Charles (Chuck) Maack Posted April 4, 2013 Share Posted April 4, 2013 Introduction - if you wishIf interested in my prostate cancer, advocacy, and mentoring background, (my “credentials” if you may) please visit the following www.theprostateadvocate.com where you can also click on the menu word "Observations" and access over 150 papers I have either authored, compiled, or posted from medical friends regarding prostate cancer, recurring prostate cancer, treatment options, treatment of the side effects that often accompany most all treatment options, and more.Month and year of dia gnosis. Example: June 2009November 1992Age at diagnosis. Example 61 years59PSA at diagnosis. Example: 7.76.8ng/mlGleason score at diagnosis. (from biopsy) Examples: 7 OR 3+43+4/7Biopsy details. Examples: Positive cores 7/12 (58%) OR (R: 4+5 75%, 4+5 75%, 4+5 95%, 4+3 20%, 3+4 15% L: -, -, -, -, -, 3+4 50%) UnknownBone scan result at diagnosis. Examples: Clear OR Metastases in pelvis and lower spineClearLymph nodes at diagnosis. Examples: Clear OR CT scan shows 2 lymph nodes positiveClearCapsular penetration (growth through prostate wall). Examples: None OR MRI shows probable extra capsular extension at left base in midline surrounding seminal vesicles and ejaculatory ductsAs the result of a tumor extending into fatty tissue beyond excise boundary, followed with 37 external beam radiation trea tmentsHighest PSA before treatment. Example: 10.46.8ng/mlInitial treatment - surgery. Examples: Robotic prostatectomy OR open prostatectomyOpen Surgery/RPInitial treatment - other. Examples: Immediate chemotherapy with Taxotere OR HIFU (High Intensity Focussed Ultrasound)EBRT 37 sessionsLowest PSA after initial treatment. Example: 0.2<0.1ng/mlMonth and year of recurrence. Example: June 2012mid-1996PSA at recurrence. Example: 2.70.81ng/mlBone scan result at recurrence. Examples: Clear OR Metastases in pelvis and lower spineClearOther scan result at recurrence. Examples: CT scan clear OR Pelvic MRI with IV contrast shows recurrence in prostate bedClearRecurrence treatment - hormone therapy. Examples: Zoladex + Cosudex continuous OR NilutamideADT2/Lupron/CasodexCurrent treatment status. Examples: Continuing ADT OR Monitoring PSA each 6 weeksLupron/Avodart/ZytigaLast few PSA scores with dates. Ex ample: PSA 0.04 Jul 2011, PSA 0.05 Sep 2011, PSA 0.07 Feb 2012, PSA 0.11 Jul 2012At beginning Zytiga 2.55ng/ml; Currently 18 months later 0.52ng/mlFinal paragraphs - anything else you wish to sayWhen a patient is moved to ADT as primary continuing treatment, I am a proponent of triple-hormonal blockade (ADT3) using an LHRH agonist or antagonist, an antiandrogen, AND a 5Alpha Reductase (5AR) inhibitor with dutasteride/Avodart preferred over finasteride/Proscar. If PSA and Testosterone levels drop to clinically castrate levels, and with these levels remaining steady for at least 12 moths, I am also a proponent for Intermittent Androgen Deprivation (IAD) stopping the LHRH and antiandrogen BUT continuing the 5AR inhibitor as a maintenance medication to inhibit returning testosterone from coming in contact with 5AR isoenzymes wherein if the testosterone were not inhibited, the testosterone would convert to the much more powerful stimulant to PC cell growth and proliferation, dihydrotestosterone/DHT. Should PSA eventually elevate to no more than 2.0ng/ml, it would be time to add back the antiandrogen followed by the LHRH medication. Should PSA and T levels again drop to castrate levels and remain there for another 12 months, IAD would again be in order, and these forgoing cycles repeated for as many years as effective with changes in medications as needed....as in my case for now over 16 years on/off ADT medications.Date updated.4 April 2013 Link to comment Share on other sites More sharing options...
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