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Any ideas guys? I got a letter today from the professor of urology who sent me to have a da Vinci with Professor Roger Kirby.
He has invited me to take part in a trial of Dutasteride (a 5 alphareductase inhibitor, also known as Avodart, Avidart, etc). It's a trial with a group on placebo and some on the real thing (double blind) to see if the well known capacity of this drug to shrink the prostate (and grow hair!!) also destroys cancer cells, which certain experts think it might.
As I have said in many different posts, my da Vinci failed to remove the whole gland and left me with 6 grams. My PSA has remained constant at 0.8 over 3 tests during 9 months. Also, sequential, differentiated scans plus US scans, seem to indicate benign tissue.
My thinking is that if there is any trend up in PSA I will go for prostate mapping via 12 trans perineal needles. If that shows cancer I'm inclined to HIFU. But I'm so pissed off with interventions, that I don't even want this big biopsy (prostate mapping) unless the PSA trends up. If it doesn't I continue Watchful Waiting.
The problem with this trial is :
(a) although it will most likely halve my PSA, if I am not on the placebo, I won't know if I have cancer cells in the residue tissue and whether the PSA is halved because the drug killed them, or whether the PSA from the cancer cells is just masked
(b) a known side effect of Dutasteride is loss of libido and impotence. Since a year out of surgery "the old chap" is showing some signs of stirring and since I do have libido OK, I don't want to risk losing that to shrink a puny 6 grams which may not even have cancer.
Seems to me that this trial would only be of interest to me if I had tracked my PSA up and saturation biopsy revealed cancer cells. Then I would know whether the drug destroyed those cells.
I think I would just be guinea pig for no purpose unless I already knew I had more cancer in there.
If it were me (and this is just me), I'd avoid any trial where there was a chance of getting a placebo. I'd go for the prostate mapping to see if they find any spots of cancer. Who knows, you may in fact be cancer free.
Ted, ... if you are looking for opinions ... then, I agree, do not participate in this trial. Continue with the watchful waiting .... see what the PSA does before taking any action or intervention.
Joe
Hi Ted,
Not sure about the "masking psa" bit. As I understand things, when we are at this sort of stage, psa is psa . It is not masked.Suggest you double check on this.
I've started Intermittant HT and have gone onto Avodart for the Off-period.
You could just try Avodart for a while & see what happens.
Regards
Rob
I guess I'll add my opinion but remember it's just my opinion and you have to go the way your heart tells you no matter what anyone else says. Having said that I'll post a couple of thoughts that probably go along with what you've already said.
First, since your PSA has been stable at 0.8 for three PSA tests over 9 months things are looking good for you right now so watchful waiting at this point seems like a good choice to me.
Second, I agree that if the Avodart shrinks what's left of your prostate your PSA will go down some but for what reason, a smaller prostate or some cancer cells that were killed by the Avodart. So your concern over being a guinea pig seems reasonable to me.
So I agree with you that the trail may not provide you with much information about yourself and a cautious approach by monitoring your PSA is probably what I'd do. Then if it starts upward seek additional treatment.
But please don't let any of our opinions change what your heart tells you to do, it's your life and you must go your own way. Recently I've been posting a lot of the information I find during my search to better understand this disease, and the more I find out the more I question some of the practices that are so common when the medical community deals with us. I may post some more stuff I just found and ask for opinions from others here too.
I think I would just ask my Doc to add Dutasteride to your treatment. It is a very effective at preventing the conversion of T to DHT. It is also yoxic to PCa cells. Both of these are good things.
There is probably no down side. It does help with urinary symptoms.
