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Old 07-05-2010, 03:44 PM   #5
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Re: recently diagnosed and scared

Hi jamesrobt,

I would also like to welcome you to the board! As of this time you have two great replies from Johnt1 and GUAMJOHN. I'm a veteran of intermittent hormonal blockade therapy in my eleventh year now as a survivor, and I'll add some comments in great to an excerpt from your initial post on July 4 (in black for your text).

I'm new to this board so I hope I'm doing this properly - please tell me if I'm not. I'm 62 years old, Caucasian, reasonably active and was diagnosed with PC 3 weeks ago following a routine check-up with my family doc. She called me to report a PSA of 23 and made an immediate referral to a urologist. After a DRE and biopsy, my Gleason was reported as 8.

Do you know if the pathologist scoring the Gleason was an expert in prostate cancer? Many pathologists doing our scoring are not; they are general pathologists handling all comers: boys and girls, men and women, for all kinds of medical conditions. There is a substantial amount of undergrading going on, but also some overgrading. If your review was not done by an expert, the doctors I follow would like to have a second opinion review done by a pathologist who is expert in prostate cancer. This is important as the Gleason score is so key to decision making and case management.

But a follow-up bone scan and MRI revealed 3 foci on my pelvic bone.

I'm sorry you got such a rough introduction to having prostate cancer. Your case, with that routine check up, reminds me of me. I was stunned to find out I had a challenging case of prostate cancer when I felt so healthy.

The radiology oncologist said that RT was no longer an option and my only course of treatment is hormones.

My impression as an informed layman is that that is sound advice from the vantage point of the standard practice of radiation, and I'm a fan of hormonal therapy. However, hormonal therapy is rarely curative (chronic and controllable can be good!) , and, in the hands of experts, you still might have a shot at a cure with radiation.

That's based on emerging research for patients with just a few detectable metastases. Such cases have been given the awkward name of "oligometastatic prostate cancer," meaning just a few mets. If the rest of the cancer suspected appears to be within the range of radiation delivered by the usual methods, it is looking like the stray mets can be individually zapped and wiped out, giving a shot at cure. However, I'm not sure how the Gleason 8 finding affects this, especially in conjunction with a PSA clearly exceeding 10. There has been at least one thread or post about oligometastatic prostate cancer on this board, recently, I think.

I've been on bicalutamide since my diagnosis and am tolerating it well.

The other responders have both emphasized a combined assault on the cancer, rather than relying just on the medium strength drug bicalutamide for a challenging case. I'll join that choir! Also, some of the side effects of bicalutamide, which may not appear for a while, are often minimized or absent when the stronger drug, usually a LHRH-agonist class (Lupron, Zoladex, Viadur, Trelstar) is also used. Adding the third drug - a 5-alpha reductase inhibititor - further hems in the cancer.

It's reassuring to read posts on this message board from men who have survived 10 years or so - much longer than the 2 to 5 years predicted elsewhere.

Modern, well-executed hormonal therapy, and second line hormonal therapy as a fall-back, are often very powerful approaches.

Finally, here's my question: there seem to be two thoughts on HT. One group says keep using bicalutamide as long as it controls my PSA (a couple of years seems to be the max) and save the other drugs until needed later. The other school says to bring out all the big guns at the very beginning. I am asymptomatic otherwise.

Most men will leave doors open for the cancer if they do not use a combined approach, especially if cases are challenging. The Primer is excellent on this, as is the book "Beating Prostate Cancer: Hormonal Therapy & Diet," by Dr. Myers.

Good luck, and I hope you will participate actively on the board.

Take care,