Friday, January 27, 2017

Approaching the Slippery Slope

 I have devoted considerable time and effort attempting to identify a safe and effective means to control or eliminate my recurrent PCa. I outlined the history of this endeavor in my previous journal entry. I have tentatively decided on the following ADT protocol recommended by a medical oncologist I consulted at the University of Michigan : Intermittent three-month-duration Lupron injections to be administered each time my PSA rises to 7.0. My current PSA is .60. His educated guess is it will take two years before the first injection will be needed. In the meantime, as per his recommendation, I will continue on Casodex as prescribed by Dr. Myers.
Up to this point I have avoided Lupron like the veritable plague. I first learned of  ADT researching options  following  my diagnosis in 2008. The known side effects are "off-putting" to say the least. It's a bit difficult to fathom at this point, but Lupron appears to be my best choice. For more perspective in this regard I have included a rough draft of a journal entry that I chose not to use until now: see below:
"ADT with Lupron is a form of medical castration. It is designed to do many of the same things as surgical castration (orchiectomy). It is associated with a range of side effects that many men find to be highly delibitating and emotionally devastating, including loss of libido, loss of sexual function, genital shrinkage, hot flashes, weight gain, loss of bone mass, "Lupron Brain"(difficulty in concentrating, clarity of thought, memory loss, etc.) enlargement of the breasts and other symptoms of gynecomastia, and a long list of less common problems. This is not a form of therapy I would wish on anyone if it could be avoided. ADT on its own is not curative and has never been established to extend the survival of men with advanced prostate cancer. It is a palliative form of care whose primary function is to minimize the risk of bone pain associated with advanced prostate cancer. Many clinicians believe that all too many men with progressive prostate cancer are treated much too early with ADT because it can be used to manage the patient's PSA level. However overly early use of ADT is also associated with risk for early onset of castration-resistant prostate cancer. ADT  has shown to have a survival benefit only when used in combination with external beam radiation therapy for men with locally advanced prostate cancer (and to have a curative impact in some of these patients)."
Stay tuned.

Tuesday, January 3, 2017

Disease Progression and Treatment Synopsis

2005 to 2008  PSA  rose from 1.39 ( Apr. 8) to 3.97 ( Sept. 4 )
2008 Diagnosed with PCa. Two cores positive, Gleason 4+3
2009 Completed PBRT at UFPTI on March 11  PSA  dropped to .8. UFPTI reviewed my biopsy slide and agreed with Gleason 4+3 determination
2012  PSA  rose from .8 to 2.59 from May to Oct.; Dr. Kwon of Mayo Clinic  identified a small cancerous lesion in  prostate by Choline Scan. Mayo Clinic reviewed  my biopsy slide and determined my Gleason to be 4+4 
2013  Began Hormone Lite as prescribed by Dr. Charles Myers; see below:
  I. Prescription Drugs
    A. Metformin 500 MG 2 daily. Anti-cancer
    B. Avodart .5 MG 3 a week. Anti-cancer
    C. Casodex 50 MG 3 weekly. Anti-cancer
    D. Zocor 10 MG 1 daily. Anti-cancer
    E. Losartan 50 MG 1 daily. Blood pressure.
 II. Supplements
    A. Pomegranate 1 daily 10 MG. Anti-cancer
    B. Vitamin  B12 1000mcg
    C. Vitamin D3 5000 IU 2 daily. Restore deficiency
    D. Super Bio-Curcumin 400 MG 1 daily. Anti-inflammatory
    E. Optmized Resveratol 250 MG 1 daily. Anti-inflammatory
  III.  Mediterranean Diet
  I.PSAs rose from .077 in Jan. to .18 in Aug. Dr. Myers increased my Casodex  from three times weekly to a daily dosage. PSAs returned to their former lower levels.
  II. Endorectal MRI at VCU; 3x5 mm tumor identified
2016  PSAs ascend from .11 in Apr to .49 in Dec. Follow-up endorectal MRI at VCU; tumor more than doubled in size to 10x7 mm .
I have considered several options the past few weeks including Pencil beam PBRT, cyberknife, prostatectomy, brachytherapy, focal beam ablation, cryotherapy , Hi Fu, modified hormone lite, full blown hormone therapy and chemotherapy. The first seven options have been pretty much eliminated each for a different reason. More recently an advisor recommended estrogen therapy which looks promising at least for a temporary period (a year or so?)
Major changes under consideration; too early and too fluid to document.
Stay tuned.