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PSA Levels almost 6 years after HDR

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Posted 2/15/2021 6:01 PM (GMT -5)
Hi Everyone,

I haven't been on this forum for a while, but thought I would pop in to share my husband's PSA chart for those of you who may be going through some bounces. It has been a super bouncy number of years, but as you can see from the graph below (click "VIEW IMAGE"), his PSA is down to 0.29. While he was bouncing I read every post I could find about bounces as a means of giving myself from hope. I hope this post does that for someone else.

Yours,

Mary

VIEW IMAGE
Posted 2/15/2021 6:58 PM (GMT -5)
Mary, giving back is a great feeling, and you are really helping a lot of guys who worry about bounces, with your post and the graph. Beest of luck to you and your husgand for a low and steady flatline near nadir.
Posted 2/16/2021 6:56 AM (GMT -5)
Mary, thanks for posting the great progress. HDR is a superior treatment for many men resulting in cancer control and limited treatment side effects. I used it more than ten years go successfully.

Your husband experienced the normal “bounces” and is still trending down to a very low PSA level. It is tough to stay patient and confident during the “bouncing”. How is he doing with side effects from the HDR?
Posted 2/16/2021 8:11 AM (GMT -5)

pjr64 said...
Hi Everyone,

I haven't been on this forum for a while, but thought I would pop in to share my husband's PSA chart for those of you who may be going through some bounces...

hi, ms. mary. i had HDR treatment las' year, and because of COVID-19, my treatment center was seeing nobody. so i had to wait a total of a year after my treatment to have a PSA blood test. my highes' PSA before treatment was 12.68. that was in oct. 2019. so, when i had my PSA done this past january 21, 2021, it went down to a 4.04. i thought that was progress, but my RO and his nurse practitioner thought after one year of HDR, my PSA should've went down much further [closer to a 1]

i talk'd wit' others and some said the same thing. they believe some cancer was either over looked or some cancer may have slipped out of my prostate. while others feel the 4.04 PSA is progress. so, seeing this helps me a little, because it proves that the PSA is not always predictable. the main thing is that there's a downward trend. i''m not sure what will happen to me, but C-ing your post helps. THANKS.
Posted 2/16/2021 12:08 PM (GMT -5)
Thanks for posting, useful to see!
Posted 9/1/2021 9:23 PM (GMT -5)

JNF said...
Mary, thanks for posting the great progress. HDR is a superior treatment for many men resulting in cancer control and limited treatment side effects. I used it more than ten years go successfully.

Your husband experienced the normal “bounces” and is still trending down to a very low PSA level. It is tough to stay patient and confident during the “bouncing”. How is he doing with side effects from the HDR?

Hi all, I have been diagnosed with prostate cancer PSA PSA, SCREENING 41.9 (H) 07/06/2021, and have only now decided to get treatment. BTW, my previous PSA are as follows:
PSA 8.1 (H) 09/11/2009:
PSA 5.3 (H) 01/16/2009
PSA 5.8 (H) 08/19/2008
PSA 5.8 (H) 05/12/2008
PSA 5.6 (H) 04/28/2008
My oncologist wants me to take hormone therapy combined with other treatments w/ the ff options:
1. brachytherapy with standard external beam radiation and hormone therapy
2. Standard external beam radiation and hormone therapy
3. SBRT and hormone therapy
The hormone therapy (injections) warns of possibly a number of side effects that its scary. I requested brachytherapy with 4-5 weeks of external beam radiation following the brachytherapy, though she insists on hormone therapy andto discuss it further with the RO who will do the HDR brachytherapy.
JNP, what was your experience on the side effects of hormone therapy?
Advise/comments from anyone would be helpful.
Posted 9/2/2021 6:21 AM (GMT -5)
oneito, thanks for posting. Looks like you are an excellent candidate for a cure with minimal side effects or issues. The combination of external beam and brachytherapy radiation is highly effective. As for the ADT, it is commonly used with radiation as it softens the cancer and helps the killing power of the radiation. Regarding side effects, they are not from the drugs like Lupron, rather from the drop in Testosterone. So whether chemicals are used or physical castration, the side effects are the same. For high risk men, ADT is used longer in the 12-24 month range to attempt to clear up any PCa cells that might have escaped the prostate.

For many men using radiation, ADT is just a three to six month course and side effects are generally minimal. The common ones are hot flashes, weight gain, fatigue and loss of sexual desire (not always loss of ability to perform). In more uncommon cases some men suffer from depression. Most of the side effects are manageable with diet, exercise, stress management, and some drugs. Mine were tolerable and diet and activity adjustments were very helpful. Because of my high risk situation I was on ADT for three years. Over that time the hot flashes diminished.

Your PSA is very high, which indicates high risk. You have G4 in some of the cores and needs to be taken seriously. How long does the doc want you on ADT? Have they assessed the possible spread by using CT or MRI scans? With high risk, it is usual to include the pelvic lymph nodes in the external beam radiation field as they are often a first area of cancer spread. Please add this to the discussion with your RO.

Based on my experience and developed knowledge…..don’t fear ADT. Side effects will diminish and disappear once the ADT regimen is stoped. Understand that it is a vital tool to use in treatment. Get ready to manage the side effects. Refine your diet to add more fruits and vegetables, reduce the fatty meats and fats in general, reduce alcohol, caffeine, and carbonated drinks. Increase activity through more walking, exercise regimen, etc. These will help manage your weight and contribute to stress management and overall good health. Talk to your RO about anti-oxidant supplements as these should be avoided during the radiation period, but can be very helpful to combat the ADT side effects.

As with many things, your attitude and approach will be important. Be positive and do positive things and the results will be better.
Posted 9/2/2021 2:25 PM (GMT -5)
JNP, Thanks much for your response--it eases some of my concerns. It seems that my prostate cancer (PC) has not metastasized (see below) to other parts of my body, so it's quite a relief for now, and considering that from 2008 to 2021 the PC cells have remained in the prostrate. My hesitance to take hormone therapy (HT specifically lupron/eligard--is that similar to ADT that you mentioned in your post?) is that, aside from the side effects, considering that I'm already 75 years old, and I think my testosterone levels are possibly low (I should probably get it tested first before deciding to get HT) I wonder if it's necessary to have HT. Although I consider myself healthy enough, I am concerned about the consequences of the side effects to my overall health, i.e. age, arthritis, depression, somewhat enlarged heart). Of course, the danger of the PC metastasizing to other parts of the body is an urgent consideration. I just could not help thinking to first determine the results of Brachytherapy and recommended radiation therapy before getting HT.

CT CHEST ABDOMEN PELVIS WITH CONTRAST
** HISTORY **:
75 years old, with history of prostate cancer, evaluate for metastasis
** TECHNIQUE **:
CT images of the chest, abdomen and pelvis acquired with 120 mL Omnipaque 300 intravenous contrast.
CTDI: 5.96 mGy
DLP: 378.74 mGy-cm
xxx
** FINDINGS **:
CHEST
HEART AND GREAT VESSELS: Heart is enlarged. Aortic and coronary artery calcifications.
LYMPH NODES: Mildly enlarged right hilar lymph node measures 1.2 cm in short axis.
xxx
BONES: No suspicious lytic or blastic lesions.
xxxnormal
ABDOMEN/PELVIS
xxxnormal
BLADDER: No significant abnormality.
PELVIC STRUCTURES: Enlarged prostate.
SOFT TISSUES: Small fat-containing umbilical and left inguinal hernias.
BONES: There is a mildly heterogeneous sclerotic lesion measuring 2.3 x 2.3 cm in the S1 vertebral body, with similar-appearing smaller lesion in the inferior aspect of the S2 vertebral body measuring up to 1.2 cm.
------------------------
WHOLE BODY BONE SCAN WITH SPECT/CT
xxx
** TECHNIQUE **:
RADIOPHARMACEUTICAL: Tc-99m MDP 21.6 mCi IV
Whole body planar images acquired approximately 3-4 hours post injection.
SPECT/CT images of chest, abdomen and pelvis were also acquired, utilizing a low-energy / noncontrast CT scan for attenuation correction and anatomic correlation purposes; this limited CT is not of independent diagnostic quality.
xxx
** FINDINGS **:
No focal bone lesion.
-----------------------
Impression
No scintigraphic evidence of osseous metastatic disease.
Narrative
WHOLE BODY BONE SCAN WITH SPECT/CT
** TECHNIQUE **:
RADIOPHARMACEUTICAL: Tc-99m MDP 21.6 mCi IV
Whole body planar images acquired approximately 3-4 hours post injection.
SPECT/CT images of chest, abdomen and pelvis were also acquired, utilizing a low-energy / noncontrast CT scan for attenuation correction and anatomic correlation purposes; this limited CT is not of independent diagnostic quality.
xx
** FINDINGS **:
No focal bone lesion.
---------------------------
Posted 9/2/2021 8:03 PM (GMT 0)
While your T might be low, it is most certainly not at castrate levels. Most docs want it under 30 to be most effective and you have to have the meds to get it there.

I suggest you have a good talk with your RO and if you do ADT, they may keep it to 3-6 months. Also ask about using the new oral medication Relugolix. It’s advantages are slightly lower side effects, particularly less cardio related, and very quick T recovery when you stop taking it.
Posted 9/2/2021 4:16 PM (GMT -5)
I was on ADT for 18 months and while it was challenging, it was a doable. On one hand, my testosterone has never fully recovered--it's less than 200--I can certainly live with that. As JNF pointed out, your PSA puts you in a high risk group and I think most ROs would want to use ADT. That said, I don't see what your Gleason score was, unless I missed that. Can you add anything about how many positive cores you had and what their scores were?
Posted 9/2/2021 6:12 PM (GMT -5)
Thank you, JNP--I will do as you suggested. And thank you, Michael for your reply.
I think the info below covers your questions, not sure. Please let me know what you think of those (Gleason?) scores.

Collected: 4/20/2021 Case #: xxx
Surgical Pathology Report
FINAL PATHOLOGIC DIAGNOSIS
A. PROSTATE BIOPSY, RIGHT APEX:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7 (PATTERN 4
= 10-20% OF TOTAL TUMOR, GRADE GROUP 2), INVOLVING 2 OF 2 CORES
(TUMOR MEASURES 13 MM IN A 15 MM CORE; TUMOR MEASURES 12 MM IN A 13
MM CORE)
B. PROSTATE BIOPSY, RIGHT APEX ANTERIOR:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7 (PATTERN 4
= 10% OF TOTAL TUMOR, GRADE GROUP 2), INVOLVING 1OF 1 CORE (TUMOR
MEASURES 3.5 MM IN A 10 MM CORE)
C. PROSTATE BIOPSY, RIGHT MID:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 4 = 7 (PATTERN 4
= 40% OF TOTAL TUMOR, GRADE GROUP 2), INVOLVING 2 OF 2 CORES (TUMOR
MEASURES 13 MM IN A 21 MM CORE; TUMOR MEASURES 8.5 MM IN A 16 MM
CORE)
D. PROSTATE BIOPSY, RIGHT BASE:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4 + 3 = 7
(GRADE
GROUP 3), INVOLVING 3 OF 3 CORES (TUMOR MEASURES 10 MM IN A 13 MM
CORE; TUMOR MEASURES 8 MM IN A 8 MM CORE; TUMOR MEASURES 4 MM IN A
6 MM CORE)
E. PROSTATE BIOPSY, LEFT APEX:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 (GRADE
GROUP 1), INVOLVING 2 OF 2 CORES (TUMOR MEASURES 2.5 AND 0.2 MM IN
A 15 MM CORE, 6 MM APART; TUMOR MEASURES 0.2 MM IN A 8 MM CORE)
F. PROSTATE BIOPSY, LEFT APEX ANTERIOR:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 (GRADE
GROUP 1), INVOLVING 1 OF 1 CORE (TUMOR MEASURES 3 MM IN A 13 MM
CORE)
G. PROSTATE BIOPSY, LEFT MID:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 (GRADE
GROUP 1), INVOLVING 1 OF 3 CORES (TUMOR MEASURES 1 AND 1 MM IN A 17
MM CORE, 8 MM APART)
H. PROSTATE BIOPSY, LEFT BASE:
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 4 + 3 = 7 (GRADE
GROUP 3), INVOLVING 1 OF 3 CORES (TUMOR MEASURES 4 MM IN A 12 MM
CORE)
- PROSTATIC ADENOCARCINOMA, GLEASON SCORE 3 + 3 = 6 (GRA
DE
GROUP 1), INVOLVING 1 OF 3 CORES (TUMOR MEASURES 3 AND 2.5 MM IN A
15 MM CORE, 6 MM APART)
Posted 9/2/2021 6:15 PM (GMT -5)
Oops, forgot to check "notification" for any reply. Mr. Administrator, please let me know. Thanks!
Posted 9/2/2021 6:30 PM (GMT -5)
Basically the G3 doesn’t count. It won’t spread or mutate. You have high PSA and G4 in five cores. That is significant. It’s the G4 that can spread and get more aggressive and cause problems. You have no idea how long it has been working so treatment is clearly indicated. The radiation combination is the best for this type of diagnosis. Only question is how long for ADT. I am sure if you were 60 the docs would want you on for 12-18 months. Currently with clear scans see what they say, but I would think six months at least. You are at your strongest now and it will pass pretty quickly.
Posted 9/2/2021 7:21 PM (GMT -5)
Based on the biopsy details, I'd certainly expect an RO to want you on an ADT. I would express your concern, but I'd be very inclined to follow their guidance on it. You know how time goes by more quickly as you get older? In the case of ADT, that's a benefit!
Posted 9/2/2021 7:38 PM (GMT -5)
Oneito, FWIW, here are my thoughts. First off, you should evaluate what is your life expectancy outside of PCa. You have an enlarged heart and aortic/coronary calcifications, looking at parents and siblings, can you make an assessment? I mean, if your parents are still alive and kicking and are 105, that would certainly influence your view of treatment. OTOH, if you honestly don't expect to make it past 85, that is another story.

The ADT will make the radiation more effective, and your PSA classifies you as High Risk, the standard protocol being something like 12-24 months of ADT. I would talk to the RO about length of ADT taking into consideration your overall life expectancy, as the standard protocol assumes that aside from PCa, you expect to live at least another 15 years, so they are looking for treatment that gives the best chance of a 15-year PCa survival. The RO might very well agree to a 6-month course for you.

Someone previously mentioned Relugolix (Orgovyx) as an alternative to Lupron/Eligard. I have been on that for 3 months now (3 more to go). I feel I have had very few side effects - no noticeable fatigue, no hot flashes or night sweats.
Posted 9/2/2021 8:11 PM (GMT -5)
Thanks, JNF. Taking into account the information you provided, I am considering going back to Option No. 3 below:
1. brachytherapy with standard external beam radiation and hormone therapy
2. Standard external beam radiation and hormone therapy
3. SBRT and hormone therapy
My MO strongly recommended hormone therapy, and according to her, helps "control cancer and makes the radiation treatment more successful. The hormone therapy (each shot lasts 6 months)", and if the side effects are so severe and I am not able to tolerate it, we can discuss stopping it early.

FYI, I just came across this study regarding the connection with ADT and dementia/Alzheimer written by Jody A. Charnow July 3, 2019, titled: Prostate Cancer ADT Raises Dementia Risk, Study Find

https://www.renalandurologynews.com/home/news/urology/prostate-cancer/prostate-cancer-adt-raises-dementia-risk-study-finds/#:~:text=Men%20who%20receive%20androgen%20deprivation%20therapy%20%28ADT%29%20for,risk%20for%20dementia%2C%20according%20to%20a%20new%20study
Posted 9/2/2021 9:58 PM (GMT -5)
Regarding six-month ADT shots, I had 1-month Lupron shots (18 of them) just in case I couldn't tolerate it. I was obviously fine since I finished my sentence. (I mean my course of ADT.) There are also 3-months shots and--I presume--other combos as well.

That said, I'd be real interested in the Relugolix mentioned above. That wasn't an option when I had my ADT. Not sure how common it is now, but worth checking into...
Posted 9/2/2021 10:08 PM (GMT -5)
JNF, re your comment "Relugolix. It’s advantages are slightly lower side effects, particularly less cardio related, and very quick T recovery when you stop taking it" -- I will mention this to my oncologist (not RO, who my MO referred me to do brachy at a different location).

Michael_T, "You know how time goes by more quickly as you get older? In the case of ADT, that's a benefit!" -- I sometimes wonder how I got to be here and now, smile! A benefit it is, considering.

Vynbal, "First off, you should evaluate what is your life expectancy outside of PCa. You have an enlarged heart and aortic/coronary calcifications, looking at parents and siblings, can you make an assessment? I mean, if your parents are still alive and kicking and are 105, that would certainly influence your view of treatment. OTOH, if you honestly don't expect to make it past 85, that is another story." -- off the top of my head, 93 would be nice. Anything past that would be great! smile

The ADT will make the radiation more effective, and your PSA classifies you as High Risk, the standard protocol being something like 12-24 months of ADT. I would talk to the RO about length of ADT taking into consideration your overall life expectancy, as the standard protocol assumes that aside from PCa, you expect to live at least another 15 years, so they are looking for treatment that gives the best chance of a 15-year PCa survival. The RO might very well agree to a 6-month course for you.

Someone previously mentioned Relugolix (Orgovyx) as an alternative to Lupron/Eligard. I have been on that for 3 months now (3 more to go). I feel I have had very few side effects - no noticeable fatigue, no hot flashes or night sweats.
Vynbal, " -- Heart disease had been the cause of death in the family. So if I get to live past 90 would be great! JNF mentioned Relugolix; I will definitely mention it to my MO (who likely will be my RO too).

Thank you all for your advice/comments! You have made my day, or night as it's 8:22 pm, 9/2/21 now.
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