It is wonderful when we survivors can report on good results. My latest PSA is lower at 0.03 ng/ml.
This comes from an initial PSA=1.0 at the start of ADT in November 2010. The accomplishment is due solely to a mono blockade with the LHRH agonist Eligard 6-month depot.
The chronology of the PSA/Testosterone tests in ADT is this;
Nov’10 PSA=1.0; T=3.76
Dec’10 PSA=0.18; T=0.28
Mar’11 PSA=0.07; T=0.28
May’11 PSA=0.05 (remission)
Aug’11 PSA=0.03; T=0.28
My next Eligard injection is set for November 2011 and it would be effective for a six-month period again. My doctor (an uro-oncologist) commented this to me;
“If the PSA maintains the trend at a lower level of 0.05 until May 2012, then I will dispense you from the medication (setting me on the first “vacation” OFF-drugs). In case of any increase along this period, then you will start taking an antiagonist and the vacations from the drugs will be delayed. A PSA=2.5 is the threshold to restart a new cycle of ADT (intermittent), but no one knows if that will be needed”.
He added that; the second cycle would be done on ADT2 (double blockade) with reservations for a 5-ARI to a latter “attack” depending on the progress of my case. He believes that “micro-metastasis” was properly diagnosed to my case in 2000, with a Gs 5 (6 at present standards) and PSA=22.4.
I think that an aggressive approach on treatment from its initial administration may present better results but one cannot preview the outcome if not based on past experiences. The important, after all, may be of having “something” working in our benefit. In my second cycle I surely will add Abiraterone as the substitute for any antiandrogen.
I am on my way for an evening celebration.
The best to my friend survivors.
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jellybean3009 (08-18-2011),Tall Allen (08-18-2011)
Congratulations Baptista on this wonderful continued progress!
I'm especially impressed that you are achieving this with just one drug! Some of us can do that, and it is helpful to get your first hand account.
I too strove to keep my PSA below 0.05 for a year on my first cycle of triple androgen deprivation therapy before commencing the off-therapy phase. Waiting for a full year as you intend to do is probably the best approach. Since then, mindful of the long time it takes me to get to 0.05 with a challenging case and an intact, unradiated prostate, I've settled for getting to a nadir around 0.01 and then going off therapy. For me, that meant I did not wait a full year after reaching 0.05.
Based on your case and response to Eligard, I'm thinking you are likely to be one of those patients who has a very long off-therapy period lasting years. You may be one of the especially fortunate patients who have had recurrences who never need a second cycle of blockade! The Scholz/Lam/Strum team of medical oncologists and their colleagues have had a paper published on improved off-therapy time resulting from using f i n a s t e r i d e during the off-therapy vacation period. I believe you would find that paper interesting, and your doctor may not be aware of it. For most of us there are minimal side effects from f i n a s t e r i d e or Avodart, its sister drug in the same 5-alpha reductase inhibitor class. I have used f i n a s t e r i d e continuously since September 2000, so it serves as a maintenance drug during my vacation periods.
Are you being scanned for bone mineral density? Are you on a bisphosphonate drug with calcium and vitamin D3 supplements to protect bone density? I believe you have posted about that, but I don't recall what you wrote.
The doctors program looks sound to me, and I am interested in his approach of using single blockade for the first cycle and moving to two drugs for the second cycle. I'm impressed with the effectiveness of triple blockade up front, but obviously single blockade works well for some of us.
The only suggestion I would make would be to measure DHT now. However, based on that very low and declining PSA, it would probably turn out to be very low, and that may be the reason the doctor is not checking it. Looking ahead to a second cycle, hopefully deferred for many years, monitoring DHT would enable a decision whether to add a 5-alpha reductase inhibitor drug early if DHT is not minimized by the two drug combination.
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I wanted to send my congratulations on your good news. Your replies to my posts about my husband have been of such help and have given us both so much hope. It is so good to hear how well you are doing. May your evening of celebration be a very fine one.
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Wonderful news, Baptista! I hope you have continued success for a very, very long future.
In response to what Jim has said, I have a couple of questions. Irv has an appointment next week to get another Zoladex injection from the urologic oncologist who performed his surgery...a week later than originally scheduled but that has already been discussed.
I'd like to address the issues I think I should be bringing up to the doctor and ask if I should be asking anything else. First, Irv, at this point, hasn't had a bone density test as this is something that isn't done until a year after hormone therapy has begun. He isn't on a bisphosphonate drug either. Is it ok for him to wait a year or should I ask that he be put on a bisphosphonate drug right away? I have a feeling that the doc will be resistant on this one. Also, Irv had his blood work done recently and his cholesterol and sugars are fine. Can he wait, then, to go on a statin drug? Again, I have a feeling we'll face resistance on this too. As for the DHT test, it isn't something promoted by the doctors here. We don't mind paying the $60 fee for it but I thought that it might be best to wait until just before Irv goes on a vacation from ADT3. What do you think about that? Other than that, I'm just trying to get Irv to get himself on Super Bio-Curcumin. I think if I don't order it myself, it might just never get done. I wish he were more independently pro-active like some of you here.
Irv does, however, go to the gym almost daily and the side effects aren't as apparent as they once were. He's managing to keep his weight down and he's more muscular now than he was before he started, due to weight bearing exercises. He also just had another PSA test done yesterday and we should have the results by tomorrow. Pray for us that it's lower than .04, please.
I'll look forward to your responses on issues to present to the doctor when we go next Wednesday. I'd like to be as prepared as possible.
Again, CONGRATS to you, Baptista.
Last edited by honda50; 08-17-2011 at 08:39 AM.
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Rhonda and Jim and friend survivors
Thanks for the well-wishing.
Rhonda; You have been an exemplar caregiver to Irv, since his diagnosis. I also think that he should be more active in handling his “duties” with the disease, and should be dressing “boxing gloves” (next to you) when confronting his doughty doctors. You are spoiling him and he is appreciating it.
I had a bone density test (DEXA) done before starting HT. This will serve as a base line for comparison with my next annual test to verify for possible bone loss (resorption) and at the same time to find for any natural countermeasures taken by my body while on the HT environment (low testosterone). A balance between the Osteoblast (that forms bone) and the Osteoclast (that resorbs bone) should exist. Calcium in the serum should be checked in addition to the DEXA scan.
If the results are steady (no changes) I may not need the “help” from a supplement. Bisphosphonates are known to be preventive medicine but they too got their own side effects. They should be taken with care. My doctor recommended Alendronic acid 70mg/week which I took during three months but stopped it because I have been doing a “revamp” on my dental care.
I am taking on on/off bimonthly periods, Simvastatin 20mg/daily (a statin) to get the cholesterol down. The last annual results were; Total=157mg/dl; HDL=41; LDL=90.
I personally recommend a control on cholesterol for guys on HT due to the low levels of testosterone. T is made from cholesterol and with the factory “closed down” (the testis), the stuff will be high and prejudicial to the cardio vascular system.
In this respect I also included an angiography, echocardiogram, and ultrasound before starting HT with the same principle of the bone density scan.
I will not take medicines of this “calibre” as preventive but when it is needed. My body if fit will do the job properly and effectively. I never checked for lack of vD because Portugal is made of fruits, nuts and sunshine. Diet and physical exercises are important in my preventive program.
DHT test is not included in the government controlled Social Security Health program here, so that it is not a typical test prescribed by the doctors. I have not taken one but I thanks Jim’s advice and have decided to get it tested now to serve me as a comparison value in the future and to verify the effect of the testosterone produced by the adrenal glands. High levels of DHT could represent an active work by the glands which could lead to failure in the HT regimen.
HT related pituitari etc. tests in 2009 was; T3= 1.42ng/mL; T4= 7.20µg/dL ; TSH= 1.46mU/L
You could formulate a list of question from my example above. The importance is that you believe in your protocol and that you can show it to Irv’s doctor. He will understand it.
I expect and am thrilled to hear about his PSA in the Zeros.
Do not allow anxiety to take over . Let the course at its own timing and be cautious prudently.
The best to all of you
Last edited by Baptista; 08-19-2011 at 05:30 AM.
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Thank you for the detailed reply, Baptista. I urged Irv to look into the Super Bio-Curcumin and he requested that I send him the link via email....so I will. As for the bone density test, the doctors here don't believe in dealing with it until a year after hormone therapy has begun as they believe that it takes a year before you see any bone loss. So, no prior tests have been done and there won't be anything to compare results to when he does, eventually, have the test done. My assumption, however, is that there must be a marker for normal bone density and bone loss can be detected when and if it occurs. I don't know what the side effects are of the bisphosphonate drugs but my hunch is that the doctor will say that Irv doesn't require such a drug at this point. However, I don't feel I have enough knowledge on that to know whether to agree or disagree. I do know that I'd like Irv's bones to remain strong as it makes sense to me that the weaker a bone is, the more vulnerable it is to the cancer. That being said, I don't think there's any immediate danger as the hormone therapy is keeping his cancer under control so far. We received his most recent PSA result which was done on August 16th. His PSA dropped by .01, from .04 to .03. This is the 6 month mark after starting the Zoladex injections, so I guess that's a good thing. I do admit that I was hoping for .01 or less but as long as the number is still on a downward trend, then I'm not complaining too much. Since his cholesterol is also at normal levels, I'm not yet very concerned about the statin drug, especially since his PSA is indicative of continued cancer control.
I look at this process of attack as taking various steps in that I don't have to focus on everything at once. So, the bisphosphonate and statin drugs are taking a bit of a back seat to the Super Bio-Curcumin at this point. That is something we don't need a doctor's approval on. I think it's worth questioning the doctor on the issue of bone density and the two mentioned drugs but I'm quite sure we'll face resistance at this point anyway. This is the same wonderful surgeon who told Irv, after checking his wound, to have the staples taken out and that there'd be no worries, in spite of the home healthcare nurses concerns, and then the incision opened wide up just as the nurse had suspected....
That's why I rely on some of you here with long-term experience to guide me on what to push for. Am I on the right track? Irv's appointment is next Wednesday so hearing back from you on the above issues before that date would be so very appreciated.
I love this board! (Sorry if this message rambled on too much)