considering chemo

jimschlemmer · Regular Joined: 28 Apr 2008 Posts: 22 Location: troy, ny

Well I got my hormone shot a couple of weeks ago and so far so good, I guess.

At the same time I got an additional PSA reading. The results since my RP are:

0.12 at 33 days
0.10 at 41 days
0.13 at 8 weeks

Clearly there's something left. If it's a localized remnant (Jonathan Epstein noted that the ECE was at an area of surgical incision) then I'd hope that the IMRT + hormones would zap it.

But given that a detectable PSA post-RP is not a good prognostic indicator, I'm thinking now of doing a course of Taxetore. I'm not sure whether taking this on at the same time as radiation is wise, though I'll do it if there's a reasonable chance of a better outcome. It may be that while I'm on hormones the PCa won't be making any hay and thus waiting for the IMRT to complete wouldn't be too bad of an idea.

Anyway, as this seems to be a pretty new application for the drug, I'm having a little trouble finding good information on it.

So any thoughts or suggestions would be greatly appreciated.

Thanks,

-Jim

Replicant · Moderator Joined: 01 Nov 2006 Posts: 273

No information for you--just wanted to wish you well. Everything you wrote sounds reasonable. If it were me, I'd want to see what happened with IMRT and hormones before going to chemo, because of the toxicity. But that's just me!
Good luck!
_________________
Replicant

Dx Feb 2006, PSA 9 @age 43
RRP Apr 2006 - Gleason 3+4, T3a, N0M0, pos margins
PSA 5/06 <0.1, 8/06 0.2, 12/06 0.6, 1/07 0.7.
Salvage radiation (IMRT) total dose 70.2 Gy, Jan-Mar 2007@ age 44
PSA 6/07 0.1, 9/07 <0.1, 12/07 <0.1, 4/08 <0.1, 11/08 <0.1
http://pcabefore50.blogspot.com

brainman · Posted: Tue Aug 05, 2008 12:05 am Post subject: Re: considering chemo

I agree with Replicant. In light of your relatively low PSA with slight fluctuations, I would opt to wait on chemo. Of course, I am not you and I would make this decision fully informed and in discussion with my own medical team.

Let us know what you do decide.
_________________
Jim
Site Administrator and long-term cancer survivor
1992 Astrocytoma grade 2, left motor strip
2005 Recurrence this time said to be an Oligodendroglioma grade 3, same location.
http://cancerforums.net/viewtopic.php?t=2405My Story Part 1: http://cancerforums.net/viewtopic.php?t=2528
My Story Part 2: http://cancerforums.net/viewtopic.php?p=7350
My Story Part 3: http://cancerforums.net/viewtopic.php?t=8029
Blog http://jimhawkinsport.blogspot.com/

jimschlemmer · Regular Joined: 28 Apr 2008 Posts: 22 Location: troy, ny

Thanks, guys.

I do need to research it more. I've come across some information that suggests that, like radiation, adjuvant chemotherapy might have better outcomes for high risk individuals.

I've been conversing with a guy who, like me, never had undetectable PSA, though he had a Gleason 9, positive margins and positive seminal vesicles (whereas I had 8, pos, neg) so he was higher risk than me.

But if long term side effects aren't too bad, I'm inclined to hedge my bets.

I recognize that it's partly psychological. I guess I have to know that I still have a weapon in my arsenal and that I'm not waiting too long to use it. The idea that after radiation I'd just have to wait, wait, wait, has been a little tough on me. But I know we all have to go through the waiting sooner or later.

-jim

Beth56 · Regular Joined: 30 Mar 2008 Posts: 30 Location: California

Jim,

I would suggest proton beam therapy before I would consider chemo at this point. All the research we have done does not support chemo very well for most cancers. But we must all choose our own paths.

About a week ago, I was watching a medical program with a cancer doctor from Long Beach Memorial Medical Center in California talk about chemo. And he even basically said the same thing. Chemo just doesn't work in the majority of cases they use it for. They are doing some interesting work there on cancer. They take tissue samples (biopsy) and match them up with specific drugs that will kill a particular cancer in test tubes. They keep trying to match until one of the drugs kills the cancer, which it is doing. One drug does not work the same for all people. So it is becoming very tailored matching one individual's cancer to a specific drug. I don't think it's being done for prostate cancer at this point, but I think lung cancer and a few others are in trials now. Perhaps something for some cancers in the future.

I wish you well on your search. Beth

chrisz · Regular Joined: 09 Apr 2007 Posts: 44

We are talking about a difference in a PSA reading of .02

Isn't that the within the margin of error ??

Shouldn't you just wait awhile and retest ??

Chris

jimschlemmer · Regular Joined: 28 Apr 2008 Posts: 22 Location: troy, ny

Beth,

Thanks for the input. I'm still trying to figure where I fit in with the research on taxotere.

The problem with relying on the research though is that it is often done in a post-ADT setting, to say nothing of the median age of the studies and specifics of the subjects (vs. my specifics). I'm considering it in an adjuvant context. I'm guessing there's not much research on that -- which of course supports the notion that it's not thought that highly of, at least at present. However, I'm thinking of going at this quite aggressively which I think most docs wouldn't recommend.

Proton beam to treat a (potentially) systemic form of PCa? I thought proton beam was a localized therapy.

Chris,

I'm not so much concerned about the .02 rise in PSA as I am the fact that it's detectable. And so I'm in the class of guys whose PSA never went to zero post-RP. Ergo, my inclination to throw everything at this disease that I can.

Better to have a few nagging conditions at a ripe old age than to be dealing with a full blown case of PCa and regretting that I didn't use some course of treatment early on that might have helped. I know these aren't the only two potential outcomes, but I keep coming back to them.

-jim

Beth56 · Regular Joined: 30 Mar 2008 Posts: 30 Location: California

Jim, all I can tell you is that during my husband's treatment, we met many men who had a failed RP who chose Proton Beam Therapy as the next treatment step. Their cancer had already escaped the prostate, but they were accepted into the program after the doctors studied their specific cases. So many men are seeking this treatment, they must turn away those who may not benefit from the treatment We met several doctors and radiologists who had chosen this treatment for themselves. There was a Pacific Islander who came for this treatment at Loma Linda with a PSA of 65. Four months after his treatment, his PSA had dropped below .5. I believe his story can be found on PotonBob.com. I hope I gave the correct specifics, but I'm sure it can be validated on that site or by the owner of the site, Bob Marckini.

I only wish that you think of this treatment as a possibility. Don't assume it's not available for your situation. I wish you the very best in your search. Beth

If you wish to look into it, here are a few of sites to visit to get more information:

http://www.protons.com/

http://protonbob.com/proton-treatment-homepage.asp

Be sure and read all of the comments section on link below:
http://www.usnews.com/blogs/on-men/2008/1/25/proton-beam-therapy-an-option-against-prostate-cancer.html

Hawk · Experienced user Joined: 22 Nov 2006 Posts: 90

[quote="jimschlemmer"]
Proton beam to treat a (potentially) systemic form of PCa? I thought proton beam was a localized therapy.
-jim[/quote]

The key is "potentially" systemic or metastatic. Radiation is a potential second chance at a complete cure if the cancer is localized. Nothing else offers such a chance at this point. For me, it is a window of opportunity I can not afford to lose.

PS to Beth56: Isn't the advantage of proton vs IHRT more applicable to those who have a prostate. SRT tends to radiate the prostate bed. As such I am unaware of the advantage of proton radiation in such a situation but open to new information.
_________________
History: PSA's 6.7 neg. biopsy - PSA 16.6 neg. biopsy - PSA's 8.2 - 8.1 - 8.7 Biopsy. 4+4 Gleason 8. Lap RP Apr 2004, age 52 All neg margins, nodes, and structures. (T2a). Post RP PSA: every 6 mo. <.1 until Feb, 08 (46 mos) PSA .1 - I then got sensitive tests (all in 2008) showing:
Feb .06 - May .09 - Jun .10 - Aug .10 - Nov .15 SRT

Beth56 · Regular Joined: 30 Mar 2008 Posts: 30 Location: California

Re: Proton Beam Therapy

No, you do not need to have a prostate in order to receive proton beam therapy. You need to have cancer. There are many uses for proton beam therapy at this time and it's use is increasing. Some of the cancers they are using protons for are eye, brain, neck, lung, breast and prostate.

The technology allows the beam to pinpoint a small area or it can be widened out to hit a larger area. And protons only kills cancer cells, not healthy cells. Some patients receive proton beam only, while others receive proton beam and photon. It's very individual and tailored specifically for you.

The only way to know if proton beam therapy may be helpful to you is to contact the facility you wish to be treated by. They will send you a video and some information. You will need to send them your medical information for evaluation to see if you are a candidate. This process takes about 3 weeks as I remember. If you are accepted, you will set up an appointment to discuss the treatment and risks with the doctor. Sometimes treatment can begin within a few weeks and sometimes it might be a couple of months. So starting the process sooner than later is better.

My husband went to Loma Linda Medical Center as we are in California. He was 62 years old when diagnosed in 2006. Gleason 3+4=7 PSA 3.2. After proton treatment the PSA lowers slowly as cancer cells die off. His PSA is now .52 and will continue to drop. He has had only minor side effects from treatment. Most of the men we have spoken to who had proton treatment have had very few side effects. But there are risks in any treatment.

Patients from all over the world travel to this center as this was the first treatment center and it has the most experience. And as I said, we met many men who had their prostates surgically removed and it failed. They chose protons for their next line of treatment.

I know that Medicare pays for this treatment and so do most other insurers. My husband has Blue Cross and they paid. They only insurer I know that doesn't pay are the HMO's. This is a very expensive treatment. I don't remember exactly what the final was when I added it up but I think it was over $100,000. The monthly housing costs in Loma Linda begin around $1,200 per month, and the medical center will help you find lodging. And some of the travel and housing costs for medical care are tax deductible. We actually had a good time there believe it or not. We made it into a vacation and went fishing and sightseeing. And they have a complete gym, spa, etc. available for patients. Along with pot lucks, meetings, dinner nights, etc. It's a very friendly atmosphere as so many come from out of town. They do everything to make your stay comfortable.

I hope this answers some of your questions. But the only way to determine if you will benefit from Protons is to contact a treatment center. I can't answer that question for anyone. But if I can answer anything else for you, please ask.

I wish you well on your search. Beth Very Happy

_________________
I lost my mother to inoperable pancreatic cancer in 1990 after caring for her at home for 9 months.

And, my husband was diagnosed with prostate cancer in 2006. Gleason 3+4=7 PSA 3.2. Treatment of choice was proton beam therapy at Loma Linda Hospital, California. His current PSA is .52 and will continue to drop as the cancer cells die off.

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