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    Had external beam radiation (40 treatments) in 2005
    marinemustangpa posted:
    After 7 years of ups and down PSA and 4 biopsies, two of which were positive. Went into treatment with a PSA 10.5 , Gleason 3+4, T1C.

    I'm now 76 and in good health other than the prostate condition. I work out 6 days a week on treadmill for 45 minutes.

    My PSA never reached a nadir under 1.0 settling in at 1.7. Over the years it has elevated until now it sits at 12.3, My Urologist has taken a conservative approach. I get PSA every four months and our goal is to maintain quality of life and treat the rising PSA when necessary. I know there are deferring thoughts on whether to treat early or wait until later. I and my Urologist support Dr Walsh's theory regarding when it is appropriate to start hormone therapy.

    I visited with my Urologist last Thursday. He did a digital exam and it was negative. He ordered a bone scan, X-Ray and CT-Scan of abdomen and pelvis. I get the tests next Tuesday. I've had several CT-Scans over the years (the first couple due to colon cancer, which I have been free of for 15 years). They have all been negative as well as the bone scan.

    Pending the outcome of the tests next week we will decide whether to treat my rising PSA with an LHRH (Lupron) or wait it out getting PSA tests every 3 months or so. I will go back to Urologist in two weeks when we will decide what course of action we take.

    I am satisfied that I choose EBRT administered by a Fox Chase affiliate and with the treatment so far to maintain my quality of life. Hopefully we can continue to do so and also choose hormone therapy at the right time. Knowing that hormone therapy is not a cure but a means of lowering PSA. With or without it the cancer is still there.

    Just thought I would share my experience and will be greatful for thoughts.

    USMC-Rte PA.
    Basir U Tareen, MD responded:
    Dear Chuck,

    It sounds like you and your doctor have taken a thoughtful and rational approach to your treatment. As I'm sure you are aware, there are differing opinions when to initiate hormonal therapy in the face of rising PSA after radiation therapy.

    I often use 10 as a "magic number" when to pull the trigger on starting hormonal therapy and at that point I will often consider using intermittent androgen deprivation therapy with "drug holidays" and re-starting of treatment when testosterone and PSA levels begin rising.

    As with any case, you should continue to make informed decisions after discussions with your urologist.

    best of luck,
    Dr. Tareen
    Fairwind replied to Basir U Tareen, MD's response:
    A Medical Oncologist who specializes in prostate cancer has the skill-set you need at this point..With a PSA over 12, its time to start thinking about ADT...JMHO....
    marinemustangpa replied to Basir U Tareen, MD's response:
    Thanks - Do you combine LHRH with androgen? I know there are varying opinions on the use of both as well as intermittent therapy. I've learned over the years there is no set answer and I also understand that the use of hormone therapy does not really stop the more aggressive cancer. I understand it kills off the more responsive but whether you take hormones or not the cancer will continue to grow. Giving sometimes false hope in that the PSA is reduced. But on the other hand it is all we have.

    az4peaks2 replied to marinemustangpa's response:
    Hi Chuck, - As you know, I have followed your journey for several years and we have had direct communication on occasion.

    It is good to see you are still kicking around and that your rather conservative treatment approach has been reasonably successful in maintaining your quality of life and that you have reached 76 y/o without greatly significant problems to date.

    According to the SS actuarial tables a typical U.S. Male who is 76 has about 10 years of remaining life expectancy (ON AVERAGE), so this is the pragmatic time-frame to be considered, when considering treatment decisions.

    Hormone Therapy (HT), usually starting with ADT, has its own set of side effects (morbidity) and I know that in the past, you have had strong feelings about preserving your quality of life. Intermittent HT usually provides a better Q of L , during the "off" periods than does continuous HT. It seems to me that you and your professional advisors are in harmony about your treatment and that, I believe, is important for your well being.

    Although it is a "crap-shoot" for each and every one of us, individually, it appears to me that you have a good chance of making the actuarial life expectancy. Good luck in whatever you decide and enjoy life, as best you can. Best personal regards! - (aka) az4peaks
    marinemustangpa replied to az4peaks2's response:
    Dear John: I too am so happy that you too are around. You have been so generous with your time and effort to provide all with the best possible available options for decision making for such a great number of years. Your kind words and personal time to have called me to discuss things will always be part of my positive thought in dealing with things. I'm so sorry that many who were part of our discussions a dozen or so years are no longer with us. But they too have contributed to our learning process.

    We all know there is no one answer? The best one can do is learn as much as possible. Read as much as possible. Discuss matters with experts. Get the necessary tests. Stay on top of things. Learn of the experiences of others as we do here. And, most importantly stay positive and as appropriate let our faith take hold. I would like to believe your view of my future will be so, but if not I do know I have had a very well lived and rewarding life. Can't ask for anything more than that.

    I pray things have been good for you.

    Olsen33 responded:
    Thanks for sharing this.
    Olsen33 replied to Fairwind's response:
    Good to know.
    marinemustangpa replied to az4peaks2's response:
    Further John, I got results back from CT-Scan and Bone Scan. CT Scan was clean unfortunately the Bone Scan marked a suspect area on left pelvis. I'm going in for an MRI of the area next week and we will take it from there.

    They didn't find any other markers except for a bit of gout on left big toe.

    az4peaks2 replied to marinemustangpa's response:
    Hi Chuck, - Older men (like us) nearly always have "suspect" areas on bone scans, so lets hope that the MRI will clarify that the lesion is an old injury or arthritic changes.

    If, however, it does turn out to be a metastasis from PCa, it it would still likely be treatable as as a chronic condition and it wouldn't change my optimistic observation about your probable life expectancy (as affected by PCa).

    It is nice that you, like me, remember those who have not been as fortunate in their PCa battles. When we lost Bill, we not only lost one of the "good" guys of the world but, also, an unbiased fountain of knowledge that was, and is, matched by very few. AND Dave was one of the most compassionate and caring people you will ever meet. Both gone too soon and missed greatly, by me.

    I wish you the very best my friend and until you tell me differently, I'll continue to hope that the "suspect'' area on your Imaging, turns out to be benign in origin.

    Semper Fi - (aka) az4peaks

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