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What is best next treatment after 20 years of active surveillance?
Prostate Cancer | Last Active: Oct 16 5:07pm | Replies (20)Comment receiving replies
If the prostate cancer goes out of the prostate to 3 pelvic & 1 para-aortic lymph nodes per CT, and leuprolide is started right away, without a recent biopsy or MRI, can a man ever go back on AS? A CT was done < 2mos later and showed "Lymph nodes: normal" and "No evidence of metastatic disease". Efforts to have more confirmation of metastasis were thwarted by about 5 different oncologists & urologists. They all just wanted to continue the same treatment indefinitely. Is it okay to go back on AS after Possible metastasis? Has anyone been able to do that? ADT w/undetectable PSA for almost 5yrs I know has taken some toll!
Replies to "If the prostate cancer goes out of the prostate to 3 pelvic & 1 para-aortic lymph..."
@jonesfit65
When you say “go back on active surveillance” do you mean just stay on ADT? If you are on ADT, you are not on AS. You’re just suppressing the currently active cancer.
A PSE test could prove that you either have cancer or do not. It’s at least 94% accurate. If it finds you have cancer, then you need a biopsy. If it doesn’t, then you could stay on “active surveillance”
If you’re talking about going back on AS without ADT Then you need to get PSA test pretty regularly, I’d want one monthly for at least three or four months, then quarterly.
You don’t mention what your PSA got up to before they put you on Lupron. It must’ve been pretty low.
Prostate cancer never really goes out of the prostate. It may shrink due to ADT, but it’s still there. Same thing with your Lymph nodes. ADT can shrink the cancer so it doesn’t show up, But you stop ADT and it is likely to rise up again.
Staying on ADT alone, for as long as you are, can make you castrate resistant and can make the whole thing worse in the future. Median survival once you become castrate resistant is two years.
The thing is ADT does not eliminate prostate cancer. It suppresses it, reduces it in size stops it from spreading, but it’s still there.
Have you been to a center of excellence to be checked out? It just sounds like the right people are not treating you if you are on ADT for five years and have nothing else done. A real strange situation these doctors have put you in.
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@jonesfit65 if you don’t get a reply from @jeffmarc, I recommend reposting your question as a standalone topic. Many can comment on this topic.
If you are near Albuquerque, I recommend getting an appointment at the UNM Cancer Center with one of their Genitourinary Oncologists, who can walk you through their protocol for ADT treatment “holidays.”
I believe that the specifics will depend upon your specific pathology and treatment history.