I have had surgery, 39 EBR treatments, and then I was put on Zoladex in july of 07. My PSA was 0.37 when I had my first shot then it went to 0.01. I had my last shot on May 30th 2008, my PSA was still 0.01. Since then I have had no treatments and my PSA has been steadily rising. My last PSA in september was 1.27. My question is how high do they let your PSA go before they resume the Zoladex ??? I haven't seen my Oncologist but the nurse says he looks at everything and that everything is fine.???? My next PSA isn't until January 2011. I kind of get the feeling that they forgot about me. Thanks Rich:
I'll add some thoughts in green to an excerpt of your post #1 on your thread.
Originally Posted by Dickiedo
I have had surgery, 39 EBR treatments, and then I was put on Zoladex in july of 07. My PSA was 0.37 when I had my first shot then it went to 0.01. I had my last shot on May 30th 2008, my PSA was still 0.01. Since then I have had no treatments and my PSA has been steadily rising. My last PSA in september was 1.27. My question is how high do they let your PSA go before they resume the Zoladex ???
First, in answer to your question, there is no consensus trigger point for restarting the heavy duty LHRH-agonist drugs, such as Zoladex. This is an area still being studied and debated. The oncologists associated with the book "A Primer on Prostate Cancer" used a trigger point of 5 for their patients on combined blockade (typically the LHRH-agonist plus Casodex (now bicalutamide) or flutamide back then). However, they acknowledge that that was their best estimate back then and not firmly based on research. They used an even lower trigger of 2.5 for their triple blockade patients, but they acknowledge that was somewhat arbitrary and was done mainly because the third leg of triple blockade, then finasteride (now Avodart or finasteride), was known to cut PSA about in half on its own, and they were striving for comparability with two drug blockade. I followed their thinking closely for a number of years, and they liked to individualize their treatments depending on how fast the patient's PSA was rising, preferably under a program of one-time or intermittent triple hormonal blockade. With a fast rise, they would intervene sooner, around 2.5 or 3 as I recall; with a slow rise, they would wait until around 4, 5 or 6. I'm not sure what their latest thinking is.
Even with my challenging case, I'm comfortable with a trigger point of about 10 to resume triple blockade. I was able to get my PSA down to <0.01 after the second cycle (19 months), and after the third cycle (also 19 months) it got down to .03, rose to .04 at which point I went off therapy, and then surprisingly fell to a low point of 0.02 before starting a slow rise. I did not plan on 10 the first time; my PSA rose rapidly from around 6 to 10, as I recall, but I knocked it back with a stint of low-dose thalidomide.
I have a highly knowledgeable buddy who has done extremely well for many years on triple blockade with a PSA that is very slowly rising and is now roughly in your neighborhood, but he plans to go back on blockade fairly early, around the 2 or 3 point, his personal preference with an eye to minimizing risk. In contrast, I know of a number of patients and their oncologists who are comfortable with a PSA rising as high as 20; that would worry me.
I haven't seen my Oncologist but the nurse says he looks at everything and that everything is fine.???? My next PSA isn't until January 2011. I kind of get the feeling that they forgot about me. Thanks Rich:
My hunch is that you are fine as far as the PSA level goes and waiting until January to take your next bearing in naviagating your way through the sea of hormonal therapy. However, I'm concerned that you are only on single agent blockade - Zoladex - without bicalutamide in support, ideally backed up also with Avodart or finasteride. Several studies have raised concern with single drug (or orchiectomy alone). A year or so ago, Japanese researchers published a multi-institutional review of hormonal blockade of various types in Japan, including single drug blockade and various forms of combined blockade, covering both drugs and orchiectomy. Guys on single LHRH-agonist blockade - your program - did fairly well, though not as well as guys on other types of blockade, until about the four to five year point, then many kind of fell off a cliff with a sharp increase in deaths due to prostate cancer , while their more fortunate peers on other types of blockade continued to be quite successful. I can give you the citation and more details if you would like them.
The fact that you recurred after surgery and radiation, in addition to your high-risk cancer case picture, indicates the need for special care. If it were me, with the experience I now have as a layman survivor (but with no enrolled medical education), I would want triple blockade with either Avodart or finasteride continued during the off-therapy period as maintenance. I would also put all the lifestyle tactics to work.
All that said, you still have a fairly low PSA after being off the LHRH-agonist for two years. That's impressive! Single drug therapy does seem to work well for some guys, and maybe you are one of them. However, that's too risky for my money. (My buddy would probably say the same thing about my approach of using 10 as the trigger point. It's odd how we each are very comfortable with some risks but very uncomfortable with other risks that many of our fellow patients take in stride, and vice versa.)
Take care and good luck with this,
Last edited by IADT3since2000; 10-04-2010 at 03:01 PM.
Reason: Added [/QUOTE] right after posting.
Hi Jim: Thank you for your reply. I talked to my nurse today and she said she would talk with the Doctor about my concerns, I hope I hear something tomorrow. I asked her if my Dr. ever uses the IADT3 and she said that on some of his patients he does. I also asked her why he never has a consultation with his patients and she just shook her head. Again thanks for your great info. The only part I didn't like to hear was after 5 year's the patients on single therapy fell off the cliff, If that is the case I have a couple of years left, and having my bride of 55 years just being diagnose with Alzheimer's, I have to stick around to take care of her. I hope you are doing good on your vacation from your therapy. Rich