Thoughts about prostate cancer treatment

[erikboy (imported)]

As I am currently chemically castrated with the help of Androcur, my T level is 17ng/dL and among others my PSA (Prostate Specific Antibody) levels have dropped more than 4 times. I have read many studies about treating prostate cancer with Androgen Deprivation Therapy. (ADT) Among them comparision of Intermittent ADT (IADT) and Continious ADT (CADT).

What I have read about, gives me impression that doctors who treat Prostate cancer are oblivious of many aspects of ADT.

For example about Androcur dosages. I wonder if they ever check Testosterone serum leveles in their patients. I haven't seen any study that take into account real serum levels of T. Instead they prescribe maximum levels of Androcur to all patients. 300mg per day. Thats insane and careless! For example I started with only 200mg per day and after a week dropped to 150mg a day and soon after to 100mg. Now after 1,5 months I am at castrate levels. - 17ng/dL. It is not even mentioned what levels they want to achieve. 2ng/dL? And I am considering to reduce my Androcur intake to 50mg a day.

Now about IADT. It seems like the earlier cancer is detected the more responsive it is to ADT. One thing is that elevated PSA levels do not indicate 100% that cancer is there. So doctors hesitate to take action, even if patients complain about restricted urine flow etc. According to what I have read they hesitate to take any early action until cancer is proved. That means prostate biopsy. And usually it means also close monitoring and going to to see a doc very often and trying to cope with enlarged prostate all the time. But generally elevated PSA and restricted urine flow leads to cancer in most cases.

And here comes my frustration, when first symptoms start to emerge, it is clear that they only get worse over time, doctors do not prescribe IADT? It means like being chemically castrated for 3-9 months until PSA drops to required levels and restricted urine flow disappear. And then quite long period, up to 3 years of no treatment can follow. Quality of life is improved for much longer with early ADT.

It is also known that prostate cancer could become insensitive to Androgen deprivation, and IADT delay that process considerably. The later phase of cancer the faster it becomes insensitive to ADT. And then prostate need to be removed.

It is so stupid in my opinion that doctors delay ADT to a last possible moment. For example I did my first PSA test when I was 40. it was quite low far from treshhold. I did it again before I started chem castration and it wasn't too much below treshhold anymore, it had increased few times since the test 5 years ago. My doc said everything is ok, while knowing that my PSA can only get higher. I also have that Urine flow restriction feeling sometimes, that also indicates that something is going on, but doc said everything is ok and prescribed alphablockers. It is not OK! There is a clear tendency toward prostate cancer!

Is it really that taboo thing, anything related to "castration", that restricts doctors to take early action? Close eyes about the clear trend? I think doctors should give a choice at least, either to suggest to go forward with IADT right away and have better QoL afterwards or wait until I get real cancer and act only then. I am past of active babymaking period anyway. And perhaps I can freeze my sperm for future or with IADT my babymaking capability would restore anyway.

Such a rant

I wonder if there are any doctors that could comment it?

[Cseriess (imported)]

So, I just went through this. My father, his brother and his nephew all does within 8 months of being diagnosed with PC. With that history, at 56 I get my PSA checked regularly. Least time it was at 10. Told, ok probably better than 50% chance I have PC and should have a prostate biopsy to get a Gleason and make a plan. 12 point biopsy came back all negative. My urologist was like"great news! It all came back clear!" I asked how we go forward. How do I keep a check as my PSA now seems so unreliable. When I asked if I could just get castrated out have a prostatectomy she was shocked. No Dr is going to remove an healthy part of my body. I told her I wasn't happy with having a biopsy every 6 months. Pointed out that if I was asking about an hysterectomy or mastectomy we would be having a conversation about it, not just a no. Very frustrating. It's sad that my options are wait until I get PC, self medicate, or go see Dr A.

[experiment (imported)]

Ask for an MRI. It takes 20 minutes and is non evasive, painless an does show any small irregularities with the Prostate and Bladder. If clear go on monitoring PSA. The elevated PSA can be due to an enlarged prostate BPH. There is another blood test that gives probabilities called a 4k test that is a simple blood test that can be taken annually that looks at a lot of different things in addition to the PSA. The PSA test in itself is highly unreliable. It does cause a lot of concern an I can attest to the psychological concerns it has caused me these past 20 years that my PSA number has gone up and down like a yo-yo.

[Chesleyt (imported)]

I just had my prostate biopsy yesterday he took 13 cores my last biopsy showed I have ASAP Wich is a pre cancerous condition so I have 50/50 chance I have cancer. Ive already been castrated earlier this year for medical reasons and am on trt. I asked him about removing my prostate and he only said it leaks. I have prostate cancer in my dad's family and they died from it plus my family has a lot of other cancers that has killed them including my father. All I want to do is have him remove it because I have had prostate problems since I was 20 and I have already had prostate surgery so I can pee. I get prostitis several times a year. So I think it would be a good thing to do. I just have to convince him of that.i have continuous anxiety because of this and get depressed about it.

[Paolo]

Good luck of convincing any practicing doctor that there's even a difference between your anus and your ear. Most of them don't know their own ass from a hole in the ground. My solution to health care, globally, is to simply make it illegal and kill all the doctors and burn all the medical schools.

I do still wish you good luck, though. You're going to need it.

[erikboy (imported)]

I have seen many doctors in my life. I can tell you that doctors of internet and google era are much better explaining you your problems. Before that it was quite normal that doctor prescribed you something, ordered to take it at certain intervals and after a certain time emerge at somekind of analyses cabinet. Mostly you got just a diagnose and off you went.

Nowadays I can learn about various conditions etc on the internet, other people experiences, other doctors diagnoses, scientific works, surveys, etc. I often asked a doc questions he is not expecting from an ordinary patient. And last time I met a general practicioner, he was willing to share his knowledge. That was enlightening, ensuring. Things are getting better. Doctors are more aware of dr. google.