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Old 01-04-2011, 02:19 PM   #1
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Failed Prostatectomy :(

Here we go again. Irv's post-op PSA was 1.1...not good at all. We are getting it checked again at the hospital's lab because I don't trust this lab. It's given higher results before. I don't know how I forgot about that when Irv went back to that lab. We'll get the secondary result tomorrow.

If it's still high, which the doctor believes will be the case, then he said, no radiation and just go straight to hormone therapy. We are told that hormone therapy can control the cancer for anywhere from 2 years to 15 years. He also had said in the past that triple blockade is debatable. I'm with you, Jim, and we will get a second opinion no matter what.

I need to know if you think it would be a good idea to get a third opinion from the states, and if so, which doctor and which hospital? Would it me John Hopkins or Sloan Kettering or both?

Irv has pride and won't except help from anybody, but his sister might be in a position to help out financially with this and I want to do everything possible with Irv.

This is just so horrible. Jim is such an inspiration though and I want to believe that long-term survival is possible...maybe probable for Irv.

Please, please, please respond. I'm not convinced that radiation should be out of the question. I need major feedback. I'm really bummed out about this...and so is Irv.

 
Old 01-04-2011, 03:15 PM   #2
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Re: Failed Prostatectomy :(

So sorry to hear that Irv has detectable PSA after RP. I think your attitude about exploring all options is great and will serve you both well as you go down the path, hopefully, to cure. I think you are wise to consider radiation, in spite of what your doctor said. Here's a quote from a recent article from doctors at the Mayo Clinic in Florida:
Quote:
"Approximately one-third of patients who undergo radical prostatectomy for prostate cancer will develop a detectable prostate-specific antigen (PSA) level within 10 years. Management of PSA recurrence is controversial, as prostate cancer may take an indolent course, or it may aggressively develop into metastatic disease. The only potentially curative treatment for biochemical failure after prostatectomy is salvage radiotherapy. Noncurative treatment options include hormone therapy or clinical trials of a novel systemic agent."
http://www.ncbi.nlm.nih.gov/pubmed/21166517

I think you are also wise to go to a treatment center where they may possibly take a multi-disciplinary approach, rather than to go to a doctor or clinic that specializes in a single approach. Perhaps they might suggest some combination of radiation and hormones. There will only be a few doctors with experience with this sort of thing, and they are most likely to be at one of the top centers. I think the top multi-disciplinary centers for Prostate Cancer are: Johns Hopkins, UCLA, MD Anderson, Sloan-Kettering, UCSF, Mayo, Duke and Cleveland Clinic. There are great, experienced doctors at all of them.

- Allen

 
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Old 01-05-2011, 11:21 AM   #3
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Re: Failed Prostatectomy :(

Hi Rhonda,

Even if Irv's PSA comes out at 1, I still think you have great potential for many, many years of happiness together. Don't let that doctor scare you or limit your hopes. Remember, Jim has been doing great for over eleven years with a very challenging case.

Baptista is right about going to an expert for PCa treatment. You might want to arrange a telephone consultation with one of the better known PCa oncologists to get an idea how they would view your situation. I recently did that with Dr. Scholz, and it was very useful. I just arranged the consultation and faxed all my documents. Dr. Scholz, and several other well known oncologists handle only PCa cases -- by the thousands. They've dealt successfully with many difficult cases, not to mention ones like Irv's. Of course it costs money ($600 for my consultation with Dr. Scholz). but it should be covered by insurance.

Don't despair. Even if Irv's cancer has metastasized, hormonal therapy properly applied can help for years, and in the meantime, new treatments will come on the scene that could turn the tables for you and all of us. If you haven't already done so, read Invasion of the Prostate Snatchers and material on the Prostate Cancer Research Institute web site to get a more optimistic view of options.

Best wishes,
Tom

Last edited by Gleason9; 01-05-2011 at 11:23 AM. Reason: corrected title

 
Old 01-05-2011, 04:26 PM   #4
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Re: Failed Prostatectomy :(

Thank you, Allen and Tom. Just to let you know, I'm in Toronto, Ontario and we are dealing with Princess Margaret Hospital so I know we are in good hands already. Second opinions, however, are never a bad thing.

Well, Irv's PSA result came back again and the result is the same. We saw the radiation oncologist and he said that there is still a chance at a cure, but I realize that it isn't a big one. He is willing to do radiation therapy but only after carefully planning a strategy due to Irv's history of ulcerative colitis.

I started thinking that maybe a shot of Zoladex might be a good plan while we wait to try and control whatever is there. I should have asked but it didn't occur to me until afterwards. Irv is going for another bone scan tomorrow and a CT scan is also planned, along with a colonoscopy with consideration of his past reports of ulcerative colitis flare ups.

What do you think of the idea of the Zoladex shot as an interim measure to try and get that 1.19 PSA down?

Also, was going to take a trip to the health food store and pick up Vitamin D3 (Irv already has Vitamin D), Pomegranate pills, and is green tea extract good? And can you buy Lycopene in any form besides eating lots of tomatoes??? I also told Irv that seeing a Naturopath might be a good idea....and a membership at the gym would be good...Am I getting fanatical yet? I want to keep my sweet man around for a very long time.

 
Old 01-05-2011, 04:48 PM   #5
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Re: Failed Prostatectomy :(

Hi Rhonda,

Probably not a bad idea to consider getting Irv started on the Zoladex. If you should decide to go the radiation route, studies have shown that its effectiveness is increased when the patient is also on hormonal therapy at the same time.

As a side note - I sure wouldn't discount the effectiveness of radiation for helping (even curing) Irv's situation. I went the hormonal/radiation route (PSA at 66 and in lymph nodes) and three years later, my PSA is .17 and still falling. (Last treatments were over two years ago, and am presently only on Avodart as maintainance therapy.)

Bless you guys!

Gregg

 
Old 01-05-2011, 05:43 PM   #6
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Re: Failed Prostatectomy :(

Thank you, Gregg. Sounds wonderful. How long were you on the Zoladex for and what were your side effects?

Oh, and those of you who take Vitamin D, I'd like to know if you take 1000 or 2000 IU per day. I've heard of both.

 
Old 01-05-2011, 06:10 PM   #7
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Re: Failed Prostatectomy :(

It doesn't really matter if those things are good or not, and they certainly won't hurt. The important thing is that it gives you a sorely needed feeling of control. It's much better than feeling helpless. Knowing how much the mind affects the body and vice versa, I think it's very important to not neglect that aspect. There are various time-tested methods to keep up your spirits - religion, Mindfulness, reiki, chakra balancing, psychotherapy, exercise, etc.

Quote:
Originally Posted by srhonda61 View Post
Also, was going to take a trip to the health food store and pick up Vitamin D3 (Irv already has Vitamin D), Pomegranate pills, and is green tea extract good? And can you buy Lycopene in any form besides eating lots of tomatoes??? I also told Irv that seeing a Naturopath might be a good idea....and a membership at the gym would be good...Am I getting fanatical yet? I want to keep my sweet man around for a very long time.

 
Old 01-05-2011, 06:33 PM   #8
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Re: Failed Prostatectomy :(

Hi Rhonda,

You've already gotten some good leads and thoughts, and I'll try to add to them, quoting from your post #4.


Quote:
Originally Posted by srhonda61 View Post
Thank you, Allen and Tom. Just to let you know, I'm in Toronto, Ontario and we are dealing with Princess Margaret Hospital so I know we are in good hands already. Second opinions, however, are never a bad thing.

Well, Irv's PSA result came back again and the result is the same. We saw the radiation oncologist and he said that there is still a chance at a cure, but I realize that it isn't a big one. He is willing to do radiation therapy but only after carefully planning a strategy due to Irv's history of ulcerative colitis.
I see it the way Allen and the oncologists do regarding radiation - it could be what your husband needs. It used to be thought that prostate cancer beyond the prostate after the RP had already spread widely in a high proportion of cases. Research has now indicated strongly that that is not true - it's often within the range of external beam radiation. However, additional scans to check the extent of spread might be wise. Dr. Scholz addresses this well in the book Tom mentioned, especially regarding the follow-on to the Combidex scan. A "fusion ProstaScint", as described in the Primer, might also be in order. (I had the earlier, unfused ProstaScint myself; it was helpful to my morale and in my decision making.)

The ulcerative colitis could tip the scales toward skipping radiation and going straight to hormonal therapy. If so, you need to know that that control range you were given, 2 to 15 years, is really skewed toward the short side. Just two years is unthinkable to me, based on your husband's case and course so far and modern hormonal blockade options. Dr. Scholz, Dr. Myers, Dr. Strum, Dr. Lam and others are seeing results more like average response (not survival, but effective control of the cancer before moving on to second line hormonal therapy or some other therapy) of either around ten to eleven years or indefinitely with intermittent triple blockade.

Dr. Charles Myers states somewhat shorter effectiveness periods in his book "Beating Prostate Cancer: Hormonal Therapy & Diet," page 53 in my edition: "Drs. Scardino and Scher reviewed their experiences at Memorial Sloan Kettering in New York City and found that half of their patients were still responding at the 10 year mark. Based on my clinical experience, this result looks to be approximately correct. My conclusion is that hormonal therapy is far more durable than generally thought. In fact, almost all men who recur after radical prostatectomy or radiation therapy will continue to respond to hormonal therapy after five years and about half will continue to respond after ten years."

Moreover, that ten to eleven year figure (or indefinitely long) is based on treatment some time ago, without recent advances. For instance, pomegranate was not known as being helpful for PC patients as recently as ten years ago, but it is looking like a valuable player now, maybe a game changer.

One final thought on this, Dr. Scholz was focusing on triple blockade patients treated intermittently, and these patients appear to enjoy unusually prolonged responses, in my layman's view, considering the limited amount of research that has been published as well as statements and informal publications by leading experts. It is very unlikely that Drs. Scardino and Scher had any patients on triple blockade for the period they were addressing.

Regarding survival after blockade "fails", research on patients treated with out-of-date hormonal blockade demonstrated survival averages after that obsolete treatment lost its effectiveness, and without the much more effective follow-on options available today, of 40 months for men who already had bone metastases when the blockade lost its full effectiveness to 68 months for men who did not have bone mets when the blockade lost its full effectiveness. If you talk to doctors, they will often give you a figure for such survival closer to 20 months. That's research based, but the research studies involved did not start the survival clock until those men entered clinical trials; it's likely that many, many months of survival were not counted during the period from failure of blockade until trial entry.

Conservatively, with a little luck, you could figure on ten years of blockade effectiveness plus five years survival beyond that. However, that does not allow for second line hormonal therapy (a friend of mine has been on it for at least four years now, with ketoconazole, doing very well), for modern chemotherapy, or other advances just emerging or already well on the way, such as Provenge. It does not allow for the realistic possibility that cures will be found for men with advanced cases within the next decade. It does not allow for aggressive use of lifestyle tactics and mild medications, like a statin, to increase odds of success.


Quote:
I started thinking that maybe a shot of Zoladex might be a good plan while we wait to try and control whatever is there. I should have asked but it didn't occur to me until afterwards.
That makes excellent sense to me. If Irv goes on to radiation, he'll probably be on hormonal blockade for a time as well, both to soften up the cancer for the radiation and to help kill and neutralize any cancer throughout the body that is beyond the range of the radiation. If he goes straight to hormonal blockade alone, Zoladex is a good way to start. However, as described in "Invasion", in the Primer and in other helpful sources, it's wise to preclude testosterone "flare" by taking an antiandrogen first. This can be done for a week or two, or for just a few days with a triple load, according to Dr. Myers.

Quote:
Irv is going for another bone scan tomorrow and a CT scan is also planned, along with a colonoscopy with consideration of his past reports of ulcerative colitis flare ups.
These scans are often useless for newly diagnosed patients, but they make sense in Irv's case. If the cancer has metastasized beyond the range of radiation - nor real likely, you can make a good case for going straight to hormonal blockade without radiation.

Quote:
What do you think of the idea of the Zoladex shot as an interim measure to try and get that 1.19 PSA down?
That's basically what I did, getting a Lupron shot within two weeks of my diagnosis to buy me some time to learn about the disease, get over the shock of diagnosis, and choose a treatment. As it turned out, advanced hormonal blockade on an intermittent basis became my sole therapy, as you know.

Quote:
Also, was going to take a trip to the health food store and pick up Vitamin D3 (Irv already has Vitamin D),
That's a very good move, but vitamin D is notoriously subject to great quality differences among brands. The brand I use is from the Life Extension Foundation. Dr. Rheinhold Veith, a premier vitamin D researcher, is at one of the Toronto universities, and his office could probably give you some good leads to other sound brands. (He has worked with Dr. Klotz, so the Klotz office could help you find him, if needed.)

Quote:
Pomegranate pills,
This is another supplement (or juice) where quality seems to matter. I've seen research on four good brands and at least a dozen that did not measure up, but I can't find the full list. Two of the good brands are POMx (the extract made by the POM Wonderful company), and the Life Extension Foundation product. I remember that the Puritain Pride version did not score high, along with a number of other widely advertised brands.

Quote:
and is green tea extract good?
I believe it is and have been taking one capsule daily for years, along with tea from about 8 to 10 bags of green tea daily, most in decaf versions. (During that first year I stuck to 14 bags daily, basically two bags in seven 12 ounce mugs, each with a little lemon juice to prevent oxidation.

Quote:
And can you buy Lycopene in any form besides eating lots of tomatoes???
I get a lot of lycopene, likely more than I need, and only a little of it from tomatoes. Actually, cooking or otherwise processing the tomatoes releases much more of the lycopene, making it biologically available, as contrasted with raw tomatoes, though I still enjoy those in salads. My main source of lycopene is V8 juice, but I also consume about a tablespoon full of cocktail sauce at lunch. Catsup also works, as does pizza and pasta sauce. There are other sources, such as pink or red grapefruit and watermelon. Strawberries are not a lycopene source, despite their red color. However, there is evidence that they too are beneficial against prostate cancer. By the way, my wife practically insisted I consume a 12 oz can of stewed tomatoes during that first year. That likely helped, but that's far from my favorite way of getting lycopene!

Quote:
I also told Irv that seeing a Naturopath might be a good idea....
I don't have experience there. Some are quacks, but some are probably worthwhile.

Quote:
and a membership at the gym would be good...Am I getting fanatical yet? I want to keep my sweet man around for a very long time.
Exercise, very specifically including strength exercise in addition to aerobic, appears to be quite important, especially to patients on hormonal therapy. To me you are sounding empowered, not fanatical. I'm convinced that empowerment is key to winning the battle against prostate cancer for those of us with challenging cases.

Regarding earlier posts in your thread, there are several points I'd like to make. It's not unusual that a urologist, even a good one, would not understand or appreciate triple hormonal blockade. However, Dr. Klotz might. He has co-authored a paper with Dr. Mark Scholz, who is one of the leading experts in hormonal therapy, especially intermittent triple hormonal blockade. I think there's a fair chance he could recommend a medical oncologist who would be willing to manage your husband on triple blockade. (As a surgeon and very busy researcher, he might not have the inclination to manage Irv's triple therapy himself.) Dr. Fernand Labrie, Laval University in Quebec, is commonly considered the "father of combined hormonal therapy," meaning two drug blockade with an LHRH-agonist (such as Zoladex) and an antiandrogen (Casodex these days, as a rule, usually I would think in its generic form, bicalutamide). I believe Dr. Labrie has come around to the view that finasteride or Avodart are a wise addition, thereby constituting triple blockade. For years Dr. Labrie has been adamantly opposed to intermittent therapy, but perhaps recent research has changed his view. (In my opinion, it should have.) Whatever his view of that, his office could probably recommend medical oncologists in the Toronto area who would be good at managing triple blockade. Allen listed some excellent US centers, but Canada, including Toronto, is quite competitive in excellence in PC. Vancouver has some outstanding doctors/researchers. By the way, some of the US centers are particularly prominent in certain areas (for example Johns Hopkins in surgery and general PC research, including chemotherapy) but not in others, where they may be quite competent but not international leaders. I don't feel Johns Hopkins is even near the forefront in hormonal therapy, for instance. Most of the best hormonal therapy doctors I'm aware of are in private practice and not associated with universities. Some outstanding radiation facilities are not associated with leading universities, though some are. I'm not familiar with the landscape of radiation talent in Canada.

Hang in there!

Take care,

Jim

Last edited by IADT3since2000; 01-05-2011 at 06:38 PM. Reason: Switched one paragraph from green to quoted right after posting.

 
Old 01-05-2011, 06:53 PM   #9
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Re: Failed Prostatectomy :(

Hi again Rhonda,

I'm responding to one of your earlier posts today on vitamin D.


Quote:
Originally Posted by srhonda61 View Post
...

Oh, and those of you who take Vitamin D, I'd like to know if you take 1000 or 2000 IU per day. I've heard of both.
The best course is to base the dose on the results of a blood test known as "25-hydroxy vitamin D. Some of us need a lot, while some need much less. Many of us will need about 5000 IU per day of quality vitamin D3. Some patients score so low that they need a special 50000 IU regimen for a while. Dr. Myers, whom I think is one of the leading experts in this, wants to see his patients have a 25-hydroxy vitamin D level in the range from 50 to 80, but not higher than 100.

I'm now taking close to 5000 units per day, but I'm also getting some from food. I'm now 67 and living in a northern lattitude (little useful sun in the winter especially), so I probably get very little from sun exposure. I have my vitamin D level checked every few months.

Dr. Charles Myers does a masterful job of describing vitamin D, supplements, and monitoring in his book "Beating Prostate Cancer: Hormonal Therapy & Diet."

By the way, at the dinner for the National Conference on Prostate Cancer 2009, Dr. Mark Moyad, MD, another leading communicator to patients about prostate cancer, thought so much of vitamin D that he gave out a free bottle to each of the several hundred of us attending the dinner.

 
Old 01-06-2011, 12:42 AM   #10
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Re: Failed Prostatectomy :(

Wow, Jim....Maybe it's because I'm tired, but that was all too way over my head and I'm so confused and don't know where to turn. I actually found the urologist's email address and sent him this message:



Hi Dr. ........
I found this contact email online and hope it was okay to use. Bone scan is tomorrow...Thursday, Jan. 6, 11 a.m. at TGH. Suddenly felt that radiation delay, due to colitis, might be a good reason to have a shot of Zoladex??? Can this be done? I'm sorry I didn't think of that today during our appointment. This is very overwhelming. Can't wait 3 months to see you at next appointment or go through waiting process of making another appointment. Hope we can see you tomorrow for a few minutes to discuss if you aren't in surgery or make an appointment as soon as possible. I'm sorry to bother you this way. I hope you don't mind.

This was his reply:

I am against it
Well have no way of knowing if the xrt helps as it will lower the psa


I don't understand the benefit of this....I want the cancer to be under control right now...and if, in the end the radiation, if done, doesn't work, then the PSA will go up and more hormone therapy will be given anyway...and if the radiation helps, then we'll be ok. I don't understand what difference it would make to hold back the hormone therapy....and if it doesn't go up, then we'll know it worked....but the main thing is to attack it and try to either make it go away or stop it in it's tracks and not take unneccessary chances.

So, Jim, can you please tell me what I should do? Should we see if we can get to the states for Irv to have a ProstaScint scan? Tomorrow he's going for a bone scan. Our GP told us that Dr. Klotz will no longer deal with us since we did not have him do the surgery. Should we send reports to one of the doctors in the states and pay $600 or whatever it costs for a report? Or is there another doctor here who we can rely on. I'm so scared and confused. I feel such a sense of urgency to be proactive and I'm just so confused. People look at me and think I know a lot. One man in our support group asked if I'm a nurse...I said "No, I'm just a reader". I need to know. I wish I knew what you know. I need a step by step approach here and now.

Our doctor doesn't believe in the hormone therapy before the radiation therapy...so, that being the case, we'd have to keep waiting until at least February at some point to see if radiation can even begin.

I'm really confused, Jim. Can you be specific in guiding me through step-by-step exactly what I need to do? I'm so tired and it's really difficult for me to cope with this at the moment.

Thank you for so much more than you can ever imagine.
Rhonda

Last edited by honda50; 01-06-2011 at 12:46 AM.

 
Old 01-06-2011, 02:31 AM   #11
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Re: Failed Prostatectomy :(

Hi again, Jim.

I have a few questions...

Quote:
Originally Posted by IADT3since2000 View Post
Hi Rhonda,

You've already gotten some good leads and thoughts, and I'll try to add to them, quoting from your post #4.




I see it the way Allen and the oncologists do regarding radiation - it could be what your husband needs. It used to be thought that prostate cancer beyond the prostate after the RP had already spread widely in a high proportion of cases. Research has now indicated strongly that that is not true - it's often within the range of external beam radiation.

[COLOR = "black"]Do you know if the above still holds true if the cancer is found in the seminal vesicles?[/COLOR]


[COLOR = "darkgreen"]However, additional scans to check the extent of spread might be wise. Dr. Scholz addresses this well in the book Tom mentioned, especially regarding the follow-on to the Combidex scan. A "fusion ProstaScint", as described in the Primer, might also be in order. (I had the earlier, unfused ProstaScint myself; it was helpful to my morale and in my decision making.)[/COLOR]


[COLOR = "black"]Do you know where the Combidex scan is offered and how much it costs? I'd also like to ask you the same question about the ProstaScint scan and would both of these scans be necessary or just one?[/COLOR]



The ulcerative colitis could tip the scales toward skipping radiation and going straight to hormonal therapy. If so, you need to know that that control range you were given, 2 to 15 years, is really skewed toward the short side. Just two years is unthinkable to me, based on your husband's case and course so far and modern hormonal blockade options. Dr. Scholz, Dr. Myers, Dr. Strum, Dr. Lam and others are seeing results more like average response (not survival, but effective control of the cancer before moving on to second line hormonal therapy or some other therapy) of either around ten to eleven years or indefinitely with intermittent triple blockade.

Dr. Charles Myers states somewhat shorter effectiveness periods in his book "Beating Prostate Cancer: Hormonal Therapy & Diet," page 53 in my edition: "Drs. Scardino and Scher reviewed their experiences at Memorial Sloan Kettering in New York City and found that half of their patients were still responding at the 10 year mark. Based on my clinical experience, this result looks to be approximately correct. My conclusion is that hormonal therapy is far more durable than generally thought. In fact, almost all men who recur after radical prostatectomy or radiation therapy will continue to respond to hormonal therapy after five years and about half will continue to respond after ten years."

Moreover, that ten to eleven year figure (or indefinitely long) is based on treatment some time ago, without recent advances. For instance, pomegranate was not known as being helpful for PC patients as recently as ten years ago, but it is looking like a valuable player now, maybe a game changer.

One final thought on this, Dr. Scholz was focusing on triple blockade patients treated intermittently, and these patients appear to enjoy unusually prolonged responses, in my layman's view, considering the limited amount of research that has been published as well as statements and informal publications by leading experts. It is very unlikely that Drs. Scardino and Scher had any patients on triple blockade for the period they were addressing.

Regarding survival after blockade "fails", research on patients treated with out-of-date hormonal blockade demonstrated survival averages after that obsolete treatment lost its effectiveness, and without the much more effective follow-on options available today, of 40 months for men who already had bone metastases when the blockade lost its full effectiveness to 68 months for men who did not have bone mets when the blockade lost its full effectiveness. If you talk to doctors, they will often give you a figure for such survival closer to 20 months. That's research based, but the research studies involved did not start the survival clock until those men entered clinical trials; it's likely that many, many months of survival were not counted during the period from failure of blockade until trial entry.

Conservatively, with a little luck, you could figure on ten years of blockade effectiveness plus five years survival beyond that. However, that does not allow for second line hormonal therapy (a friend of mine has been on it for at least four years now, with ketoconazole, doing very well), for modern chemotherapy, or other advances just emerging or already well on the way, such as Provenge. It does not allow for the realistic possibility that cures will be found for men with advanced cases within the next decade. It does not allow for aggressive use of lifestyle tactics and mild medications, like a statin, to increase odds of success.



What is a statin drug and at what point would it be taken?



That makes excellent sense to me. If Irv goes on to radiation, he'll probably be on hormonal blockade for a time as well, both to soften up the cancer for the radiation and to help kill and neutralize any cancer throughout the body that is beyond the range of the radiation.

So, how do I deal with this? If we can't get a hormone shot to give short term control of the cancer, then how can we afford the time to spend the time to shop around for a medical oncologist who does? It's like being between a rock and a hard place.


If he goes straight to hormonal blockade alone, Zoladex is a good way to start. However, as described in "Invasion", in the Primer and in other helpful sources, it's wise to preclude testosterone "flare" by taking an antiandrogen first. This can be done for a week or two, or for just a few days with a triple load, according to Dr. Myers.

Are you saying that he should take Casodex for a week or two and then Zoladex for three months before having surgery? Will there be more side effects with both? My friend's boyfriend said, after three months after his Zoladex shot, he still had no side effects. So, when will they show up? And what medication will counter-act the side effects.


These scans are often useless for newly diagnosed patients, but they make sense in Irv's case. If the cancer has metastasized beyond the range of radiation - nor real likely, you can make a good case for going straight to hormonal blockade without radiation.



That's basically what I did, getting a Lupron shot within two weeks of my diagnosis to buy me some time to learn about the disease, get over the shock of diagnosis, and choose a treatment. As it turned out, advanced hormonal blockade on an intermittent basis became my sole therapy, as you know.


Why Lupron and not Zoladex? Is one different, or more effective than the other one?



That's a very good move, but vitamin D is notoriously subject to great quality differences among brands. The brand I use is from the Life Extension Foundation. Dr. Rheinhold Veith, a premier vitamin D researcher, is at one of the Toronto universities, and his office could probably give you some good leads to other sound brands. (He has worked with Dr. Klotz, so the Klotz office could help you find him, if needed.)

I have two kinds here, Health Balance and Webber Naturals. Being in Canada, the brands might be different. The HealthBalance is made by Costco. I guess I'll have to check into it.



This is another supplement (or juice) where quality seems to matter. I've seen research on four good brands and at least a dozen that did not measure up, but I can't find the full list. Two of the good brands are POMx (the extract made by the POM Wonderful company), and the Life Extension Foundation product. I remember that the Puritain Pride version did not score high, along with a number of other widely advertised brands.



I believe it is and have been taking one capsule daily for years, along with tea from about 8 to 10 bags of green tea daily, most in decaf versions. (During that first year I stuck to 14 bags daily, basically two bags in seven 12 ounce mugs, each with a little lemon juice to prevent oxidation.



I get a lot of lycopene, likely more than I need, and only a little of it from tomatoes. Actually, cooking or otherwise processing the tomatoes releases much more of the lycopene, making it biologically available, as contrasted with raw tomatoes, though I still enjoy those in salads. My main source of lycopene is V8 juice, but I also consume about a tablespoon full of cocktail sauce at lunch. Catsup also works, as does pizza and pasta sauce. There are other sources, such as pink or red grapefruit and watermelon. Strawberries are not a lycopene source, despite their red color. However, there is evidence that they too are beneficial against prostate cancer. By the way, my wife practically insisted I consume a 12 oz can of stewed tomatoes during that first year. That likely helped, but that's far from my favorite way of getting lycopene!



I don't have experience there. Some are quacks, but some are probably worthwhile.



Exercise, very specifically including strength exercise in addition to aerobic, appears to be quite important, especially to patients on hormonal therapy. To me you are sounding empowered, not fanatical. I'm convinced that empowerment is key to winning the battle against prostate cancer for those of us with challenging cases.

Regarding earlier posts in your thread, there are several points I'd like to make. It's not unusual that a urologist, even a good one, would not understand or appreciate triple hormonal blockade. However, Dr. Klotz might. He has co-authored a paper with Dr. Mark Scholz, who is one of the leading experts in hormonal therapy, especially intermittent triple hormonal blockade. I think there's a fair chance he could recommend a medical oncologist who would be willing to manage your husband on triple blockade.



Do you suggest that I call his office and try to get a recommendation?


Hang in there!

Take care,

Jim

Last edited by honda50; 01-06-2011 at 03:10 AM.

 
Old 01-06-2011, 02:38 AM   #12
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Re: Failed Prostatectomy :(

Quote:
Originally Posted by greggeva View Post
Hi Rhonda,

Probably not a bad idea to consider getting Irv started on the Zoladex. If you should decide to go the radiation route, studies have shown that its effectiveness is increased when the patient is also on hormonal therapy at the same time.


Do you know how I can possibly have a look at those studies? I'd really love to see.


As a side note - I sure wouldn't discount the effectiveness of radiation for helping (even curing) Irv's situation. I went the hormonal/radiation route (PSA at 66 and in lymph nodes) and three years later, my PSA is .17 and still falling. (Last treatments were over two years ago, and am presently only on Avodart as maintainance therapy.)

Bless you guys!

Gregg

 
Old 01-06-2011, 03:46 AM   #13
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Re: Failed Prostatectomy :(

I'm not sure I can help you too much in finding those studies regarding the use of hormonal therapy in conjuction with radiation. (There are few guys on the board here who are really good at that. I'm definitely not one of them.) I did find a few studies by googling a string of words like "studies hormonal therapy conjunction radiation prostate." The most recent one I found was from 2008. You might ask Jim about this topic. I'm betting he knows how to get hold of the info through the "board approved" government web sites.

Gregg

 
Old 01-06-2011, 08:14 AM   #14
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Re: Failed Prostatectomy :(

Hi Rhonda,

I wouldn 't be too quick to rule out salvage radiation, if it's possible for Irv to have it. I too had a failed RP after 3 years and then underwent salvage radiation at the Juravinski Cancer Center in Hamilton. Being from Toronto, I'm sure you would know of the place.

My Prostate cancer is a gleason 8 ( that makes it very aggressive), and I had some doubt as to whether radiation would do any good or not. My oncologist ( DR. Lukka, at Juravinski ) also was quite frank with me and said that because it was a Gleason 8, it could be difficult to try to eradicate the cancer.

So far it's been about 20 months since the radiation and I have no detectable psa at this time. Also the side effects of the radiation have all but disappeared, but I certainly did have very annoying side effects in the beginning after the radiation. Because I'm in the worst catagory for prostate cancer ( Gleason 8-10), I expect the cancer will return at some time in the future, but I'm hoping that will take a good long time!

My only choice if and when the cancer returns will be hormone therapy and we are very fortunate to have someone on this site that knows a great deal about it. Unfortunately hormone therapy is not cure but can prolong life for quite a while.

Whatever you decide, I wish you and Irv the very best of results. And try not to despair. My wife Anne knows exactly where I stand and deals with it very well and always has encouraging words for me. And believe me, that helps very much!

Take care...Lionel

 
Old 01-06-2011, 02:00 PM   #15
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Re: Failed Prostatectomy :(

Here are some studies you might want to discuss with your RO:

Radiotherapy after radical prostatectomy: does transient androgen suppression improve outcomes? They conclude "Radiotherapy combined with a short-course Total Androgen Suppression after radical prostatectomy appears to confer a PSA relapse-free survival advantage and possibly an overall survival advantage when compared with RT alone."
http://www.ncbi.nlm.nih.gov/pubmed/15145146

Prospective study evaluating postoperative radiotherapy plus 2-year androgen suppression for post-radical prostatectomy patients with pathologic T3 disease and/or positive surgical margins. They conclude: "The combined treatment of postoperative RT plus 2-year AS yielded encouraging results for patients with pT3 and/or Positive Surgical Margins" http://www.ncbi.nlm.nih.gov/pubmed/19211197

Higher doses (over 67 Gy) are also associated with better outcomes. http://www.ncbi.nlm.nih.gov/pubmed/19464818
Modern IGRT techniques have low toxicity, so quality of life should not be compromised by the higher doses.

If you are interested in supplements that enhance radiosensitivity of the cancer while protecting healthy tissue, search my posts on that subject. I avoided all supplements (including some popular "anti-oxidants") where it is unknown whether or not they might interfere with the radiation. Oxygenation is critical for the radiation to work. There is no supplement better than exercise for oxygenating tissues.

 
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