My husband, age 58 at the time, diagnosed with PC in 2011. Biopsy showed prostate over 70% filled with cancer, with no symptoms. Immediate Radical prostatectomy (DaVinci) with Dr. Samadi in NYC. Results: G7, No lymph nodes involved but it did escape one of the seminal vesicles. Minimal urine leakage but its there and getting a bit worse, and complete ED but sensitive feeling retained.

Radiation followed for 39 treatments. He did great! PC free for 3 years. Then, slowly the PSA started creeping. It's Doubling. Now he goes for PSA sensitive tests every 3 months and it is continuing to double. It's up to .22.

They say too small to detect where it is. Just let it go. Wait. We thought we were done with this. Obviously the cancer has spread "somewhere" or "many places" and is growing.

What next? How long do you wait? He's almost 63 now, and very active playing tennis, softball, bowling. He has no symptoms other than this darn test showing growth.

Any ideas would be very helpful. Thanks.

Hello W.O.A. My grandfather was recurrent at the same age. He died at 94 of something else.

Welcome to the forum. If the recurrence is a small number of PCa metastases, so-called oligometastases, then metastasis-directed therapy (MDT) either with surgery or radiotherapy may be effective rather than a systemic approach with hormone therapy. Here is a study about that might be interesting.
www.europeanurology.com/article/S0302-2838(14)00889-6/fulltext/metastasis-directed-therapy-of-regional-and-distant-recurrences-after-curative-treatment-of-prostate-cancer-a-systematic-review-of-the-literature

Wife-On-alert-

Until last week, I would have said that there was at best equivocal evidence of benefit for starting hormone therapy earlier (that is, before mets are detected, and PSA is rising rapidly). To my chagrin, some researchers in Australia demonstrated that there is a significant benefit to early treatment:

Timing of androgen-deprivation therapy in patients with prostate cancer with a rising PSA

Yet, if his disease characteristics otherwise look good, a case could be made for waiting. At any rate, you should be talking to an oncologist about all this, not a urologist. If you're in NYC, I can recommend Howard Scher at MSKCC.

- Allen

Nobody looks forward to ADT, that's for sure......But sooner or later, ya gotta do what ya gotta do...Enjoy these next 6 months, make this a summer to remember...

Allen,

I think the endpoint of the study you cited should not have been overall survival but PCa-specific survival. If I compare this study with the study by Studer et.al
Studer EORTC 30891
you can see that Studer found a significant difference between immediate and deferred ADT in respect to overall survival, but none regarding prostate cancer specific survival. Which is the more important endpoint, however. Also the study by Studer et.al. included about three times the number of patients than the Australian study.

So I still think there is at best equivocal evidence of benefit for starting hormone therapy earlier just as you did in the past.

There is also a study by Schroeder et.al. which looked into immediate and deferred ADT for metastatic prostate cancer patients: www.ncbi.nlm.nih.gov/pubmed/18823693 The study did not find any clear difference in overall survival or PCa-specific survival for this group of patients.

George

Post Edited (George_) : 5/18/2016 10:38:08 AM (GMT-6)