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Old 11-08-2012, 01:36 AM   #1
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Dad Diagnosed With Gleason (3+5)

My dad is diagnosed with Gleason (3+5) today.

My parents currently live in China with my sister in a provincial capital city.

I live in the SF bay area. My parents visited me numerous times in the last few years.

We are in total shock and trying to cope with the news.

My dad is 66 years old with good health.

His tPSA is over 100. His fPSA is 16.86.

His bone scan came back negative.

He will have CT scan for lymph nodes in the next few days.

Prostate cancer is not very common in China. The number of operations performed in the province where my parent live is relatively small.

I plan to have my dad's prostate biopsy specimens sent to Dr. Jonathan Epstein in JHU for reexamination. Is there anyone familiar with international shipping of prostate biopsy specimens?

Surgery, Radiotherapy, Hormone therapy, what should we do?

My sister is contacting doctors in Beijing that have more experiences with prostate cancer. I want to take my dad to a hospital with prostate cancer expertise in the SF bay area. Can anyone recommend some good hospitals and doctors? My dad has no medical insurance in the U.S.. Does anyone know the cost of the treatments in the U.S. without medical insurance?

Your helps are greatly appreciated.

Thanks,

Tim

 
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Old 11-11-2012, 06:13 PM   #2
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Re: Dad Diagnosed With Gleason (3+5)

Tim, Do you know the history of the PSA readings? My PSA's were rising and I had a biopsy when it got to 4.5. The biopsy showed no cancer. One year later, I had a urinary tract infection the day they took the blood sample for the PSA and it came out at 112. A repeat 4 months later showed 11. It eventually came back down in 6 to 9 months and by that time it was 6+. If your dad had an infection at the time the blood sample was taken, the PSA reading can go out of sight.

A Gleason of 8 (3+5) is high and I would want to have it removed. My brother had an 8 also. His was removed 13 years ago and he is doing well and currently has PSA's of zero.

Good luck
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Old 11-11-2012, 07:46 PM   #3
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Re: Dad Diagnosed With Gleason (3+5)

Thanks, Billy.

I will check with my sister to see whether PSA is taken when dad had an infection.

We are contacting surgeons in Beijing.

Good luck to everyone.

 
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Old 11-12-2012, 04:13 PM   #4
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Re: Dad Diagnosed With Gleason (3+5)

If it is confirmed that he has Gleason 5 cells and with such a high PSA, I would worry that it is not confined to the prostate. My inclination for such high risk disease would be to use a multimodal therapy like hormone therapy (starting now and continuing 2 years after treatment) + brachytherapy boost to the prostate + external beam radiation. There are several good options in the Bay Area including the radiation oncology department at Stanford and at UCSF (I know of Dr. Carroll there by reputation).

You can plug his biopsy results into a nomogram (e.g., Memorial Sloane Kettering makes one available online) to see what the risk is that the cancer is not contained. Based on that, you may want to rule out surgery as an option.

If cancer is detected in his lymph nodes, that will change his treatment options.

- Allen

 
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Old 11-13-2012, 01:31 PM   #5
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Re: Dad Diagnosed With Gleason (3+5)

Quote:
Originally Posted by emeraldglen View Post
My dad is diagnosed with Gleason (3+5) today.

My parents currently live in China with my sister in a provincial capital city.

I live in the SF bay area. My parents visited me numerous times in the last few years.

We are in total shock and trying to cope with the news.

My dad is 66 years old with good health.

His tPSA is over 100. His fPSA is 16.86.

His bone scan came back negative.

He will have CT scan for lymph nodes in the next few days.

Prostate cancer is not very common in China. The number of operations performed in the province where my parent live is relatively small.

I plan to have my dad's prostate biopsy specimens sent to Dr. Jonathan Epstein in JHU for reexamination. Is there anyone familiar with international shipping of prostate biopsy specimens?

Surgery, Radiotherapy, Hormone therapy, what should we do?

My sister is contacting doctors in Beijing that have more experiences with prostate cancer. I want to take my dad to a hospital with prostate cancer expertise in the SF bay area. Can anyone recommend some good hospitals and doctors? My dad has no medical insurance in the U.S.. Does anyone know the cost of the treatments in the U.S. without medical insurance?

Your helps are greatly appreciated.

Thanks,

Tim
Nine years ago my 47 external radiation treatments for prostate cancer cost $50,000. I only had to pay about $6,000 of it. But there is better radiation now that I don't know about: Proton Beam Therapy Radiation.

 
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Old 11-30-2012, 11:34 AM   #6
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Re: Dad Diagnosed With Gleason (3+5)

Some updates.

Opinion from Dr. Epstein is worse. 100% of the 12 slides are positive. Gleason score is now 5+4.

He suggests HT and RT. Said surgery will probably make no sense at this point.

Bone Scan negative (11/05/2012).

I think that CT scan is also negative.

Current Treatment:
Patient is on Hormone Therapy, beginning from 11/08/2012.
Bicalutamide tablet 50mg (AstraZeneca): 1 tablet daily, beginning from 11/08
Leuprolide injection: Once every Month, beginning from 11/08
Other Medication:
Tamsulosin Hydrochloride Sustained Release Capsules: 1 capsule daily, beginning from 11/08
Liptor tablet: 1 tablet daily, beginning from 08/28/2009

I read Dr. Walsh's book and Dr. Meyer's Book at HT and diet.

I am going to buy the recommended diet supplement in Dr. Meyer's Book.

Is there anyone experienced with taking diet supplement in Dr. Meyer's Book?

What should we proceed from this point? What is the expected life span for this stage of prostate cancer?

Thanks,

Tim

 
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Old 11-30-2012, 03:47 PM   #7
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Re: Dad Diagnosed With Gleason (3+5)

Are you looking at an old edition of Dr Snuffy Myer's book? The problem with books is they get outdated so quickly.

There was a large study conducted on Selenium and Vitamin E and the risk of PC, called the SELECT Trial. They found that they both increased the risk of prostate cancer (JAMA, Oct 12, 2011). They both would work against the radiation treatment.

Large amounts of Vitamin D (and especially Calcium) have been associated with an increased risk of PC, as have very low levels of Vitamin D. It has also become increasingly unclear that supplementing Vit D will protect bone mineral density.It is not a good idea to take too much. Zometa, available by Rx, may protect his bones from hormone therapy and may prevent bone metastases.

Lycopene has been found to be useless against PC when it has been tested in prospective clinical trials.

The other supplements may be helpful, especially soy isoflavones. My friend says that gamma tocotrienol has been helpful in slowing down his PSA, but it should not be taken during RT. Aspirin may be good too.

By prescription, there is some evidence for Metformin, statins and Celebrex.

- Allen

 
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Old 11-30-2012, 04:00 PM   #8
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Re: Dad Diagnosed With Gleason (3+5)

Quote:
Originally Posted by Tall Allen View Post
Are you looking at an old edition of Dr Snuffy Myer's book? The problem with books is they get outdated so quickly.

There was a large study conducted on Selenium and Vitamin E and the risk of PC, called the SELECT Trial. They found that they both increased the risk of prostate cancer (JAMA, Oct 12, 2011). They both would work against the radiation treatment.

Large amounts of Vitamin D (and especially Calcium) have been associated with an increased risk of PC, as have very low levels of Vitamin D. It has also become increasingly unclear that supplementing Vit D will protect bone mineral density.It is not a good idea to take too much. Zometa, available by Rx, may protect his bones from hormone therapy and may prevent bone metastases.

Lycopene has been found to be useless against PC when it has been tested in prospective clinical trials.

The other supplements may be helpful, especially soy isoflavones. My friend says that gamma tocotrienol has been helpful in slowing down his PSA, but it should not be taken during RT. Aspirin may be good too.

By prescription, there is some evidence for Metformin, statins and Celebrex.

- Allen
The version I have is the second version, published on 2007, which I bought from Dr. Meyer's website.

 
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Old 11-30-2012, 04:11 PM   #9
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Re: Dad Diagnosed With Gleason (3+5)

A lot has been learned in the last 5 years.

 
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Old 11-30-2012, 04:16 PM   #10
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Re: Dad Diagnosed With Gleason (3+5)

I agree with you, Allen.

I canceled some orders.

I plan to ship

POMx Pills

Nature's Way Soy Isoflavones Standardized -- 60 Capsules

Nature's Bounty Lycopene 10mg, 60 Softgels

Source Naturals Vitamin D-3 2000 IU (no calcium)

to my dad

Last edited by emeraldglen; 11-30-2012 at 04:18 PM.

 
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Old 01-06-2013, 05:40 PM   #11
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Re: Dad Diagnosed With Gleason (3+5)

some updates:

After 1st month HT, tPSA dropped to 28.10, FPSA dropped to 4.37

After 2nd month HT, tPSA dropped to 11.53, FPSA dropped to 2.77

I am a bit worried about the 2nd month result. The PSA drop is only around 60%.

Should we add Radio Therapy or other hormone drug into the mix now?

One thing that hinders the possible addition of RT treatment is the weather there.

Currently it is very cold in my hometown (lowest temp is around minus 10-15 celsius).

Last edited by emeraldglen; 01-06-2013 at 05:52 PM.

 
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Old 01-07-2013, 08:37 PM   #12
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Re: Dad Diagnosed With Gleason (3+5)

Has his testosterone level come down to less than 50ng/dL (1.74 nmol/L) or preferably below 20 ng/dL (.69 nmol/L)? It may be that he requires a different GnRH agonist or, even better, if available there, a GnRH antagonist like Degarelix (Firmagon). An antiandrogen will help stop whatever T or other androgens are left from turning on the cancer cells. Bicalutamide is the #1 choice in the US, but there are several others available. The third element he can add to his hormone therapy would be a 5-AR inhibitor like finasteride or dutasteride. It prevents T from converting into DHT, which is a much more potent androgen. This year, some new anti-androgens, abiraterone and enzalutamide became available for men whose PC has been unresponsive to other anti-androgens.

It seems to be critical that he get his PSA down below .5 before his RT begins.The following pubmed abstract links to a full text version which states that the PSA response to hormone therapy is the critical determinant of benefit when combining it with radiation therapy. It is not the duration of HT, but rather how low one can drive the PSA response (i.e., the PSA nadir) to HT that is most important. If he can use a more potent combination of hormone therapies to drive his T and thus his PSA lower quicker, he is likely to have a better outcome.
http://www.ncbi.nlm.nih.gov/pubmed/23227960

- Allen

 
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Old 01-07-2013, 10:10 PM   #13
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Re: Dad Diagnosed With Gleason (3+5)

Quote:
Originally Posted by Tall Allen View Post
Has his testosterone level come down to less than 50ng/dL (1.74 nmol/L) or preferably below 20 ng/dL (.69 nmol/L)? It may be that he requires a different GnRH agonist or, even better, if available there, a GnRH antagonist like Degarelix (Firmagon). An antiandrogen will help stop whatever T or other androgens are left from turning on the cancer cells. Bicalutamide is the #1 choice in the US, but there are several others available. The third element he can add to his hormone therapy would be a 5-AR inhibitor like finasteride or dutasteride. It prevents T from converting into DHT, which is a much more potent androgen. This year, some new anti-androgens, abiraterone and enzalutamide became available for men whose PC has been unresponsive to other anti-androgens.

It seems to be critical that he get his PSA down below .5 before his RT begins.The following pubmed abstract links to a full text version which states that the PSA response to hormone therapy is the critical determinant of benefit when combining it with radiation therapy. It is not the duration of HT, but rather how low one can drive the PSA response (i.e., the PSA nadir) to HT that is most important. If he can use a more potent combination of hormone therapies to drive his T and thus his PSA lower quicker, he is likely to have a better outcome.
http://www.ncbi.nlm.nih.gov/pubmed/23227960

- Allen
Thanks, Allen.

I will check out what additional medications are available to my dad.

 
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Old 09-02-2013, 12:14 AM   #14
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Re: Dad Diagnosed With Gleason (3+5)

Some updates:

PSA now drop to just over 3.

Bone scan/CT scan find one spot (on the spine). The doctor suspected that it is the early stage of bone metastasis. But he was not sure because it may be caused by other reasons. A few lymph nodes in bladder region may be effected.

My dad had a small bladder stone removal operation that did not heal as quick as we want. He feels better now.

He had his first Iv of boniva a week ago.

The doctor suggested surgical castration and then RT.

 
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Old 09-02-2013, 01:35 AM   #15
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Re: Dad Diagnosed With Gleason (3+5)

Tim

You have not shared enough information on the treatment and on the tests. The lower PSA is indicative that the drugs he is taking are still effective, but he should have a Testosterone test to verify if he is in chemical castration. This is important to do before saying "Yes" to his doctor's latest suggestion for surgical castration. Maybe your dad doesn't want the painful monthly shot but he can move up to a 6-month shot that would do the same "work" and would avoid the inconveniences.

Surgical castration is a permanent measure that will leave your dad lacking testosterone (T) forever, and T is necessary for other body functions. The Eligard shots can be continued (with higher 6-month doses) or discontinued when one wants to return to a T normal status. I wonder what is behind the reason for his doctor's suggestion for surgical castration, now after 10 months on Leuprolide.

I think that your dad's PSA could still go further down if he increases the HT protocol (doses and blockades). The radiation should be done the soonest and it will also be effective in bringing down the PSA. The RT field should include the findings detected in the bone and CT scans for the spot in bone and Lymph nodes.

I would recommend to have the radiation done at modern facilities with the latest equipment (IMRT/IG) and experienced physicians. One can expect better outcomes and lesser side effects if the facilities are proper.

Can you share some info about the hospital he is attending?
Some laboratories doing the PSA use assays with higher tolerances making it difficult to get to the lower levels. You should inquire about their professionalism too.

Best wishes for a successful treatment.

Baptista

 
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