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Attack early or hold back?

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User

Posted 14 Feb 2015 at 10:45

Hi,

I was diagnosed last October after a routine blood test showed a PSA of 6.8. The Biopsy showed 1 core out of 10 was cancerous and it was Gleason 10. The subsequent Bone, CT and MRI scans found it in my ribs, vertebrae and a 'mark of interest' in a lung. I was classified as a T2N0M1b and was immediately put onto Casodex followed two weeks later with a three month Decapeptyl injection. By Christmas PSA down to 1.3. Had second injection and my first review is coming up next week so hoping PSA down even further. So far so good.

Lucky is a strange word to use here and in many regards I am in a good ish place. My PSA started at a number some members strive to reach, it was only in one core, the capsule is still intact and its not in the lymph nodes.

However, it is a top of the shop, aggressive, Gleason 10, I do have multiple bone mets and there is that question over a lung.

The big question I have is, should we be hitting it harder now while it is small and being held back through lack of testosterone? The HT is obviously doing its stuff and will do as long as it can, but I read of people diagnosed after me on early chemo or radiation to the prostate itself to kill the mother ship so to speak. Do these things help at this stage or is it better to hold back some weapons for later? If they are advantageous now what is the route to getting to and where?

Thanks for reading and I would welcome your views and advice.

Tony

Edited by member 14 Feb 2015 at 14:35 | Reason: Not specified

User

Posted 14 Feb 2015 at 15:14

Tony

I know you will get several replies to this and every one may be slightly different. I am not a medically qualified person so this is just my opinion and what I would have tried to persuade my Husband's oncolgist to do if I had my chance over again. If you are relatively fit and strong outwardly but with an aggressive metastatic cancer there seems to be a growing trend to hit it with everything but the kitchen sink as early as possible. This approach is also being used as part of the stampede trial and other smaller trials under way here in UK as well. So If I had a male member of my family or in my circle of friends in your situation I would be looking to hit this as hard as possibe as early as possible.

Several Men on this forum are well down this route with very positive and encouraging results.

I wish you all the very best

User

Posted 14 Feb 2015 at 16:42

If I was in your position, I would be wanting to hit it with anything and everything asap. Just my personal viewpoint.

My cancer was deemed aggressive, rise of PSA by 0.9 in a month. I opted for robotic surgery asap. Looking back I would not change that selection.

Whatever you decide to opt for, best of luck.

dave

User

Posted 14 Feb 2015 at 17:47

Hi Tony

A biopsy taking 10 samples is somewhat hit and miss so at G10 there could be other cancer cores present. If you agree then that might add more weight to your hitting hard now thoughts. Note my profile showed all clear on first biopsy then G8 on second some 7 weeks later.

Good luck

Ray

User

Posted 14 Feb 2015 at 18:05

Tony, that is indeed a low PSA for someone with multiple bone mets. Look back at your diagnosis letter - was the one core described as adenocarcinoma or another type of prostate cancer? There are 27 types in total - adeno being the most common but also rarer forms which particularly like searching out bones and lungs and need a slightly different treatment path.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 15 Feb 2015 at 14:40

Hi Tony,

I'd suggest it is the scan results that you need to focus on. The biopsy can give only part of the situation as Ray mentions correctly.

We don't even know how much of the core was found with P.Ca. Was it 99% cancer or only 5% ? Even then, the needle may have just clipped the edge of tumour giving a false impression of area affected.

Likewise, the psa may be less helpful. With high grade Gleasons, sometimes the psa output is very low. In other cases it can be in the thousands with a similarity of spread. Different variants no doubt. I have known men who are no longer with us whose psa didn't rise above say 10'ish.

I'm doubtful that any local treatment to the prostate would be offered with visible & active bone mets. Surgery certainly not & radiation probably kept on the shelf for dealing with any pelvic pain if it should ever occur. ( There is a fixed limit on pelvic radiation amounts. )

So, any extra treatments would be systemic ones most likely. e.g. Chemo, or trying one of the more powerful newer drugs like Abiraterone or Enzalutamide earlier rather than later.

I think that the medics will want to give the current HT time to judge response. Only an adventurous Onco or a trial will bring in chemo early usually. If any pain started then a more powerful systemic treatment as mentioned might be brought forward.

Early chemo is still under review & trial. Probably worth bringing up at each meeting & discussing the Oncologist's approach at your hospital. It can vary a bit. Only your medical team have the full details & it seems sensible to ask the questions and then see how satisfied you are with their answers. e.g. Are they aiming to try & eradicate as much of the P.Ca. as possible or are they putting quality of life above all else ?

Personally, I believe in hitting hard. And accept the side effects as part of the treatments. Others favour the least intervention for as long as possible.

User

Posted 17 Feb 2015 at 23:08

Thank you for all of your responses they have been a great help and made me think. I have many more questions for my upcoming review and more work to do in contemplating quality of life vs heavy treatment if and when I establish a route to it.

Thanks again.

Tony

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