YANA - YOU ARE NOT ALONE NOW

PROSTATE CANCER SUPPORT SITE

BRONZE

Grant Martin and Sandra live in London, UK. He was 66 when he was diagnosed in January 2007. His initial PSA was 25.7 ng/ml, his Gleason Score was 4+3=7 and he was staged T3 N0 M1. His choice of treatment was Intermittent Hormone Therapy. Here is his story:

May 2002: PSA reading of 6.0 ng/ml. Doctor (lady) said not to worry; it needed to get up into the hundreds first if it was to be cancer. No suggestion of annual check-up, and naively I didn't check again until ....

Nov 2006: PSA 25.7 ng/ml

Jan 2007: Biopsy result Gleason 4+3, present in 10 out 11 cores. 2 cores appeared to show tumour had pushed outside the prostate

Feb 2007: Bone scan showed six metastases, 3 in lower spine, 2 in left hip bone and a rib. Started on Cyproterone Acetate

Mar 2007 (end of): MRI scan shows T3 N0 M1. PSA down to 5.3 ng/ml

May 2007 (end of): started on 3-month course of Zoladex + Cyproterone Acetate

I was diagnosed in Jan 2007 just as we were off for 4-week trip to Hong Kong and New Zealand.

I managed to get a bone scan a few days before we left. The urology registrar at Charing Cross Hospital in London rang me on my mobile (only switched on as an alarm clock!) at midnight in Hong Kong because the bone scan showed a few metastases. He urged me to start on antiandrogens as soon as we got to New Zealand. Long story about that, but the only one their health service had available was Cyproterone Acetate (well, there are only 4.2M people to fund their Health Service).

Back in UK Charing Cross wanted me to go on permanent Zoladex, despite probability of the cancer becoming hormone refractory within 2-3 years. Looked around the Internet to learn that intermittent hormone treatment (IHT) appears to have equal survival rates -- President Mitterrand apparently survived 14 years on this. Took a second opinion, to discover that recent European research shows that a 3-month MAB (maximum androgen blockade) course followed by a holiday has no worse survival rate than the 9-month course that was the current IHT practice.

How long will the PSA remain within bounds once the current treatment course stops?

UPDATED

September 2007

 

 

Closer reading of the research study, however, revealed that for metastatic cancers, the period on IHT would have to be up to nine months afer all, not the three I was hoping for. The slow fall in my PSA (apparently the bone mets are the main culprits) underlines this. Now I'm hoping that I can start a holiday from the treatment at Christmas 2007, and that I won't have to go back on HT until late in 2008.

I'll keep you posted.

 

UPDATED

January 2008

 

 

Consultant has confirmed PSA is low enough (at 1.91) to stop treatment for now. PSA is to be monitored monthly. Once it rises to the 10-15 range, then it's back on HT to bring it down again.

Keep your fingers crossed, guys, for a long holiday!

 

UPDATED

March 2009

 

 

After stopping treatment Jan 2008, my PSA started to rise quite rapidly --

Jan 1.41,

Feb 4.01,

Mar 8.94,

Apr 10.7.

I dreaded the thought of going back to Zoladex, particularly as libido had returned during this off-treatment period. So my oncologist suggested using a different regime -- three months on, three months off -- based on an antiandrogen (Flutamide) rather than the LHRH agonist Zoladex.

I started this mid April 2008, which brought the PSA back down to 3.44 by mid July, the end of the three-month on-period. PSA now rose even faster:

Aug 14.8,

Sept 21.2.

So I put myself back on Flutamide mid Sept, fully expecting that this brush with IHT was now over and it would be back to Zoladex. But my oncologist suggested we persevere, this time adding Avodart (Dutasteride) to Flutamide. PSA came down in the next three-month on-period:

Oct 4.77,

Nov 4.87,

Dec 4.71.

But within one month of stopping, my PSA was 19.8. So I accepted it was back to long-term LHRH agonists, this time Triptorelin, which my oncologist reckons has a slight edge over Zoladex (I’m taking cyproterone acetate in parallel).

Testosterone levels were restored during the year since there was no LHRH agonist to suppress it, and I put the increased PSA low points down to that. Although IHT had not given me the respite hoped for, it has been a good year, where my libido returned even though ED was not fully conquered.

I'd still recommend people try IHT; that it did not work too well for me is not to say that others won't get much longer periods off treatment, and such periods are to be treasured. After two years I still have no symptoms other than reduced urinary flow (which seems to respond inversely to my PSA level!).

For the record, I’m of the non-dairy, non-red-meat persuasion (which dropped 20lbs off straight away), and take 5,000IU of vitamin D3 daily. I am physically much fitter than I was two years ago (I work out in a gym and swim 3 times a week) and am hoping that this will counteract the lethargy that afflicted me when first I went on to Zoladex in 2007.

Grant's e-mail address is: grantm@dfsoft.co.uk