My PCa history

[Maxi54]

After rising PSA from 6.92 in March 2012 to 9.98 in April 2013 Uro performed Prostate Biopsy in April 2013.

12 samples were taken: worst sample 4+3 (30% involvement) and four samples 3+4 (5% involvement).

Scheduled for robotic prostatectomy, but before it Uro gave me four shots of Fermagon.

Uro surgeon plan was to shrink prostate size before surgery. Original size 7.43x5.61x5.97cm and volume 130.3mg. After four months of HT prostate size 5.91x 5.0x4.12 cm and volume 63.7ml.

September 2013 Robotic Prostatectomy:

pT2c bilateral pNx

Gleason score: Primary pattern 7 , Secondary pattern 3, Tertiary 5. Tumor involve 5%, EPE not identified, SUV not identified.

According to Surgery Report prostate was removed in two pieces and no seminal vesicles where removed. Also no samples of lymph nodes where taken. (seems to me that surgery didn't go as suppose to).

February 2014 PSA 0.05 testosterone 571 (recurrence).

May 2014 Abdomen and Pelvis MRI show left SV nodule 7mm, suspicion for recurrent tumor.

June 2014 start HT (Lupron and Casodex), September 2014 RO took me off Casodex because DVT in my calf, stayed on 3 months Lupron shots for 18 months.

August 2014 start RT for prostate bed (40 sessions 35+5 busters for total of 72 Gy)

September 2017 PSA 0.01

August 2018 PSA 0.02

June 2020 PSA 0.03

February 2022 PSA 0.7

March 2022 PSA 1.03, testosterone 115 (PSA doubling time 2.5 month).

March 2022 PET CT F18 show three right periaortic lymph nodes 0.4cm, right second rib and left seventh rib lesions.

April 2022 staged mHSPCa started HT (Lupron and Erleada).

August though October 2022 Radiation to the lymph nodes 30 sessions (25+5 busters 45Gy+12Gy for total of 57Gy).

Till March 2024 PSA <0.02

I have all typical SE of prolong HT but the worst is progressing Rheumatoid Arthritis causing much pain mostly in my spine what I believe is accelerated by HT(Lupron and Earleada).

Because of muscles and joint pains I'm considering to stop HT and watch PSA.

My only problem is if intermittent HT not going to make my PCa prognosis worst than continue HT.

[janebob99]

If you're considering stopping Lupron/Erleada ADT, you may want to consider substituting transdermal estrogen ADT for Lupron/Erleada. Look up papers about the PATCH trial in the UK that's doing a head-to-head comparison of estradiol ADT to Lupron ADT. Side effects are much lower on estradiol therapy.

Estradiol Pros vs Cons

[Maxi54 in reply to janebob99]

Thank you Bob for this. I will discus Transdermal Estrogen Therapy with my MO. Looks good from the stand point of the patient because side effects are less troublesome than Lupron and Erleada. My only question is if Estrogen Therapy is already SOC in US.

[j-o-h-n in reply to Maxi54]

Are you 69 years old or 74 years old?

Good Luck, Good Health and Good Humor.

j-o-h-n

[Maxi54 in reply to j-o-h-n]

I'm 69.

[j-o-h-n in reply to Maxi54]

I was 18 years old when you were born.

Good Luck, Good Health and Good Humor.

j-o-h-n

[Boywonder56 in reply to j-o-h-n]

so your older than.....blu cheese...electric vehicles...a damn good scotch....and the piece of popcorn i found in me couch....you got any old jokes ...

[j-o-h-n in reply to Boywonder56]

Sure, but I can't remember them....

Good Luck, Good Health and Good Humor.

j-o-h-n

[janebob99 in reply to Maxi54]

Not SOC in the US yet. That will have to wait for the Phase-III PATCH trial results that will be published this Fall.

Most docs will allow is the use of transdermal estrogen (TDE) "add-back" at a low dose, in addition to doing standard ADT. Low-dose TDE could be a single, large estrogen patch that has 0.1 mgE2/24hr dosing (one patch at a time). That will mitigate the hot flushes and osteoporosis from standard ADT.

Bob