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Old 10-22-2012, 02:14 PM   #1
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Cryosurgery Advice

Currently into my tenth month of HT (Lupon/Casodex/Avodart) and intend to continue to a least next April current psa <.07.

Recently had a consultation with an oncologist in Malaga. He suggested that there was still a chance of a cure in my case, due to the fact my psa has never gone above 1.4 since surgery in 2008 he thinks that the cancer is still confined to prostate bed.
The oncologist feels Iím too fit and healthy to continue with HT as this may last only a few years, but is willing to support me if I want to go intermittent HT.


He suggests to let my psa rise to at least 1.5-2.0 and use MRI to locate the tumour. The tumour would then be eradicated with cryosurgery carried out by Italian surgeon Dr Franco Lugnani. In Malaga.
Cost for this procedure is between 12000-14000 Euros.
Obviously this throws up a few questions.

1. Is it possible that after failing surgery and SRT that a cure could be possible.
2. Is this just a money making exercise, with a high risk of failure.
3. Is MRI possible to locate cancer with a psa as low as 2. Isnít Color Doppler the preferred method.

As anybody been down this route, google does not seem to throw up any similar cases.

 
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Old 10-22-2012, 05:15 PM   #2
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Re: Cryosurgery Advice

landcrab47,
My surgery failed with my PSA finally reaching 0.5. I went to Loma Linda University Medical Center and had salvage using Proton Therapy. PSA 0.01 after 2.5 years and no side effects.
Check out the Rinecker Proton Therapy Centre in Munich, Germany. I have read that many people have had bad results from Cryo and that it is very practitioner dependent.
Bob

 
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Old 10-23-2012, 12:57 PM   #3
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Re: Cryosurgery Advice

Hi Landcrab47,

A very good friend of mine is in a similar situation. He's experiencing rising PSA after RP and SRT, and has been through a cycle of HT. Like you, he is now letting his PSA rise to about 2.0 in the hopes of detection, treatment and cure. In his case, he will be going for a C11Acetate PET/CT scan next week in the hope that his PC is oligometastatic (limited to just a few lesions so far) and can be treated and cured with highly targeted SBRT to any affected lymph nodes or bone mets.

There are so far only two PET scans that can detect metastases that small - C11Acetate and C11Choline. C11Choline was FDA-approved just this month and is being given in the US only at the Mayo Clinic. C11 Acetate is in clinical trials in just a few places in the US. Because the half-life of C11 is only 20 minutes, they have to be generated in by a cyclotron in the same location as the PET scan -- it can't be shipped. I've talked to advocates for both and seen photos of the scans. The Mayo folks say theirs has higher resolution. The Acetate proponents say that, unlike Choline, Acetate is not excreted through the bladder, which would mask any mets in the urinary tract area. My layman's guess is that they are both quite good.

If the C11 Acetate PET finds too many mets to be treated with SBRT, he will go back on HT. If it finds just a few metastases, those will be treated with SBRT. SBRT uses very precise, high dose rate X-rays to eliminate the mets in 5 treatments. It was initially developed to treat brain tumors where that kind of precision is critical. I am somewhat skeptical of using cryo for that purpose. In fact, I discussed that with some clinicians at the Arizona Molecular Imaging Center who are conducting a clinical trial of C11 Acetate. Unlike SBRT, cryo may only be used to treat any lymph node mets found, but not bone mets. Also, there is a concern that cancer cells may protect themselves with a substance called Cold-Shock Proteins.

If the C11 Acetate finds no mets, his next step would be a very specialized kind of MRI using feraheme as a contrast agent. It has the ability to detect very small amounts of cancer in lymph nodes (but not in bones). It is not currently FDA-approved but is in clinical trials. There are no other kinds of MRIs that have the ability to detect lesions that small. In fact, the best "multiparametric" MRIs (e.g., T2, DCE, DWI and MRIS), using 3 Tesla machines and endorectal coils, cannot detect lesions smaller than about .8cc and require a very experienced radiologist to find them. An advantage of the other two techniques is that any lesions light up (with the PET scan) and black-out (with the feraheme MRI), facilitating detection by even a less skilled radiologist.

Here is a study where both of these techniques were used:
http://www.ncbi.nlm.nih.gov/pubmed/22417806

You are lucky that one of the world leaders in both of these technologies happens to be in Europe, at the Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.

As to your last question on Color Doppler, Color Doppler US (CDUS) has been successfully used to find very small tumors in the prostate itself, smaller than the ones found so far by multiparametric MRIs. However, I don't see how it can be used to find tumors in the lymph nodes or bones.

- Allen

 
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Old 10-23-2012, 04:47 PM   #4
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Re: Cryosurgery Advice

Tall Allen,
I have read that for patients whose PSA reaches 2.0 after surgery the results are dismal and that the sooner the better you have Radiation Therapy for salvage. The article I read was several years old quoting Dr. Kevin Slawin of Baylor.
Bob

 
Old 10-23-2012, 05:08 PM   #5
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Re: Cryosurgery Advice

Harpman,

That's an entirely different situation. That refers to the case of someone who has not yet had SRT. In that case, SRT should really begin before PSA reaches .2. Landcrab47 has failed both RP and SRT and has been on HT.

It is necessary to come off of HT and allow the PSA to rise in order for any tumors to be detectable using current methods. There is a risk to that, but no more than the risk of the vacations on Intermittent HT, when PSA is also allowed to rise. For most men, the potential of a cure far outweighs that risk.

- Allen

 
Old 10-23-2012, 06:15 PM   #6
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Re: Cryosurgery Advice

Tall Allen,
Right. The SRT didn't twig when I read your posting and I would be doing the same thing as your friend. I'll just mention the article I read entitled, "Prostate Cancer: Curcumin Curbs Metastases, Study Shows" in case you didn't read my posting on another thread. It may be of help to your friend.
Bob

 
Old 10-23-2012, 09:02 PM   #7
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Re: Cryosurgery Advice

Curcumin looks great on paper, but fails miserably in real life for two reasons. First, it is poorly absorbed through the gut. Some preparations include "bioperine" derived from black pepper, which increases absorption. However, then it runs into the second obstacle -- the liver. The liver eliminates it almost totally on the first pass from the digestive tract and it is excreted before it can get to the prostate cells where it might do some good. Scientists have modified curcumin into dimethoxycurcumin and "ASC-J9" which do make it through the digestive obstacle course. They are in early clinical trials now.

- Allen

 
Old 10-24-2012, 05:00 PM   #8
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Re: Cryosurgery Advice

My favorite supplement this month is called gamma-tocotrienol. It's chemically similar to Vitamin E; in fact, Vitamin E may block its beneficial effects. My friend who is in avery similar situation to Landcrab's has been taking it for a month and his PSA velocity has dropped by 40%. It is thought to work by enhancing the anti-cancer effect of the Estrogen Receptor-beta.

- Allen

 
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