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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2006salvage rt, aggressive tx
I'm learning a lot. This may not be news to anyone else, but I am just picking it up so I thought I'd share it. For one thing, those of you who may be candidates for salvage RT and are reaching the 0.1 ng/mL level of PSA, salvage RT is definitely most effective when done at that PSA, next most effective while it is <=0.2, and most ineffective if you get to .2. I have info on that you might want, email me privately (it is copyrighted). Also it works best with rising PSAs but otherwise good indicators (no pos margins, etc). Also about RT after RP, in many ways it has less SEs than when used as the primary treatment. For various reasons. This would be a plus, also the bladder neck fills the former-prostate space, so in our case that would be good, since we had positive bladder neck margins. Still, it is not clear cut at all that RT would be helpful in the situation we have. And I can't find a % increase in secondary cancers nor can I find any sort of assessment of what kind of increase in secondary cancers one might have when he already has a high risk of other cancers. The genetics consult we are getting in a week *might* provide some information about that. The other thing is that this is so uncharted. PCa is anyway, in many ways. But chemo as a first-ditch effort instead of last-ditch seems to be off the radar. We're doing adjvunct chemotherapy, and as far as I can find so far, that hasn't been documented in anyone. Usually it is only used after ADT failure. I sure would like information on it used earlier, if anyone has any. ADT is considered a 'holding pattern' treatment, not curative. So is chemo, but if it is used proactively....maybe it can cure. What we're hoping, anyway. Anyone know anything about that? Best regards to all. Tomorrow is chemo I. I am really looking forward to meeting with the radiation onc because I *hope* he will tell me why Steve's bone scan looked so weird. If anyone wants to see a bone scan that doesn't look like the pictures on the Internet, let me know. I can accomodate. ;o) > Also about RT after RP, in many ways it has less SEs than when used as > the primary treatment. I read and posted just the opposite a week or two ago . . . and the music goes 'round and 'round. I.P. > > Also about RT after RP, in many ways it has less SEs than when used as > > the primary treatment. [quoted text clipped - 3 lines] > > I.P. I've been wanting to tell you I was wrong when I said that the micro-assays didn't mean much. Why did they say there were worse SEs? > I've been wanting to tell you I was wrong when I said that the > micro-assays didn't mean much. I suspect no one knows their significance yet; most docs dismiss them as of little to no diagnostic value. Mine, for example, clearly and almost precisely doubled two successive quarters, then flatlined. > Why did they say there were worse SEs? If I recall correctly, it had to do with higher doses and a broader field than initial RT, in a more powerful attempt to kill a bigger and perhaps more robust target. I.P. > I'm learning a lot. This may not be news to anyone else, but I am just > picking it up so I thought I'd share it. For one thing, those of you > who may be candidates for salvage RT and are reaching the 0.1 ng/mL > level of PSA, salvage RT is definitely most effective when done at that > PSA, next most effective while it is <=0.2, and most ineffective if you > get to .2. I'm long past that decision, but may I assume that you are talking pre-HT PSAs?  SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum > I'm long past that decision, but may I assume that you are talking pre-HT > PSAs? Yes, the .1 PSA was pre-HT. After a week on Casodex alone, it was <.04 (undetectable). Today is also the first Trelstar. I thought you did have RT. >> I'm long past that decision, but may I assume that you are talking pre-HT >> PSAs? > Yes, the .1 PSA was pre-HT. After a week on Casodex alone, it was <.04 > (undetectable). Today is also the first Trelstar. > I thought you did have RT. I am referring to your assertion regarding RT, in general. Wherein the 0.1 standard is concerned, may I assume you are talking about 0.1 before HT is applied. If HT is applied, the cancer could be systemic and yet be 0.1. And RT would be very nearly useless in that case. This is not consternation. I was just wanting to make sure I understood. As for me; yes, I had RT a long time ago. That's why I'm long past that decision. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum > I am referring to your assertion regarding RT, in general. Wherein the 0.1 > standard is concerned, may I assume you are talking about 0.1 before HT is > applied. If HT is applied, the cancer could be systemic and yet be 0.1. > And RT would be very nearly useless in that case. This is not > consternation. I was just wanting to make sure I understood. I'm not sure, Steven. I don't recall them specifying, but I assumed they were all referring to PSAs not under the influence of hormones. What surprises me actually, is that anyone would prescribe RT without ADT, the difference is so clear. That would be like doing a clinical trial and instead of two chemo drugs, doing one chemo and one placebo. > What surprises me actually, is that anyone would prescribe RT without > ADT, the difference is so clear. That would be like doing a clinical > trial and instead of two chemo drugs, doing one chemo and one placebo. During the dark ages, when my dad got PCa, they did surgery (RRP only) and HT (Estrogen) and when spots showed up RT (Cobalt). Then you died. There were very few cures because it usually wasn't caught in time for complete removal. Way back when I was Dx'd, the typical treatment was surgery (LRP or RRP only); if that didn't work radiation (EBRT was king); if that didn't work HT; and when that failed (no "if" intended), chemo. Then you died. Now, there are combinations and reordering of treatments. That, I think, can be attributed to the pace in which cancer research is being conducted. It is not a slow, methodical progress. Studies and findings and results and atypical treatments are coming at us a light speed and from 7 directions with 7 times 7 permutations. Frankly, I cannot imagine a practicing urologist or oncologist that can keep up with it all. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum True Steve, I would say that there is probably a combination of treatments out there at this moment that could stop this disease from progressing any further. Maybe even kill it. The nanotechnology field by itself will revolutionize medicine. Unbelievable. We may live to see 100 years old. Keep the faith and hope alive. Dave P > What surprises me actually, is that anyone would prescribe RT without > ADT, the difference is so clear. Three reasons pop to mind: 1. RT fights localized cancer, while ADT fights systemic. ADT is arguably overkill on localized cancer treatable w/RT, and local RT is useless on systemic cancer. (Is systemic bone met treatment with Strontium 90 still a viable tool?) 2. SEs. 3. More subtle differences in such things as timing, biochemical vs clinical vs symptomatic failure, potentials for cure and exacerbation, and the long list of unknowns and contradictions. I.P. > > What surprises me actually, is that anyone would prescribe RT without > > ADT, the difference is so clear. [quoted text clipped - 3 lines] > arguably overkill on localized cancer treatable w/RT, and local RT is > useless on systemic cancer. (Is systemic bone met treatment with Many people, with good reason, think that all PCa is systemic. That there are PCa cells throughout the body even when the tumor is still localized. Besides that, the studies show that ADT treatment with RT works far better for localized PCA than more advanced. If ADT were overkill in that situation then it would not have such an impact on the RT outcomes in those favorable circumstances. Uncharted, chemo as first treatment sounds good. Also using the vaccine's as a first treatment when the psa is low sounds better These have both been given as last ditch treatments. Most Docs won't give salvage until they know there is a rise in psa. The research I have states that anything under 1 iworks. Of course the lower the better. The best results have a psa <.6 showing 80% effectiveness 5 years after treatment. Where is the cutoff calling it adjuvant vs salvage? This is confusing with the new ultrasensitive psa test. I thought that <.1 was undetectable and the ultra sensitive test were somewhat unreliable. My two cents .......Everyone is different but the med oncs & rad onc's I saw at Hopkins and Sloan feel that SRT was the best way to go. I will only begin HT if my PSA doesn't become undetectable. Perhaps if they saw my rising PSA they would have suggest HT too. But they didn't want to confuse reductiion in PSA from HT with curative effects of SRT. I just had my 14th radiation session and have nearly no SE's....well maybe some slight fatigue. Little guy hasn't bounced back but with the blue pills I can have some normalcy. My Rad Onc says in his experience that guys who have had a RP have less SE's than those having RT as primary treatment. 6/03 - PSA 2.0 6/04 - PSA 2.5 8/05 - PSA 4.2 11/05 - PSA 5.89 BIOPSY 8/16/05 T2A, 3+5 = 8 RP 12/13/05 PATHOLOGY GLEASON 3+5=8 TERTIARY 4, SEMINAL & LYMPH - NEG EXTRACAPSULAR EXTENSION TO MARGIN POSITIVE MARGIN - RIGHT APEX PSA POST RP 1/26/06 = 0.5, 2/1/06 = 0.55 PSA on 3/27/06 = 0.95 START SRT ON 3/27/06 (72 GRAY ON 39 SESSIONS) Hoping for independence from PCa on this July 4th. Good luck to all. > Uncharted, > chemo as first treatment sounds good. Thanks, Dave. I was really expecting more dismay that we were going that way. No one has dissed it. Although we did RP first, we are not waiting for failure before the chemo. > Also using the vaccine's as a first treatment when the psa is low > sounds better Are the vaccines approved yet? Or just avail as trials? Not that this applies to us. > These have both been given as last ditch treatments. It seems to me that it is time to start testing them as first-ditch treatments. > Most Docs won't give salvage until they know there is a rise in psa. > The research I have states that anything under 1 iworks. Of course the > lower the better. The best results have a psa <.6 showing 80% > effectiveness 5 years after treatment. Where is the cutoff calling it > adjuvant vs salvage? The study did not discriminate 'salvage' and 'adjuvant'. This was something I picked up in other research. I have been swimming in RT-post-RP research. The study only talks about salvage, and makes a distinction between two scenarios. Here I will cut-and-paste quote from the study: "RT is administered for salvage therapy after prostatectomy in two main scenarios: (1) for a delayed rise in prostate-specific antigen (DR-PSA) after the PSA has dropped to undetectable immediately postprostatectomy and (2) for a persistently detectable PSA (PD-PSA) after surgery." > This is confusing with the new ultrasensitive psa test. I thought that > <.1 was undetectable and the ultra sensitive test were somewhat > unreliable. You may see dozens of my apologies for decimal place errors in recent PSA# posts. I am only apologising again because I am afraid that someone might see my error and not see the correction because they don't read the whole thread. So I am putting it everywhere. The numbers were supposed to be 'one point oh' and 'two point oh'. Here is another quote from the study: "A strict pre-RT PSA cutpoint has not been defined, but the evidence suggests that lower pre-RT PSAs are associated with higher FFBF rates. The best results have been seen when the pre-RT PSA is <= 1 ng/mL. A significant decline in FFBF is seen with the pre-RT PSA cut point is increased from <= 1 ng/mL to 1.1 to 2, and then to > 2 ng/mL." My two cents .......Everyone is different but the med oncs & rad onc's I saw at Hopkins and Sloan feel that SRT was the best way to go for me. I will only begin HT if my PSA doesn't become undetectable after SRT. They didn't want to confuse reductiion in PSA from HT with curative effects of SRT. I just had my 14th radiation session and have nearly no SE's....well maybe some slight fatigue. Little guy hasn't bounced back but with the blue pills I can have some normalcy. My Rad Onc says in his experience that guys who have had a RP have less SE's than those having RT as primary treatment. 6/03 - PSA 2.0 6/04 - PSA 2.5 8/05 - PSA 4.2 11/05 - PSA 5.89 BIOPSY 8/16/05 T2A, 3+5 = 8 RP 12/13/05 PATHOLOGY GLEASON 3+5=8 TERTIARY 4, SEMINAL & LYMPH - NEG EXTRACAPSULAR EXTENSION TO MARGIN POSITIVE MARGIN - RIGHT APEX PSA POST RP 1/26/06 = 0.5, 2/1/06 = 0.55 PSA on 3/27/06 = 0.95 START SRT ON 3/27/06 (72 GRAY ON 39 SESSIONS) Hoping for independence from PCa on this July 4th. Good luck to all. "For one thing, those of you who may be candidates for salvage RT and are reaching the 0.1 ng/mL level of PSA, salvage RT is definitely most effective when done at that PSA, next most effective while it is <=0.2, and most ineffective if you get to .2." This jumped out at me immediately because it is contrary to everything I've read to date. Moreover, RT at PSA .1 would not be considered salvage but adjuvant because it would predate biological failure. Laurel was kind enough to e-mail the study, we've conferred, and, sure enough, she got the decimals in the wrong place. The correct numbers are 1.0 and 2.0 not .1 and .2. Frankly, I would not wait for 2.0. Also, the study's discussion of SEs of SRT omitted one little thing - ED. I was told that SRT was likely to knock out what function I was fortunate to have regained post-RP. :-/ Bill Denton RP 2/12/02 PSA 1/06 .67, waiting for 4/12 result (hoping <.75) Memphis > Laurel was kind enough to e-mail the study, we've conferred, and, sure > enough, she got the decimals in the wrong place. The correct numbers > are 1.0 and 2.0 not .1 and .2. Frankly, I would not wait for 2.0. Also, I think I cannot post a PSA number ever again. Every single time I have posted one lately, I have put the decimals wrong. Even when I corrected myself, I did it again. It is some kind of mental block, because I am a whiz at 10-key and never make mistakes. So it is not my typing. I guess if I need to write a PSA number I will call someone on this list and have them post it for me, or I will have to write out the numbers instead of using digits. Thank you very very much Bill for correcting this for me. ;o) > I think I cannot post a PSA number ever again. Every single time I have > posted one lately, I have put the decimals wrong. Even when I [quoted text clipped - 3 lines] > this list and have them post it for me, or I will have to write out the > numbers instead of using digits. Or you can write it and explain it parenthetically, e.g., 0.02 (two hundredths of a nanogram). Looking at it and describing it kinda puts it into some perspective. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum I started ADT with Chemo in a Phase II Clinical Trial in July 2004 - chemo for six months - ADT for two years. Two years will be up this July. My Research Medical Oncologist is shooting for a curative treatment and not a pallative treatment. Who knows? You are a statistic of one. And who cares about SE's anyway? For me they have been very mild - also tolerated the chemo better than most. If the treatment plan does not work, well, he's bought me ten years instead of three years. The optimistic thing about the whole process is knowing that fighting Prostate Cancer is a waiting game - researchers are so close. They know how to kill the cancer, the trick is to not kill the patient. I do not regret one bit my aggressive treatment plan. Today PSA is 0.1 and two mets to the spine are gone with only new bone growth in its place. Completely disease free. For how long? Only the Creator knows. If and when the cancer rears its ugly head, then time for another bullet. Good Luck, Take Care. Mike (Gourd Dancer) > I'm learning a lot. This may not be news to anyone else, but I am just > picking it up so I thought I'd share it. For one thing, those of you [quoted text clipped - 27 lines] > > Best regards to all. Tomorrow is chemo I. > I started ADT with Chemo in a Phase II Clinical Trial in July 2004 - chemo > for six months - ADT for two years. Two years will be up this July. My [quoted text clipped - 16 lines] > > Mike (Gourd Dancer) Oh, yeah, Mike, thank you. You know, when we decided to go with chemo/ADT after an RP had pos margins and + lymph, I kind of figured we'd be at least questioned as to why we were doing that. Since it is supposedly only for 'hopeless' cases. What actually happened is that I am hearing from a lot of people who are doing chemo/ADT way before it is 'hopeless', treating like we are. It doesn't seem like anyone's talking about it much. One woman I talked to wasn't writing because she could relate to us, it was another question I had asked and that just came out. And, I am not sure you realize we are doing that. At least, I don't think I said so in this post. Are we some kind of groundswell out there? People who are not 'hopeless', doing chemo? Without benefit of clergy--ur, clinical trials? laurel Are we some kind of groundswell out there? People who are not 'hopeless', doing chemo? Without benefit of clergy--ur, clinical trials? Some Doctors and researchers have stated that combining hormone and chemo early can provide a knockout punch to PCa and some have shown excellent results, stopping the progression for months - years. Todays medicine is evidence based. Doctors are reluctant to prescribe any treatment unless there has been scientific proof that it works. It seems that hormone treatment has been around for 30 years with little advancement. Companies are making billions off it - the same for Chemo. There are many trials and research studies going on at this time. Singnapore and other Asian countries are taking the lead with stem cell and biomedical research. They are actually taking/hiring our best research scientists. I said it before that the cure for prostate and other cancers is right around the corner and its going to come from another country with help from US scientists. I think if I knew then what I know now and if it were permitted by the medical (and insurance) establishment, what with my gleason, PSA and SVI, that when my PSA started to climb after RRP, I would have hit it with RT, HT and Chemo. Of course, with what I new then, that would have been considered tomfoolery. And, after we learn what we learn in the next 5 years, we might find that it is tomfoolery. SignaturePSA 16 10/17/2000 @ 46 Biopsy 11/01/2000 G7 (3+4), T2c RRP 12/15/2000 G7 (3+4), T3cN0M0 Neg margins PSA .1 .1 .1 .27 .37 .75 EBRT 05-07/2002 @ 47 PSA .34 .22 .15 .21 .32 Lupron 07/03 (1 mo) 8/03 (4 mo), 12/03, 4/04, 09/04, 01/05, 5/05, 10/05, 2/06 PSA .07 .05 .06 .09 .08 .132 Non Illegitimi Carborundum > Are we some kind of groundswell out there? People who are not > 'hopeless', doing chemo? Without benefit of clergy--ur, clinical [quoted text clipped - 14 lines] > other cancers is right around the corner and its going to come from > another country with help from US scientists. Laurel, Passive treatment equates to Pallative treatment in my book as Aggressive treatment equates to Curative treatment. No one really knows what is the right path. I just care to throw myself into the Research Arena rather than the FDA-approved Arena. Only time will tell; and, I feel like I am buying time... Yes, in the past Chemo was "reserved" for the "hopeless" as a last ditch effort to prolong life (and, after the body was ravished and weakened by cancer). In the past, there were cancer chemo warriors taking one for tyhe team so to speak by ketting researchers test the poisons on their bodies since the outcome was hopeless. This gave researchers the opportunity to test concentrations of chemo to see what strength kills cancer without killing the human body. After twenty-five years, most researchers believe that they have close to the right combination, hence the testing on strong bodies where cancer is early in its destructive path. Will it work? Buying time sounds real good to me. Mike >> I started ADT with Chemo in a Phase II Clinical Trial in July 2004 - >> chemo [quoted text clipped - 42 lines] > > laurel > Passive treatment equates to Pallative treatment in my book as Aggressive > treatment equates to Curative treatment. No one really knows what is the > right path. I just care to throw myself into the Research Arena rather than > the FDA-approved Arena. Now I understand more why there are studies, "62 men from a single center".... Because unless you choose treatment that is going on in a clinical trial (that may be out of date) or you choose treatment that is the lowest-common-denominator, you are, as you said earlier, a sample of one. > Only time will tell; and, I feel like I am buying time... Yep, I'm thinking (if needed by us as individuals at all) that the vaccine is just around the corner. Combined with nanoparticles.... > I'm thinking (if needed by us as individuals at all) that the > vaccine is just around the corner. Combined with nanoparticles.... Maybe in other countries, but that corner is way down the block in the U.S., according to its leading U.S. sources. I.P. |
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