PSA Persistence after RP and Salvage Radiation

Ebearla is a pill that kills testosterone. You take 4 per day, cost 15,000. Per month. Yes, very expensive. Similar to Zytiga or abireterone
After 11 years of this, I feel most of the medicines work to restrain the PSA. They are not designed to cure cancer but to contain it. As you can see $15,000 per month is a great incentive to keep you on the medication. My urologist sells me mine, it does not come from the pharmacy. I suggest you see a naturopath and add that to your treatment regime. It will include boost and vitamins and minerals and some diet changes. All easily doable.

Obviously, your cancer had spread already. Now you’re in need of finding where it has landed and in what form and treating that. If you haven’t had a pet scan or bone scan, I would suggest one of those and if you want, see a naturopath to change up your diet and add more vitamins and minerals. Do you want to eat as healthy as you can.

Ebearla must then be like the Zolodex injections I am on 3 months each

Enzalutamide is planned in Jan 4 pills a day 13K CDN for 90 pills yet our health care covers it if over 65 I am 78

Comments appreciated

Perform routine DRE's? PSA? You decide.

A few years ago the medical establishment decreed that routine PSA testing be discouraged or declined (mine only continued as a professional courtesy).

Likewise, a few years ago, I switched from an excellent primary care physician (female) who always did a DRE, to an excellent new doc (male) who has never done a DRE on me in the 12 years with him. I was surprised. He said is was no longer recommended.

Someone somewhere in the medical establishment must have decided that the DRE "yield" in PCA was too low to justify, or perhaps there were too many false positives.. I always thought this odd since I seem to recall that in the early days of PSA testing, the literature indicated the DRE picked up some cancers that PSA missed. In the case of my physicians, they belong to the same major medical center.

So, DRE? Here's the experience of a friend, same age as me whose PCA diagnosis proceeded mine by six months. He was not receiving a routine DRE. His PSA's routinely ran in the high one's. One day, he was temporarily moved to a different primary care doc. This one did perform a DRE and found a suspicious nodule. It was biopsied. His PSA was 2.1; the biopsy was significant Gleason 7/8. He proceeded to Brachytherapy then EBR and now on Lupron (and hates it).

So, I concede that this is anecdotal, but should we continue to do DRE's? How are these medical decisions being made? On what data?

So, what about PSA? Should we have discontinued routine PSA testing? I have a 30 year record of PSA tracking over time, and it caught my PCA, but not before my doc was convinced that an annual PSA value of 1, 2, 4, and finally 7 justified evaluation. We should have done an MRI at 4 for sure or more frequent testing after 2. How are PSA values being employed today to make evaluation decisions? What are the guidelines, Based on what data?

"Perform routine DRE's? PSA? You decide."
Exactly. I believe all these things are certainly indicators but not necessarily proof of Prostate cancer, you need the biopsy for that.

My GP was a non believer in DRE's.

My PSA rise was discovered at 11. Off to a very experienced urologist who did a DRE, he said the result of that test was absolutely normal, and he was perplexed about the PSA. The biopsy showed Gleason 7.

So, in my case the GP was correct, the DRE would have told him nothing.

On the other hand, while on my journey I became aware a friend had this and his PSA went up a little a DRE caught irregularity and the biopsy showed Gleason <6. Radiation, no ADT, about 7 years ago, still good.

...and in my friends case....a DRE likely saved him from a lot of issues that those of us who get diagnosed a little later deal with.

Go figure. Seems everyone is different.

Based on my recent prostate cancer experience, I believe the PSA and DRE are not being utilized to the extent they should be. With any individual test, there can be false positives - Annual mammograms, cardiovascular stress tests, etc... However, these tests are indicators for potential serious conditions and should be taken seriously. In my situation, they were not. My primary care physician started taking my PSA when I was 50, and it was 1.5. Three years later my PSA rose to 3.0, then two years later it rose to over 6. My doctor never mentioned this to me, but fortunately a friend within the same hospital organization reviewed my health records while analyzing my cholesterol history. She saw that my PSA level and slope increase were high and told me that I definitely had an issue with my prostate that needed to be addressed. Within three days I had an appointment at Mayo-Rochester. A week later, an MRI showed I had a lesion and we decided to do a biopsy. Another week, and the biopsy showed cancer - Gleason 7 (4/3). Six weeks later I had a radical prostatectomy (prostate/seminal vesicles & six lymph nodes removed). Absolutely wonderful experience at Mayo-Rochester. The Doctors, nurses, and support staff were outstanding. I was amazed with the level of care given to me at Mayo versus my local hospital in Iowa.
Based on my experience and subsequent research, I believe prostate cancer indicators (PSA, DRE, etc.) are not being utilized because of the high costs associated with MRI's, biopsies, etc... In my case, acting on the PSA increase earlier would have opened up so many more treatment options and not allowed for the cancer to advance to the stage it had.

Take care and Happy New Year!!

Jim

What is PLN system? How and what could I treat it with, radiation? Thanks, Nate

Nate

I get lazy sometimes and use abbreviations when I should be spelling them out...

I'm referring to the pelvic lymph node system which is where prostate cancer cells go to and establish new metastatic sites, initially too small to be seen by imaging when they are micro metastatic but depending on doubling tones, can rapidly become visible on imaging.

Best to discuss with your radiologist on how they would treat the entire pelvic lymph node system as it may depend on imaging. In my case, one of the four was pretty high and would not have been in a standard treatment field.

Here's a link which may help you understand- https://training.seer.cancer.gov/lymphoma/anatomy/chains/pariental-pelvis.html

Kevin