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Cancer: Prostate Message Board
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Old 12-19-2011, 10:26 AM   #1
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Prostate cancer 4 years post IMRT, HDR brachy and hormones

Am an over 50+ year old otherwise healthy man semiretired professional. I was diagnosed with Advanced prostate cancer in 2007 during a routine colonoscopy by Internist, MD stat PSA of 39.3 and DRE enlarged asymmetrical and nodular the following day with Urologist, MD urologist did in office biopsy 03/2007 with demonstrated Gleason’s in 21 samples of 4+4 =8s and 4+5=9s. I was immediately treated with Hormones by Urologist, MD. Confirmed prostate hypertrophy with CT and MRI on followed with second Urologist, MD showing a negative cystoscopy for invasion and negative bladder biopsy. Negative PET scan. Received in major university medical center brachytherapy – high dose-rate (HDR) from combined with IMRT with Radiation.

Followed also by Medical Oncologist, M.D., Chairman of the Department of Urology and Chief of the Division of Urologic Oncology.

I was on the hormones under Urologist, MD of (Casodex (bicalutamide) and ZOLADEX (goserelin acetate implant) about three years with a PSA of .01 for most of the period.
Developed slight bilateral gynecamastia and the typical hot flashes on the hormones, tolerated the chemical castration well otherwise with always soft, non enlarged, non-nodular DRE’s.
Was reasonably symptom free from removal of hormones, four months.

In June 2011, I began to have symptoms of pain in the left side mid back and left lower neck radiating out to the peripheral regions respectively. Performing three sequential lab tests revealed a rapidly increasing PSA follow up with Diagnostic Bone scan, Plane films, MRI and CTs have confirmed 2 distinct metastatic lesions in the bone on the left side in the body of a cervical vertebra and in the left pedicle of a thoracic vertebra. Also seen on the CT’s was activity in a lesion in left femoral neck, sclerosis in the pelvic bones and an enlarged precarinal lymph node which is reactive. There was also right iliac lymphadenophy as well as a right external iliac node.
ALSO seen two small liver cysts and a left upper renal cyst.

I saw a chief of oncology in late 2011 and he had suggested returning to the hormones (Casodex and Zoladex), adding XGEVA - Denosumab injection (Prolia) infusion and to get localized radiation to the two bony sites. However I would like to consider all of the options including the Gamma Knife or targeted treatment directed at achieving tumor ablation alternatives radiofrequency ablation or stereotactic body radiation therapy (SBRT), as options to the traditional x-ray. I am not very excited about doing x-ray treatments so close to the cervical spinal cord.

I am now 12/2011 considering the administration of the (Casodex and Zoladex), adding XGEVA, against other options of Oncological medical therapy option.

I am now looking to make an informed assessment before continuing next phase of treatment.

Last edited by Administrator; 12-19-2011 at 06:45 PM.

 
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Old 12-20-2011, 10:27 AM   #2
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Re: Prostate cancer 4 years post IMRT, HDR brachy and hormones

NatuaralCure
Your post indicates that you are well educated in the matters of prostate cancer and know well about your status. The protocol for treatment you describe seems to be a good choice in your case.
I would recommend you to investigate on clinical trials which may provide you similar protocols with the latest drugs. This is a good opportunity to gain access to medications which have proven to be effective. Just visit the site http://clinicaltrials.gov/ct2/results?term=prostate+cancer.
Alpharadin (radium-223 chloride) is one of the newer drugs which have shown to be effective in treating cancer in bone. You can read details using a net search engine.

All treatments have risks and side effects. I would recommend you to read details on the influence of the treatment and to get second opinions from several specialists.

The best to you.

Baptista

 
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Old 12-27-2011, 10:02 AM   #3
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Re: Prostate cancer 4 years post IMRT, HDR brachy and hormones

At this point it may be helpful to seek a 2nd opinion from a specialist that treats advanced prostate cancer patients. If you are being treated at a major institution they are limited in the protocols they can use. An experienced Prostate oncologist like Dr Myers in Earlysville Va or Dr Scholz in Marina Del Rey Ca may be able to shed some light on the newer protocols that are showing promise.
JohnT

 
Old 12-28-2011, 05:32 AM   #4
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Re: Prostate cancer 4 years post IMRT, HDR brachy and hormones

Hi YnoNaturalCure,

Here's just a quick thought to add to the responses on your thread. Has any doctor discussed adding Avodart (or finasteride) to the combo of Zoladex and bicalutamide? While these drugs are mild in themselves against prostate cancer, by sharply reducing DHT available to fuel the tumor, they make the antiandrogen far more effective, thus greatly boosting the impact of the other drugs. It's possible you might get more mileage out of the Zoladex and bicalutamide by simply adding Avodart. Has your DHT level been monitored as well as your testosterone level while on combined blockade? That should have been done. Ideally, DHT should be less than 5. If not, the back door of the barn is open and the cancer is being fueled, even in the face of Zoladex and bicalutamide. (DHT is better at binding to androgen receptor, the protein that constituts the fuel ports for the cancer cell, than bicalutamide; in effect, it muscles bicalutamide out of its blocking position.) Triple blockade, intermittently, has been my only therapy for a challenging case. (In addition I've had supporting drugs and some drugs on a temporary basis to extend the off-therapy period, specifically thalidomide. I also believe that a lifestyle program featuring nutrition/supplements, a mild drug (statin), exercise and stress reduction have helped.

I believe that the docs who approach the disease like the ones Johnt1 mentioned would take this approach.

Adding Avodart to the approach you are considering near the end of your post, plus monitoring for at least testosterone, DHT and PSA, might bring you renewed success.

Take care,

Jim

 
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