How worrisome is this?

Mel, sorry for the uptick. Determining the meaning of this is above my pay grade but at least you will be seeing one of the world's preeminent prostate cancer docs next week. I'm sure he will have a plan and I look forward to hearing what he thinks.

Good luck.

Jim

If I understand correctly, you are on intermittent androgen deprivation therapy (IAD), you do not have signs of clinical disease progression, and your PSA is less than 3ng/mL, but showing possible early signs of rising.

Pictures say a thousand words...see this flowchart published by the Prostate Cancer Foundation
http://www.pcf.org/site/c.leJRIROrEpH/b.7633981/k.3C11/Intermittent_Androgen_Deprivation.htm?msource=aug11np&auid=8824347

Jerry L., I would agree that the repetition of an intermittent course was not very clear in the flowchart I previously referenced.

This one (also from ASCO, but a different report) is better in that regard; see Figure 2:

http://jco.ascopubs.org/content/31/16/2029.long

The actual "actionable" trigger-levels are left to the individual patient-doctor.

Mel-what's your current testosterone? Are you on Avodart?

At .04, you should be able to buy some "treatment" free time. That is what I would be thinking.

Jerry:

 

Here is what I wrote a friend:

 

>>>>>>>>>>>>>>>>>

There is really no grand plan. But there might as well be, because the tx. is what gets you at the end. Is the tx. worse than the disease? I guess not, in the sense that croaking from a heart attack is better than croaking from advanced PC.

Did I mention the latest research??? Until very recently, they kept coming out with new drugs, thankfully forcing chemo further down the line (pecking order). However, some MAJOR new research is showing a huge advantage in combining chemo with HT for those with metastasized PC. It's like a 15-month greater OS (overall survival). There is very little advantage if mets are not showing.

I think, from my telephone consultations with Dr. Lam, that he will let my PSA rise to over 2. He then wants me to go to Mayo, where they have developed a new C-11 Choline Scan. It's the most sensitive thing out and it would be used in lieu of a bone scan/ CT scan as it shows bone and soft tissue. Then, it depends what they find. If I'm lucky, they find one large deposit in one spot where they can irradiate it. Dr. Kwon, at Mayo, presented some cases where this effectively CURED the PC. The odds of my PC acting this way are miniscule. If no mets are found, I think he would let my PSA go to 5 and then we do the HT combo again. Lather, rinse, repeat. If there are a few mets, we can do radiation or perhaps the chemo/HT horror.

Anyway, that's based on conversations months ago.  I'll see what he says Tuesday.

I'm still really bummed out.

Mel

Long term management mode with just enough treatment to control the cancer without disrupting your quality of life. I would take 25 years of that. Hopefully, Mel, that is the course you are on.

Jack

Jerry, you said above:

"We have certainly seen the extremes on HW about when to go on HT...everything from less than .1 all way to guys waiting to see something on scan. I don't think anyone is wrong...how can you argue with anyone that can delay ADT for years with no mets.."

That is worth commenting on for sure. Just here among our group of men at HW...you, me, Mel, and all the rest dealing with advanced cancer, there is no absolute right or wrong.

No matter how we research, no matter how much faith we have in our own doctor(s), at the end of the day, it comes down to at best, an educated guess, but still, a guess. Wish there were better methods to eliminate more of the "guess" factor out of such critically important treatment or non-treatment decisions.

So there is a gamble if you do go for treatment(s), and there is a gamble, of course, if you don't continue a treatment, or delay a treatment (as in my personal case).

Right now, feeling pretty good about my past 3 year gamble not to treat, especially since my PSA magically dropped almost in half since late last year, with me doing nothing but waiting with my doctor. The real proof, will be at my next PSA, in December. Was that drop a one time shot, or perhaps a fluke, or somehow related to my massive and quick weight loss, I honestly don't know.

And Mel, you have well researched your every treatment move, from the time you were first dx'd, I will give you high credit for that. You being using great doctors, and doing all the things they recommend to you. But as you well know, your unique set of PC has a mind of its own, as does mine, Jerry's and everyone else.

Too bad there has to be so many variables along the way that we can not possibly predict. Would make all of our treatment decisions so much easier, and ease the anxiety factor from many people's minds.

David

There is a lot of discussion about "hitting it hard," particularly for younger men  .  I was just reading some of the CHAARTED study material about the extraordinary improvement ("game-changing") in overall survival, in particular amongst men with less advanced but still metastatic hormone-sensitive PC.  Your source of ongoing PSA generation is yet-to-be-identified and so discussions of chemo are premature, but know that your general approach of "hitting it hard" is the basic standard of care for men in your situation.  Good luck.

Jerry L, let me know what you find out from the webinar.  Unfortunately, I'm unable to attend/participate, but I really wanted to...

My understanding is a little different than what you wrote.  ALL the trial participants were advanced PC cases, but they also set a target of accruing only "high volume mets" men which they could not meet, and so later they expanded the trial to also include "low volume mets" guys (but again, all had advanced PC).  High- and low-volume definitions, for the purposes of this trial, are documented in the literature. 

They have now gathered enough data for the trial as a whole to define the MEDIAN improvement in OS which I believe is 17 months, and also enough data to determine the MEDIAN improvement for the (larger) subset of the group which had high-volume mets which I believe was 15 months.  But, since they started later with the low-volume subset of men, they have not YET been able to determine the MEDIAN OS improvement for those men.  But the results so far look very good, and likely better than the 14 month OS improvement for high-volume men.

So, when you say that the "jury is still out," I believe that is (sorta) correct, but I do not believe that "it was just the opposite."  It's not that the data for the low-volume guys is "not significant," it is simply not complete at this point in time.

Please let me know what you learn from the webinar...

Mel, sorry to hear you are bummed, but it certainly is understandable. Have you considered being aggressive with it at this point? While it's still very low, it would seem to me that a chemo treatment schedule or Provenge might be something worth pursuing. There was an article on here many, many moons ago about how dr's were considering revising the normal treatment schedules given the many new treatments. I would think that you are closer to cure NOW than you would be in a year or two when your PSA reaches 4 or 5. I wish I could remember who posted the article and the name, but it escapes me. Anyway, I hope you resolve to kick its a-double-s in some way!

Mel, just a small clarification on what I’ve read about the CHAARTED study (maybe Jerry L. will chime in with what he learned from the webinar), which is what I believe you just referred to.   Early chemo was very helpful to the study population with “high volume” mets, and they have published the improvement in Overall Survival (OS).    The study is observing improvement in men with “low volume” mets but do not have enough data yet to measure the OS benefit because these were a late addition to the scope of the study.   I don’t believe that they included men like you who have mets assumed based on recurrent PSA but not yet identified by radiological imaging…of course this is why you are talking about going for advanced scans in the future, because it (metastisis) is believed/known to be there, somewhere. But the other thing with CHAARTED is that the patients in the study were new to ADT, whereas you have already had a full course of hormone treatment.