 09-07-2010, 06:00 AM   #9
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Quote:
Originally Posted by Baptista View Post
Jim,
GuamJohn,
JohnT

Thank you for the comments on my post. I am relying very much on your insights and material from the net. Amazon.uk has not sent me yet a copy of Myers’ BIBLE so I have many question marks to clarify. Could you please give me an insight on the following, if possible?

Am I wrong in thinking that practitioners of HT follow protocols, and that such is set at the beginning of the treatment? Or is HT fixed on the basis of “trial & error” along the period of treatment?

My Oncologist is DR Myers. I believe he starts with a protocol based on his understanding of the current situation however he will adjust based on results


What kind of Monitoring is used by practitioners to certify If a cancer (biology) is responding to “protocol A”? And how long does it take to change protocols (A to B)?

I would think it would be case dependent as to changes. I started triple blockade with Dr Myers and he asked for monthly PSA for 6 mos the as my PSA was decreasing to every 3 mos. When I started my Lupron, Casodex holiday two mos ago I was put back on monthly PSA tests.

I understand that HT is applied on a Single, Dual and Triple drugs each directed to different purposes. The classical ADT3 seems to be a combination of an Anti-androgen + a LHRH agonist + a 5α blocker. Why is a LHRH agonist used on single protocols if it is known that it causes “flare”?
Being from the same group, is there a drug that can be considered better than the other?

In my case I was given Casodex before Lupron I think for 30 days to reduce flair. I believe this is common. It is my understanding that Lupron and Zolodex are equally effective not sure about others



Very little is written about cases using estrogens (DES) and orchiectomy surgery. It may be because most materials on the net are posted in the United States where those treatments are less common. Do you know of protocols incorporating these kinds of treatments? Are they included in the same scenario as on a Single, Dual and Triple Blockage?

No Comment



I believe that the behavior of cancer cells is influenced on the principle of adaptation to newer situations. They have the power of changing their way on how to survive, once supplies of testosterone are cutoff. Albeit the release from the side effects, to trick the cells into believing that “testosterone is going to be there always” may be the positive approach of the intermittent application (now you have it, now you don’t). Have you came a cross of any report on this basis? If such, orchiectomy should not qualify for an intermittent methodology? What about estrogens, are they proper for an intermittent approach?

No Comment

Androgen deprivation by surgery or medication gives differ results in terms of Erection Dysfunction. In surgery ED is permanent. Is there any other aspect or side effect one should consider as important when deciding between both treatments?

Jim has some previous posts on side effects and counter measure and may comment here. In my case ED was an issue after RP and Radiation as I was Hormone therapy after RP for a year and one half or two ( don’t have my records with me) after during with I also had radiation. During my first holiday function returned. Again after staring second hormone rounds the problem returned, but after about 60 days into second holiday function has again returned. I would caution that this seems not to be the norm from some things I’ve read.

My doctor is a urologist and belongs to a team of surgical oncologists experienced in the diagnose, and treatment of cancer. They practice in Lisbon biggest hospital. I think that I am in good hands. However, if unsatisfied I would not mind in changing “clubs”. Do you think that it would be possible to have a treatment applied on the “other side of the globe” far from where you live? And could the monitoring job be done by a third party?

Again in my case I consult with Dr Myers mostly by phone and email. All my blood tests, bone scans etc I send to him via internet. Once a year I trek to the east coast from Guam in the west Pacific and visit with him. Takes usually about 26 hrs door to door but I would be travelling to New York anyway to hub to where my kids are in Canada so the side trip isn’t actually very much


I read that HT drugs ‘side effects are nasty. Most of them require medication to counter the symptoms and many of the drugs require previous health fitness, as a condition for its application. In this regard, what kind of questionnaire was given to you at the beginning of your treatment? And in your experience what could you suggest to patients on HT, apart from what it is written on the BIBLES (Myers and Scholz)?

Again I think Jim has posts on the side effects and counter measures so I will defer to him

Dr Myers questions can be accessed via the Internet however I don’t think I can give out his office web site on the forum. There are also video blogs with his answers to questions available via internet which you can find. I believe sone things he used to recommeng like vitamin E and selenium he no longer recommends. He also has added things like Full Spectrum Pomegranate capsules, Super Bio Curcumin and nitro 250 micronized resveratrol



Thank you in advance for the help and interest in my case.

Best Regards,
Baptista
Hope some of this helps.
John

 
Old 09-11-2010, 10:11 AM   #10
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi John (guam)

I appreciate your detailed post to my questions. It is interesting to know that you are in Guam. I have visited your island several times in the past, in one occasion I stayed 6 months for a marine project at Tamuning bay. Which part of the island are you living?

In regards to your answers could you please clarify the following:
“I would think it would be case dependent as to changes. I started triple blockade with Dr Myers and he asked for monthly PSA for 6 mos the as my PSA was decreasing to every 3 mos. When I started my Lupron, Casodex holiday two mos ago I was put back on monthly PSA tests.”
1) How many months were you on ADT3 and where did you get your shots, in Guam?
2) Did you take the three drugs every day (shots were for how many months)?
3) What was your PSA before starting ADT and how long did it take to get to 0.01?

“Again in my case I consult with Dr Myers mostly by phone and email. All my blood tests, bone scans etc I send to him via internet. Once a year I trek to the east coast from Guam in the west Pacific and visit with him. Takes usually about 26 hrs door to door but I would be travelling to New York anyway to hub to where my kids are in Canada so the side trip isn’t actually very much”
4) How did you manage this type of consultation, How did you firstly contacted Dr. Myers?
5) Do you think that I could get the same style of consultations as yours, from my country?
6) How much did it cost your treatment?
7) Do you pay only each time you visit him?

“Dr Myers questions can be accessed via the Internet however I don’t think I can give out his office web site on the forum. There are also video blogs with his answers to questions available via internet which you can find. I believe sone things he used to recommeng like vitamin E and selenium he no longer recommends. He also has added things like Full Spectrum Pomegranate capsules, Super Bio Curcumin and nitro 250 micronized resveratrol”
8) What kind of extra drugs did you take for the side effects?
9) What supplements did Dr. Myers recommend you to take?
< edited >

Many thanks for the information.
Regards,
Baptista

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Old 09-17-2010, 04:03 AM   #11
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Sorry I took so long I was travelling I will reply below

Quote:
Originally Posted by Baptista View Post
Hi John (guam)

I appreciate your detailed post to my questions. It is interesting to know that you are in Guam. I have visited your island several times in the past, in one occasion I stayed 6 months for a marine project at Tamuning bay. Which part of the island are you living?

I lived in Yona for 8 years then moved to upper Tumon 2 years ago.



In regards to your answers could you please clarify the following:
“I would think it would be case dependent as to changes. I started triple blockade with Dr Myers and he asked for monthly PSA for 6 mos the as my PSA was decreasing to every 3 mos. When I started my Lupron, Casodex holiday two mos ago I was put back on monthly PSA tests.”

1) How many months were you on ADT3 and where did you get your shots, in Guam?

After being off all blockade I started again in May 2007 and my PSA was 1.2, I was unable to get below .8 PSA on Lupron and Casodex then I made my first visit to Myers in June 2009. He put me on triple blockade, I dropped to <.01 in about 5 mos . I had last 3 mos Lupron shot in Feb 10 then dropped casodex in June. I am still at <.01 but expect tor start rising again My local Physician was happy to give me the shots but my wife was qualified to give them so I had her do it unless she was off Island.

2) Did you take the three drugs every day (shots were for how many months)?
Casodex and adavart Daily (pills) and lupron shot every 3 mos

3) What was your PSA before starting ADT and how long did it take to get to 0.01?
Above

“Again in my case I consult with Dr Myers mostly by phone and email. All my blood tests, bone scans etc I send to him via internet. Once a year I trek to the east coast from Guam in the west Pacific and visit with him. Takes usually about 26 hrs door to door but I would be travelling to New York anyway to hub to where my kids are in Canada so the side trip isn’t actually very much”

4) How did you manage this type of consultation, How did you firstly contacted Dr. Myers?

I contacted their office by email. I filled out a long questionaire they sent me then went to visit him on a trip to US. He agreed to treat me in conjuction with a local physician, I consult directly with him using email, (and phone if I wish) I send him copies of all tests from here or Philipines if I get them there. I go stateside once a year in June so I intend to drop by his office when I am there

5) Do you think that I could get the same style of consultations as yours, from my country?

He consults with patients in Australia (for sure) and Europe (I believe) in the same way.

6) How much did it cost your treatment?
The largest part of the cost was the drugs of course, The cost of the drugs here is I believe about the same cost as mainland US and way more expensive than canada and Australia. I am not sure what cost would be where you are. if you have a drug plan then the cost might not be that much.

7) Do you pay only each time you visit him?
Yes but if you need long consults by email or ohone you will be charged. i have never required this. They will give you a price schedule if you contact them.

“Dr Myers questions can be accessed via the Internet however I don’t think I can give out his office web site on the forum. There are also video blogs with his answers to questions available via internet which you can find. I believe sone things he used to recommeng like vitamin E and selenium he no longer recommends. He also has added things like Full Spectrum Pomegranate capsules, Super Bio Curcumin and nitro 250 micronized resveratrol”

8) What kind of extra drugs did you take for the side effects?
The only side effect drug I took was estrogen patches to reduce risk of bone thinning and had the added benifit of reducing hot flashes,

9) What supplements did Dr. Myers recommend you to take?
< edited >

Many thanks for the information.
Regards,
Baptista
All the best

 
Old 09-17-2010, 04:25 PM   #12
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi John,

Thank you very much for the reply. I understand now on the possibility of choosing an overseas oncologist and continuously living with my family in this beautiful Conner of Europe, my country.
It is interesting knowing you get tests done in the Philippines. I also got many tests done at Makati med and St. Lucks on the occasion I was living there for a Port project in Mindanao and constantly travelled to Japan (my surgeon) and USA (my oncologist) for consultations. The PCa is a globalized disease with no frontiers.

In regards to your treatment, could you please answer to these questions;
1) When and Why did you start hormonal therapy?
2) How long were the cycles?
3) What was the third drug you start taking from Jun 2009?
4) Were you been given any detailed protocol (doses, etc) by Myers to be followed?
5) Who is directing you to take what and when for the side effects drugs?
6) What tests are you required taking?

Could you please give me by mail the site address of Myers contacts and any other information you may think I should know.
I hope I did not become “heavy” with so many questions.

I appreciate your helping me.
Baptista

 
Old 09-18-2010, 09:59 AM   #13
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi Baptista,

John may already have replied, but I thought you might like a second perspective on some points I think I've not mentioned before. I found it very useful and reassuring to learn different experiences of men on triple blockade when I was starting out. I'll be very brief where I think you've already seen what my experience has been.


Quote:
Originally Posted by Baptista View Post
Hi John,

Thank you very much for the reply. ...

In regards to your treatment, could you please answer to these questions;
1) When and Why did you start hormonal therapy?


Quote:
2) How long were the cycles?
I've just posted a long response to Gleason 9 that covers single cycle intermittent blockade as well as multi cycle. While many patients have done fine with just one cycle of thirteen months to a year and a half, some of us with challenging cases take longer. With the goal of achieving a PSA of <0.05 and staying at that low level for a year, my first cycle of triple blockade took 31 months. That's extraordinarily long, but my case was extraordinarily challenging, with the PSA having to drop all the way from 113.6. I was then off therapy for 31 months!

My second cycle of full triple therapy, started when my PSA reached about 10, took 19 months. At that point the guidance had eased a bit, and, following advice at a conference from Dr. Mark Scholz, my goal was to just reach <0.05 and then go off therapy, without staying for a year, which is what I did. I was off therapy for 19 months. I substantially recovered from side effects in three to four months, and I was fully recovered by six months. That's been the pattern this time and the middle time.

My third cycle took 19 months, and I have now been off for 5 months with my last PSA at 0.11 and slowly rising, as expected.



Quote:
3) What was the third drug you start taking from Jun 2009?
I'll leave that one to John.


Quote:
4) Were you been given any detailed protocol (doses, etc) by Myers to be followed?

My protocol, after my treatment evolved to triple blockade within the first nine months, was Lupron, Casodex (now bicalutamide and much less expensive) 50 mg, plus finasteride at 5 mg, later increased to 10 mg. I was on Fosamax to aid bone mineral density, and later on a statin drug (simvastatin), both to cope with side effects of blockade.

A vital point is that some of us are different enough from the norm that we may need more frequent treatment than usual with the LHRH-agonist, or we may need a higher dose of bicalutamide, or we may need Avodart versus finasteride, or vice versa. The point is that it is vital that at least both testosterone and DHT be tested to see how the patient is responding, and then, if the response is good, every now and then. Other tests, such as for LH (leutinizing hormone), may also be needed.


Quote:
5) Who is directing you to take what and when for the side effects drugs?
It's nice to have an expert managing your treatment. Short of that, the experts have published books and newsletters that provide guidance. While my medical oncologist is a highly educated, highly intelligent doctor, I have helped educate him about triple blockade. That's a role many of us can handle, if needed, once we become empowered patients.

Quote:
6) What tests are you required taking?
In addition to ultrasensitive PSA tests (sensitive down to <0.01), testosterone tests occasionally, and DHT tests occasionally, liver function tests are important to make sure the patient handles the bicalutamide adequately (can be discountinued when that is verified). My oncologist also routinely has me tested for a comprehensive metabolic panel and a complete blood count, and he gives me a focused physical exam every four months. I have more-or-less annual bone mineral density scans to monitor bone density, and I also have occasional vitamin D3 tests as that is related to bone density and to prostate cancer. Of course, I've had no medical training, so please don't regard this as authoritative. Also, individual patients would probably need additional tests that were tailored to their circumstances. Nonetheless, I think this set of tests would cover most patients.

Quote:
...
I hope I did not become “heavy” with so many questions.

I appreciate your helping me.
Baptista
I can't speak for John, but please ask all the questions you want. There are enough twists and turns that you cannot learn it all at once. It seems very clear to me now, but it took a while before I got a grasp of the main points.

Take care,

Jim

 
Old 09-21-2010, 10:43 PM   #14
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Hi Jim,

Thanks a lot for the answers and the help in clearing my thoughts. JohnGuam is a good example on the possible way for a globalized treatment on ADT, and so it maybe myself. How was the conference on Prostate Cancer in Los Angeles, have you gotten newer conclusions from the experts? I would love to attend it too.

I read your posts of your long experience in IADT3 and your response to Gleason 9, and I know you have loads of information on HT. Could you help me in these questions regarding estrogens (DES) and orchiectomy surgery:

1) Do you know of protocols incorporating these kinds of treatments?
2) Can they be use in the same scenario as on a Single, Dual and Triple Blockage?
3) Can estrogens be applied on an intermittent approach?
4) What should I consider in regards to the side effects (apart of ED) of orchiectomy?

Thank you in advance for the help and interest in my case.

Best Regards,
Baptista

 
Old 09-22-2010, 02:39 PM   #15
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Re: PSA Relapse Following Salvage Radiotherapy, can you help?

Quote:
Originally Posted by Baptista View Post
Hi John,

Thank you very much for the reply. I understand now on the possibility of choosing an overseas oncologist and continuously living with my family in this beautiful Conner of Europe, my country.
It is interesting knowing you get tests done in the Philippines. I also got many tests done at Makati med and St. Lucks on the occasion I was living there for a Port project in Mindanao and constantly travelled to Japan (my surgeon) and USA (my oncologist) for consultations. The PCa is a globalized disease with no frontiers.

In regards to your treatment, could you please answer to these questions;
1) When and Why did you start hormonal therapy?
I was treated at UCLA Medical Center. I started hormone therapy 3 months after therapy because my PSA after surgery did not drop to the appropriate level. It was still around 10. My Urologist suggested Casodex for 30 days then Lupron only, 3 month shots.. I had a consult with a radiation Oncologist there and he suggested the same but also suggested radiation since the Gleason was 4+5 he said I should be more aggressive in treating it. I elected to do both. Had i kown about triple blockade I would have likely went to it immediately

2) How long were the cycles?

I was on Lupron for 15 months and my PSA stabilized at .1 My local oncologist took me off and a year later I was at 1.2. I stopped at UCLA on a trip to the mainland and they advised that I should go back on Lupron which I did. They also advised that if it didn’t knock it back below .1, I should add casodex. I added casodex after 6 mos because I was still around 1.2 and it dropped to .8 then stayed there. After hearing about triple blockade on this site I read the books, then went and visited Dr Myers.

3) What was the third drug you start taking from Jun 2009?

Avodart

4) Were you been given any detailed protocol (doses, etc) by Myers to be followed?


Lupron depot 22.5 mg every three months

Casodex 50 mg daily

Avodart .5 mg daily

Estrogen Patch to reduce hot flashes and counter possible bone density decrease (while on triple blockade only)

Ursodiol To counter possible liver problems (while on triple blockade only)



5) Who is directing you to take what and when for the side effects drugs?

Dr Myers in consultation my local physician

6) What tests are you required taking?

I have had yearly bone scans because I had a hot spot on the coccyx from the beginning. It was pain from the coccyx which prompted me in the beginning to change doctors to the personal Dr that discovered the prostate cancer. Ironically this year St Luke’s and Dr Myers both agreed that although the hot spot was still there it was not the malignancy that was once feared.

I also have bone density scans every couple of years.

The only other tests are a battery of blood tests. Every one to three months. Dr Myers likes to see the Ultra Sensitive PSA, testosterone, Di hydroxy testosterone and Vitamin D levels once a month when he changes things.



Could you please give me by mail the site address of Myers contacts and any other information you may think I should know.

I don't think we can post this type of information here, and i am not even sure if we can do it in a private post so I will sen it yo your email along with some other information

I hope I did not become “heavy” with so many questions.

Not at all. You can ask as many questions as you want and i will answer if I can.

I appreciate your helping me.
Baptista
All the best

 
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