Hello Bruce,

I'm sorry about your rising PSA.

I'm not a doctor.  My opinions are purely those of a layman who
has, himself, been treated for cancer.  So I'm not qualified to
give any expert advice.

Now having said that, here's my inexpert advice:

If you aren't already doing it, I would start by taking those
nutritional supplements that are thought to have a positive
impact on cancer.  See the recent thread here on pomegranate
"Another report on benefits of pomegranates" and look for other
info about supplements.

Who knows if they really work, and who knows which ones work, or
how much to take (there is a discussion of that vis a vis
pomegranate in the above thread.)  But if they don't hurt and
don't cost an arm and a leg, maybe they can help slow things down
for you.

Secondly, I would try hard to find a medical oncologist who
specializes in prostate cancer.  It would be a rare urologist or
radiation oncologist who really understands this stuff.  It's not
their specialty and most of them know no more than, Give the guy
some Casodex pills, then give him a shot of Lupron.  When the
Lupron stops working, kiss him goodbye.

A qualified med onc can do much more than that.  Specifically,
they can try double or triple ADT if they think it's warranted,
intermittent ADT if they think that's warranted, provide
recommendations on supplements, take blood tests that may tell
them more about your disease than just the PSA tells, find and
treat negative reactions and side effects of the ADT and, if and
when the ADT stops working, they can try other techniques such
as secondary ADT or chemotherapy and can guide you in finding
clinical trials.

If you tell us the general area where you live, someone here may
be able to recommend a doctor to you.

As to when to start ADT, there is debate about that.  Dr. Patrick
Walsh, one of the foremost experts in the world on PCa, thinks
there is no benefit to starting ADT earlier than when the PSA is
way out of control.

However, in spite of the good doctor, I would be inclined to
start it earlier rather than later.  My reasoning is: It can
never be good to have more cancer in your body rather than less.
With less total cancer in the body it seems to me there are fewer
tumor cells to mutate into ADT resistant cells.

The argument for early ADT isn't just based on emotion.  There
have been studies that support it.  My radiation oncologist, a
researcher at the National Cancer Institute (I was treated in a
clinical trial there) said that recent evidence indicates a
survival advantage for early ADT over late.

You've been placed by fate on a rocky path that none of us like
to follow.  But with good treatment and a little luck, it can turn
out to be a very long path, with years and years of good living
still ahead.

Best of luck.

   Alan

(snip)

Omigod.

Is this a genuine cancer specialist? Is he well-experienced in treatment
(tx) of prostate cancer (PCa)?

I've seen all too much about medics who either don't care or don't know
about the side effects (SEs) of "chemical treatment." Now here's one who
perhaps knows about them but declines to deal with them. Or doesn't know
how.

"Chemical treatment" is a vague term, but I presume that he means
androgen deprivation therapy (ADT) by which means one hopes to starve
PCa cells that require testosterone (T) and its powerful metabolite,
dihydrotestosterone (DHT), to survive and proliferate. Or maybe he means
use of such meds as Taxotere™ (docetaxel).

There is much that can and should be done to deal with, for example, the
SEs of ADT. They are so well known to medics who care that they have a
name: Androgen Deprivation Syndrome (ADS). See the encyclopedic website
of the Prostate Cancer Research Institute (PCRI) at
http://www.prostate-cancer.org/education/sidefx/Strum_ADS.html or
http://tinyurl.com/g6fzp

Using the Search function on the term ADS will produce many hits.

The SEs of Taxotere are also covered on the PCRI site.

One should bear in mind this grim item: The SEs of doing nothing are
terrible.

The medic has done nothing about a serial rise in PSA for over a year.
What is he waiting for? Metastases? And he doesn't want to see you for
six months?

It might be prudent to consult a medical oncologist who is familiar with
tx of PCa. Some are listed on the PCRI site via a link at
http://www.prostate-cancer.org/resource/find-a-physician.html

Good luck!

Regards,

Steve J

"There is NOWHERE in oncology where waiting for the tumor cell
population to increase (and to mutate) is in the better interests of the
patient."
--Stephen B. Strum, MD
Medical Oncologist

Bruce the Muce!  I remember.  Haven't heard from you in a couple of years.
Glad to see you back.

Doubling time of 21.71 months or 1.81 years.  Not bad, but certainly the
PSAs are getting into a range where you want to do something.

Whether or not it's a good decision, I do not know.  But, it is YOUR
decision, not his, to make.  It is true there are side effects with ADT.
I've been on Lupron for 4+ years and Casodex for more than a year.  I made
the jump when my PSA was 0.32.  I have had just about all the SEs and have
never regretted my decision.  My PSA is less than 0.04 and has been since
July 2006.

There are lots of ways to handle the side effects.

I think you've analyzed the situation correctly.  It seems that PSA is
now growing fast enough to merit ADT.  But you might try to get some
additional opinions from oncologists, particularly about the type of ADT
and its timing.

Have you tried compounds like Preparation H?

Prep H is mostly just petroleum jelly, together with some other
soothing ointments.  It coats the walls of the rectum and reduces
friction from bowel movements and from the walls of the rectum
rubbing against each other.

It works pretty well for me.

   Alan

Wow! You guys really do respond with alacrity! Thank you!
I really appreciate your thoughts and advice on my post.  Living as I do,
well out onto the prairies of Canada, in the Province of Manitoba, there is
little choice when it comes to specialists. It is common for people in rural
or small town places to travel for medical service and that's what we do.
However we do not have many options as to which physician/specialist we get.
We consider ourselves lucky, sometimes to get med service at all, what with
the shortages of doctors and nurses.
Be that as it may, we do get seen and treated, eventually.
I have been reading a lot of posts and had lots of visits to web sites in
the past day. It seems that those of us who have PCa want early treatment
for rising PSA, but there are those professionals (I guess?), specialists
who are split by the quandary of early treatment vs later treatment.  My
Radiation Oncologist in Winnipeg is obviously one of those who prefers not
to start ADT early. My preference is early, and when my PSA began to rise I
was upset by his stand. In the last year or more I've been accepting his
decision without argument, just sort of sitting back FDH (Fat Dumb and
Happy) and letting my health care be managed by others.  Finally, with the
exponential rise becoming obvious, it is time for me to make some decisions
about my Tx.
Thanks to you people, I feel more confident in taking charge, or at least
making my opinion heard in the right places.
I think I'll start with my local GP who is new to us as our Doc of 3 years
left town. I hope he can find an oncologist who specializes in PCa, or at
least someone who cares, and will make the appropriate referral.
As for the proctitis, I will give Preparation H a try. Thanks for the
suggestion.
Bruce

Wow! You guys really do respond with alacrity! Thank you!
I really appreciate your thoughts and advice on my post.  Living as I do,
well out onto the prairies of Canada, in the Province of Manitoba, there is
little choice when it comes to specialists. It is common for people in rural
or small town places to travel for medical service and that's what we do.
However we do not have many options as to which physician/specialist we get.
We consider ourselves lucky, sometimes to get med service at all, what with
the shortages of doctors and nurses.
Be that as it may, we do get seen and treated, eventually.
I have been reading a lot of posts and had lots of visits to web sites in
the past day. It seems that those of us who have PCa want early treatment
for rising PSA, but there are those professionals (I guess?), specialists
who are split by the quandary of early treatment vs later treatment.  My
Radiation Oncologist in Winnipeg is obviously one of those who prefers not
to start ADT early. My preference is early, and when my PSA began to rise I
was upset by his stand. In the last year or more I've been accepting his
decision without argument, just sort of sitting back FDH (Fat Dumb and
Happy) and letting my health care be managed by others.  Finally, with the
exponential rise becoming obvious, it is time for me to make some decisions
about my Tx.
Thanks to you people, I feel more confident in taking charge, or at least
making my opinion heard in the right places.
I think I'll start with my local GP who is new to us as our Doc of 3 years
left town. I hope he can find an oncologist who specializes in PCa, or at
least someone who cares, and will make the appropriate referral.
As for the proctitis, I will give Preparation H a try. Thanks for the
suggestion.
Bruce (not the Muce, originally, but why not now?)

Hi Bruce,
I'm from Canada as well.
I couldn't find the Manitoba cancer guidelines, but here's the BC's ones.
<
http://www.bccancer.bc.ca/HPI/CancerManagementGuidelines/Genitourinary/Prostate/
Management/default.htm

They get as good results as anywhere else in the world.
This is a link off their page, regarding treatment deicisons.
http://www.cfpc.ca/cfp/2004/Jan/vol50-jan-cme-2.asp
Your PSA seems to be rising very slowly. You might want to ask the oncologist if
there are other sources of PSA in the body. The oncologist from BC, on
sci.med.diseases.cancer says there are, but he did not state which organs.
And other ways to reduce the PSA.

If you've ever lived with a woman who went through menopause (for some it lasts
4 or more years), drenching sweats and mood swings, that gives a glimmer of some
of the side effects of hormone therapy.  If you've got good quality of life now,
perhaps the oncologist wants to protect you from the side effects.  "pay me now"
in side effects, or "pay me later" in side effects. And after all, there's other
types of cancers. Do you lie awake in bed worrying about lung or colon cancer?
Do you lie awake worrying about heart attack?  Or falling through the ice while
ice-fishing ?  If not, why would you worry about a slowly rising PSA ?

3 of my grandparents and one other relative lived well into their 90's. I think
that was lifestyle factors. Only 2 of their 8 children lived till 80.  I think
the average age of death for Canadians now, is similar to the US.
72 for males and 75 for females.  Do you want to spend the next 3 - 8 years
drenched in sweat and moody as all get out, or have quality of life? And deal
with it, when it happens?

Food for thought?  Perspective? When talking with your doctors, including your
risk factors.
Best,

J