How will I know if prostate cancer treatment has helped?
I have had 41 external beam radiation treatments, 25 full pelvic treatments and 16 "Boost" treatments aimed at the prostate only. I am receiving hormone therapy also that requires one shot every three months. So far I have had two treatments. When I was first diagnosed, my Urologist said three hormone treatments was all I could have as more would cause brittle bones. Now, this same doctor says I may have to take these shots for the rest of my life. When I asked how I would know if treatments have helped, he replied six months after I'm off the hormones a PSA test would tell. Now that's really a Catch 22. Has anyone experianced these same treatments and what are your results? My Gleason score from my biopsy was 9, so removal was out of the question.
My bone scan did not show any cancer there. I am told the full pelvic treatments were for cancer cells that may have been in the lymph nodes. My Gleason score from my biopsy was 9, so removal was out of the question. My bone scan did not show any cancer there. I am told the full pelvic treatments were for cancer cells that may have been in the lymph nodes. Several good answers, to the answerers who wanted me to go to link, I've tried and didn't get anywhere. To the researcher, read the post, PSA levels are no good as long as you're on hormone therapy and I was told, I might be on hormone for the rest of my life. No removal is what I was told as soon as I met with the Urologist who did the biopsy. I could overhear him talking with his assistant about what the tumor looked like with the sonogram while doing the biopsy. I can only speculate that the cancer had left the prostate. A bone scan showed that it had not got into the bones. It could also be that the insurance company would only pay for one procedure and radiation was chosen. There are some good answers here, there are a couple that refer me to a link that doesn't work and one that sounds good except it doesn't answer the question. I have provided all the details. I guess I'll just let this go to vote.
Cancer - 6 Answers
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Welcome to the uncertain world of cancer treatment. You do know that there is no cure for cancer, only treatment that might lead to remission and eventually after a long passage of time . . cure. Malignant cells have the ability to lay dormant in the body and reappear after an undetermined amount of time. Thus, you may need to stay vigilant for the rest of your life. Sounds like you need to have a serious discussion with your doctor. Here are some sites with information about prostate cancer. It might also help you to get in touch with others who have this disease: Prostate Cancer Foundation http://www.prostatecancerfoundation.org/ NCI: Prostate Cancer http://www.cancer.gov/cancertopics/types/prostate Medline Plus: Prostate Cancer http://www.nlm.nih.gov/medlineplus/prostatecancer.html NCCN: Prostate Cancer Treatment Guidelines http://www.nccn.org/patients/patient_gls/_english/_prostate/contents.asp NCCN: Clinical Practice Guidelines in Oncology - Prostate Cancer http://www.nccn.org/professionals/physician_gls/PDF/prostate.pdf Best to you.
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The PSA test can show if the cancer has returned because it would be higher than normal. See on reg check ups after 50 you get the PSA level checked if it is higher than normal you could get more tests. If you have cancer then you get the treatments which should bring the PSA level back down to normal. (or at least closer to normal.) The doctor will compare your PSA to your previous PSA levels and "normal" levels. This will determine if the cancer has returned. The hormone therapy will lower the testosterone in you body which is directly linked to the prostate. The lower the testosternone the better. But because the hormone therapy will lower the testosterone the PSA level isn't acurate until your body is doing it on its own with out the help of hormones. Radiation treatments can also affect the PSA level, but the doctor shoudl know this and would take that into consideration when checking the PSA level.
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Well this is a very good question. I will do my best to answer this for you since this is my area of expertise. I do not know your case or stage, but according to what you have told me, I can make a few assumptions and try to answer as best as possible. 1. Considering you had 25 full pelvic treatments I am going to make an assumption that you were intermediate in your staging. This means that you may have had some extracapular extension of your cancer outside the prostate. This would be the reason for having had full pelvi irradiation. 2. With the 16 smaller shots, or boosts, this is to take the dose up in the tumor area and decrease the normal tissues. 50Gy is a typical dose for any microscopic disease. The reason for the boost is to take the cancerous area to a higher overall dose and to provide more cell kills to the cancer. 3. Hormone therapy is an adjunct that will also help to decrease any cancer and to help with the radiation in fighting the disease as well. 4. A psa will tell the doctors how you are doing. The reason for waiting 6 months after your last shot is because the efficacy of the shot is about 3 months. In orer to have it entirely out of your system, and allow your hormones to return to a normal state, you need an additional 3 months. At this time they will be able to take a blood sample and let you know how you are doing based off of your PSA levels. 5. You can also ask your physician for a bone scan. This will also be able to see if there any metastic lesions forming anyplace else in your body. 6. You could also ask your physician if he thinks it might be a good idea to have a PET/CT done. He might say that it is a high cost exam and that your insurance won't pay for it. You can tell him if he refers you to a facility that is enrolled in the National Pet Registry that they will cover the cost of any diagnosis of cancer....so now you can have him order the test. This will also be able to detect any potential of spread to other places in your body. 7. You could also ask your physician if a CT Scan would help at all. Of course, after radiation, you have to wait about 6 months in order to allow your body to return to normal as well internally. Radiation continues to work at the cellular level for up to 4-6 weeks after your treatment depending on what dose you were treated up to. The most important thing is to remember to ask your physician questions. If you are not satisfied, then ask another physician. You should be able to ask your urologist, if he is not willing to help, then go to your radiation oncologist. Also....do not ever let anyone tell you that you can not be cured. Prostate cancer is a very curable and treatable disease. It is not a death sentence. Continue to go to your check ups, ask plenty of questions, and really communicate with your physician. Good luck and congrats on being a cancer survivor.
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Arthur R, As you are aware,I,too,have had 41 radiation treatments. I've also had 2 1/2 years of hormone treatments, the last of which was 2 years ago.My cancer had spread so my prostate was removed. Since stopping the hormone treatments I have grown hair(everywhere),my breast's have stopped growing and my latest PSA was .06,which is terrific.Your Urologist,has indeed,raised the "Catch 22" flag.Your PSA will indicate whether the treatment is working but stopping them may not be an option.My Urologists tells me that if(or when) the test results show an upward movement I will probably have to start them again.Given my original prognosis,I consider myself very lucky.I suppose it is best for you to remember that the hormone treatments have been proven to prolong life expectancy by many,many years.That,along with your radiation treatments,probably means that you and I will be at heavens' gates together------ at 103 years old! Thinking of you as always. P.S. My Gleason score was 9.7 before surgery.Why the "no removal" decision?
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Let me see if I can help you a bit. After your third hormone treatment, you will go off for 6 months, retest the PSA, & then if your PSA is low enough, you can stay off the hormone therapy & just get the PSA rechecked in 3-6 month intervals for life. When the PSA levels rise again, then the Dr. will discuss the possibility of going back on the hormone shots. An eventual tolerance to the hormone therapy will develop down the road, that is why you are on for a certain amount of months & then off. This hormone therapy does cause Osteoporosis. I would highly suggest adding a good Calcium supplement along with Vitamin D to combat this inevitable side effect. My father was on this therapy on & off for 8 years & suffered from this along with hot flashes & uncontrollable sweating, weight gain, bone pain,& a host of other things. He chose to eventually go off because of the side effects. The decision comes down to an individual choice of what you wish your quality of life to be & how controllable your case may be. If I were you, I would suggest getting a 2nd opinion on your treatment plan. Looking back on my Father's care, that is something we didn't do, that I wish we had done!. We followed his Urologist's hormone therapy plan & didn't try any alternative therapies. I am unsure with your Gleason numbers why they didn't decide on surgery after your radiation. If you have a Cancer Institue in your state, I would start there to get an appointment with a specialist in Prostate Cancer. If you don't have one, ask your Radiologist who he would recommend. I would also suggest seeing if you qualify for any investigational drug studies being conducted with Prostate Cancer specialists in your area. The hormone therapy companies got in trouble a few years back for bribing Dr's with kickbacks to keep patients on these shots & they settled it for a record 875 million $$$$$!!! So, I am always suspect of motives. Anyway, as far as helpful sites, I suggest www.mdanderson.org & then just type in prostate cancer. I think that is a great resource & they have an 800 number you can call for advice. My prayers are with you & I hope that I have been of some help! Be strong in your fight ! God Bless! ADDITIONAL QUESTION: My husband just brought up this morning, if surgery isn't an option what about Radioactive Implant(seeding).? In our past research we found that a diet with limited dairy is best.. If you have milk make sure it is hormone free. Also, if you can buy hormone free meat & eggs that is key. The more you limit your outside hormone influences the morre control you will have in your cancer. I know I mentioned Vit. D & calcium earlier, but no matter what increase your intake of those. If you can get at least an hour a day of sunshine along with taking Vitamin D3 (3 Capsules a day, for a total intake of 15,000 IU) that is as important in treating the cancer as much as helping in the bone loss. I would get the D3 from a health food store in your area. Thorne makes a good brand called D-5000. In addition, take 3000 mg of Calcium Citrate daily.( capsules are easiest to take) If you have any bone pain, take MSM capsules 3000 mg twice daily. You can get this anywhere & any brand is fine (inexpensive) New studies have found Lycopene 10 mg. twice a day is extremely beneficial in fighting the cancer cells. EGCG (Green tea extract....decaffinated) 200 mg. twice a day. Try & not drink soda pop as it will pull calcium from your system. Also the aspartame in diet drinks can create toxicity enhancing cancer cell growth. If you have any more questions please email me, my husband is a Dr. & I spent the last 12 years researching everything I could to help my Dad during his fight. NOTE: DO NOT TAKE MUTIPLE VITAMINS containing SELENIUM or CADMIUM because a new study in Britain shows these may ne linked to Prostate Cancer. INSURANCE: Your insurance will pay for whatever treatment your Dr. deems necessary to eradicate the cancer. If you have problems or questions with insurance coverage contact your treatment hospital & ask for the Patient Advocate for assistance & advice.
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