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Re: PSA Level of 518 and MRI Results Showing 90% Probability of Prostate Cancer

I know a chap in his late 60's who had a PSA ( I believe ) of more than a thousand. He was given 3-5 years to live about 7 years ago but is doing nicely with an experimental Hormone Regimen that is given for periods of time and then stopped ( totally for about 1.5 years now ) and restarted to prevent his body from becoming resistant to it. Kind of similar I guess to interval training techniques for athletes. He reluctantly goes back on shortly as his PSA is beginning to climb. He doesn't like the side effects of the Hormone therapy. Bottom line, advances are helping to prolong life.

Re: PSA Level of 518 and MRI Results Showing 90% Probability of Prostate Cancer

Sorry you have to confront this dreaded cancer. With a psa at that level and the MRI information, very consistent with PCa and metastasis and L (lumbar areas like L2, L3) and thoracic areas like T7,8,9 are fairly common areas to show up. It is possible in some instances to do spot radiations to eleviate possible pains, and stop PCa in that area from proliferation. (see cyberknife or SBRT information on searching).

A common heavy hormone therapy is used on most patients here in the USA. Myself disagree with the remove everything approach and at his age also troubling. Not sure what options you have or can afford to do. Do you have any kind of insurance plan? See commonly used drugs for PCa at www.hrpca.org (see proven treatments tab) gives you a better idea of what has been used by others.

Best to you and will look for your pathology report information, too. Quality of life is important in all this too, get another opinion on the remove everything idea especially in his case.

Re: PSA Level of 518 and MRI Results Showing 90% Probability of Prostate Cancer

Hi all,

Just got the biopsy results yesterday:
Nature of specimen:
TRUS biopsy prostate: a. Right Lobe (7 strips) b. Left Lobe (7 strips)

Gross:
a. Right Lobe: Multiple strips of prostatic tissue measuring 10-20mm in length each. Processed in 2 blocks.
b. Left Lobe: Multiple strips of prostatic tissue measuring 5-8mm in length each. Processed in 1 Block.

Miscroscopic:
a&b: Sections of the prostatic cores from both lobes show more or less similar picture. The tissue comprises of mostly hyperplastic prostatic acini with hypertrophied stroma. At least 4 fragments from right lobe and 3 fragments from left lobe show infiltration of the stroma by difuse sheets of malignant cells with enlarged hyperchromatic nucleus containing a prominent nucleolus. Perineural lymphatics appear to be free.

Diagnostic:
a&b: Poorly differentiated adenocarcinoma of the prostate, Gleason Grade 4, total Gleason Score: 4+4.
Extent of involvement: four fragmented cores from right lobe and three fragmented cores from left lobe.
Perineural lymphatics: free.

The urologist advised 2 alternatives for the treatment:
1. S/C Lucrin 11.25 every 3 months and Casodex 50 mg daily for 2 weeks OR
2. Orchidectomy

With the confirmed high Gleason Score and metastatic prostate cancer, our initial thought is to go for the intermittent hormone therapy (combined with herbal therapy and strict diet).

Appreciate your advise on this and please also enlighten me on below:
- Should I get a bone scan for my father? I am afraid he will be paralized in case we do not take prompt action.
- In Indonesia, the most common injection used is Zoladex (at least from what I read in the website/discussion forum). Does anybody know if we can replace Lucrin with Zoladex?

My father has no medical insurance, but I will try my best to get him the most appropriate treatment.

Thanks,
Roni



Re: PSA Level of 518 and MRI Results Showing 90% Probability of Prostate Cancer

Other factors from pathology, number of positive cores found the percentages of PCa in them, type of PCa assuming his is the typical version and not some variant type (rarer to have anyway).

The uro-doc is offering typical possible offerings, that psa of 518 is huge and suggests metastic PCa or micro mets, less chances of hiding from scannings limitations for detection (it is imperfect sciences), should show up on scans is highly likely. So, being an average guy and no credentials except being a curious type throwing out my reply. The orchiectomy is cheaper and simple, just doesn't sound to great to a male, others have done this with useful successes, the side effects are similar to the drugs offered.

Zoladex is basically the same thing as Lupron, Eligard, Trelstar....they are all LHRH types of drugs for PCa. Zoladex is like a pellet injected under the skin (belly area typically) whereby Lupron is liquid and injected into buttocks area typically. Zoladex will leave a black and blue mark visible for a month or so and then disappates away (not a big deal really). Zoladex is generally cheaper too. I have done both of these and other things, the side effects are basically the same. Hope you do well on these choices and there are still others, nothing is overly simplistic in PCa. Casodex generic is reasonably priced (low) and you can read about its effects, the two together is called ADT2 or CHB and other names. It can render better results perhaps, and using casodex prior like 12+ days prior to Zoladex or any LHRH is very important, especially in your case.

Re: PSA Level of 518 and MRI Results Showing 90% Probability of Prostate Cancer






"The uro-doc is offering typical possible offerings, that psa of 518 is huge and suggests metastatic PCa"

Hi Bob,

It's been said many times on this forum that there are no rules, that every case is unique. In my case, I was diagnosed with a PSA of 800 with the cancer confined to the capsule. I haven't had a bone scan, MRA or CAT, so who knows what's lurking . I feel good, but that's no indicator. My PSA, with Degarelix, has been lowered twice to .05.

Jack from New Jersey

Re: PSA Level of 518 and MRI Results Showing 90% Probability of Prostate Cancer

Roni,

Sorry to read what we suspected would be the case. Certainly you can go for 12 weekly Zoladex jabs. The Casodex at the start is important to deal with the initial PSA flare from the Zoladex treatment. I thinbk you should dismiss the thought of intermittent Zoladex treatment. With your father's hsitory he is likely to be on this for life















Roni, I'm sorry to read what we suspected might be the case with your father. You can certainly go with Zoladex (10.8 mg twelve weekly is usual)but I think your father will be on this for life. I doubt if anyone would advise intermittent use in his case. Certainly the Casodex will be needed for at least fortnight at the start to deal with PSA flare (I think I had it for 28 days).

As regards rhe bone scan, I'm sure it is advisable in case large enough mets show up, which would enable focussed treatment of them. But it is quite possible that the disease will have spread via micromets (which don't show up but which can be well controlled for years by the Zoladex.

I see that cost is a consideration here, does anyone think that DES(much cheaper than Zoladex)might be a route to take?

Zoladex is chemical castration but is reversible. Orchidectomy isn't. Whether to go for the latter is a matter for your Father's self image.

Good Luck!

Ed














Re: PSA Level of 518 and MRI Results Showing 90% Probability of Prostate Cancer

Bob, Ed,

Thanks for your feedback. I just arrived back from Malaysia.
So for my father treatment, we have discussed with the urologist in Penang and decided on the following:
1. 11.25 Mg Lucrin (Lupron or they call it Tapros in Indonesia) injection every 3 month
2. Everytime the injection is done, Casodex will be consumed continuously for 2 weeks
3. Take vitamin D supplement on a daily basis (Bio Enhanced)

In addition to the above, we will also take the herbal therapy (similar to the one taken by Stephen Taylor, refer to www.cacare.com) and implement strict diet (the aim is to go for vegetarian diet, less processed food and minimum sugar). Every 3 month, we will monitor the PSA level and see whether the hormone therapy needs to be continued or temporarily stopped.

Fortunately the cost of Lupron/Zoladex in Malaysia/Indonesia is much cheaper compared to Singapore (I don't know why the price is Singapore is ridiculously higher, around 3 - 4 times higher) so I can still afford to go for this option.

Best Regards,
Roni

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