Re: Avodart after treatment

[Guest guest]

> I was treated with radiation and

> seeds 4 years ago and was advised to go on Avodart to reduce

> the likelihood of a recurrence. The Avodart is causing

> breast enlargement, may be contributing to ED and costs

> quite a bit. I wonder if it's necessary and if any one else

> got the same advice. My PSA has been <.01 since treatment

> and I get annual color doppler ultrasounds which have all

> been negative. Thanks.

I have no expertise in this area and am not qualified to give you

advice. However, having said that, I'll try to offer whatever

ideas I can.

If you have not been taking an LHRH agonist (Lupron, Zoladex,

Eligard, etc.) recently (in the last two years) and your PSA has

remained undetectable, it seems to me that you ought to be able

to try to get out from under the Avodart. If it were me, I would

discuss it with my doctor and, unless he came up with a good

reason, I think I'd get off the drug.

The side effects of Avodart are generally thought to be less than

the " heavier " androgen deprivation drugs, and some doctors think

they're not a serious problem. But it's a good bet that those

doctors haven't been taking Avodart for four years. They may not

understand what you're experiencing.

You could increase the frequency of your PSA tests in order to be

sure that removing the Avodart isn't allowing a recurrence to get

established. If your PSA goes up by some amount (I'm not sure

how much) then it would be time to consult with a doctor about

it, possibly getting back on the drug.

Best of luck.

Alan

[Guest guest]

Avodart does not reduce the likelihood of having a recurrence.

 

I was treated with radiation and seeds 4 years ago and was advised to go on Avodart to reduce the likelihood of a recurrence. The Avodart is causing breast enlargement, may be contributing to ED and costs quite a bit. I wonder if it's necessary and if any one else got the same advice. My PSA has been <.01 since treatment and I get annual color doppler ultrasounds which have all been negative. Thanks.

-- T Nowak, MA, MSWDirector for Advocacy and  Advanced Prostate Cancer Programs, Malecare Inc. Men Fighting Cancer, TogetherSurvivor - Recurrent Prostate, Thyroid, Melanoma and Renal Cancers

www.advancedprostatecancer.net - A blog about advanced and recurrent prostate cancerwww.malecare.org - information and support about prostate cancer

http://health.groups.yahoo.com/group/advancedprostatecancer/ - an online support group for men and their families diagnosed with advanced and recurrent prostate cancer

[Guest guest]

Thanks . Given your credentials you must know what you're talking about. But

can you tell me what info you're drawing from? Thanks.

>

> > **

> >

> >

> > I was treated with radiation and seeds 4 years ago and was advised to go

> > on Avodart to reduce the likelihood of a recurrence. The Avodart is causing

> > breast enlargement, may be contributing to ED and costs quite a bit. I

> > wonder if it's necessary and if any one else got the same advice. My PSA

> > has been <.01 since treatment and I get annual color doppler ultrasounds

> > which have all been negative. Thanks.

> >

> >

> >

>

>

>

> --

> T Nowak, MA, MSW

>

> Director for Advocacy and Advanced Prostate Cancer Programs, Malecare Inc.

>

> Men Fighting Cancer, Together

>

> Survivor - Recurrent Prostate, Thyroid, Melanoma and Renal Cancers

>

>

>

> www.advancedprostatecancer.net - A blog about advanced and recurrent

> prostate cancer

>

> www.malecare.org - information and support about prostate cancer

>

> http://health.groups.yahoo.com/group/advancedprostatecancer/ - an online

> support group for men and their families diagnosed with advanced and

> recurrent prostate cancer

>

[Guest guest]

I've been thinking about the Avodart issues raised by Phil,

and Chuck. I don't have any expertise in this area but, for

whatever they are worth, here are some thoughts on the subject.

First of all, I assume that both and Chuck are right. I

assume that if there is cancer in your body, Avodart will not

kill it all off ('s point), but it might slow its growth so

that a recurrence of detectable cancer might not appear until

later than it otherwise would (Chuck's point.) Conceivably, it

might slow any growth to the point that a man dies of something

else without ever seeing a " recurrence " of the cancer.

If a man has detectable cancer, treatment with Avodart seems like

a reasonable course of action. It is one of a number of

treatment options that should clearly be considered.

But what if a man has no detectable cancer, which appears to be

Phil's situation. Should he take Avodart in hopes of delaying a

future recurrence that may or may not ever appear?

I think that in this situation side effects need to be

considered. If Phil stops taking the Avodart, the side effects

should stop. That is a clear, definite improvement in his

health. If he does that, the cancer might recur sooner than it

otherwise would, or it might not recur at all. The radiation

might have gotten all of it.

If it were me, I think I'd trade off the hypothetical health

benefit (slower return of cancer) in favor of the definite

benefit (elimination of the side effects. Then I would want to

get frequent PSA tests (at least every six months, maybe 3-4) to

see if I had guessed wrong and the cancer was coming back. If it

were coming back, I'd want to still hold off, calculate a PSA

doubling time, and figure out all of my options, then decide when

and what treatment to try.

Is that worse than staying on the Avodart? In the worst case it

might be, but maybe not very much.

Alan

[Guest guest]

Actually, the question is what information or evidence is there that Avodart suppresses or delays a reoccurrence? Without evidence one cannot assume that it will affect a reoccurrence In May of 2010, the FDA rejected the claim that Avodart delayed the development of prostate cancer. Of course, this has nothing to do with the issue of a reoccurrence.There have not been any studies or trials that have shown that or any of the 5ar-inhibitors delays any sort of reoccurrence. Does this mean that it doesn't? No it doesn't. But what is the evidence that it does? To assume that Avodart delays a recurrence is no different than to assume that an aspirin or a vitamin also delays a recurrence.I am also concerned that Avodart could possibly mask an early recurrence because it does affect PSA levels. If you are aware of an early reoccurrence you still might be able to stop the cancer before it leaves the prostate bed. T Nowak, M.A., M.S.W.Director of Advocacy & Advanced Prostate Cancer Programs

Thanks . Given your credentials you must know what you're talking about. But can you tell me what info you're drawing from? Thanks.

>

> > **

> >

> >

> > I was treated with radiation and seeds 4 years ago and was advised to go

> > on Avodart to reduce the likelihood of a recurrence. The Avodart is causing

> > breast enlargement, may be contributing to ED and costs quite a bit. I

> > wonder if it's necessary and if any one else got the same advice. My PSA

> > has been <.01 since treatment and I get annual color doppler ultrasounds

> > which have all been negative. Thanks.

> >

> >

> >

>

>

>

> --

> T Nowak, MA, MSW

>

> Director for Advocacy and Advanced Prostate Cancer Programs, Malecare Inc.

>

> Men Fighting Cancer, Together

>

> Survivor - Recurrent Prostate, Thyroid, Melanoma and Renal Cancers

>

>

>

> www.advancedprostatecancer.net - A blog about advanced and recurrent

> prostate cancer

>

> www.malecare.org - information and support about prostate cancer

>

> http://health.groups.yahoo.com/group/advancedprostatecancer/ - an online

> support group for men and their families diagnosed with advanced and

> recurrent prostate cancer

>

[Guest guest]

I started Avodart following RP after seeing Dr. Snuffy Myers following my surgery. A little history: I had RP in April of 2011, going in with with a Gleason 7 (3+4) and 30-90% involvement in 6 of 12 cores, all on the right side. There was a bump detected by the DRE and an endorectal MRI showed very possible extracapsular extension. Following surgery I had clear surgical margins, but extracapsular extension was found in 3 locations on the right side, mostly near the apex. No lymph node involvement (9 nodes excised) and no seminal vesicle involvement. The pathology report showed a Gleason 7 (4+3 instead of 3+4) and most disturbing was a tertiary Grade 5. There were Gleason 9 foci identified, presumably the ones which resulted in the tertiary Grade 5. By September of 2011 there was still an undetectable PSA (<0.008) measured in 6 week intervals, so I was certainly happy about that. I spent all summer “shopping around” for radiation oncologists and was ready to begin adjuvant radiation + HT, but a visit to Dr. Snuffy Myers in September 2011 changed my mind. He felt there was a good chance that by following his dietary and supplement regimen I could significantly delay recurrence, if it occurred at all. It would be worth waiting until there was at least some evidence of a rising PSA before beginnng radiation + HT. In addition to various supplements, he also prescribed 0.5 mg Avodart daily which I started in September and I also started monthly checks of PSA, testosterone levels (free and total), D3 and DHT. The DHT did indeed drop significantly after beginning the Avodart, the total T went up which is as expected when taking Avodart alone (without Lupron). The use of Avodart in this situation is somewhat controversial from what I’ve read. I had already been taking most of the supplements Dr. Myers recommended when I went to see him. Shortly after starting Avodart (which was 5 months after surgery) my PSA has started to creep up, from <0.008 (undetectable) to 0.02, 0.04 and 0.05 (measured every month). This is still not technically a recurrence but it is no longer undetectable so it is obviously of great concern to me. The timing of the rise in PSA coincides with starting Avodart, but I would think this is coincidental. I am now debating what to do next – how long to continue these monthly PSA checks and at what point do I start radiation + HT. It’s a tradeoff between better effectiveness of radiation when performed as soon as possible after surgery (adjuvant) vs. the possibility that this rise in PSA may not be of significance and perhaps level off. I’ve checked the PSA levels in two different labs with blood drawn on the same day and the results have been within 0.01 of each other, so the PSA rise appears to be real, not a measurement error. --- Rich

[Guest guest]

Rich,

What did your free T do after starting Avodart?

Doug

[Guest guest]

Here’s my summary of T, DHT and PSA results: 1) Pre-Avodart 8/31/11 Total T = 403, Free T = not measured, DHT = 24, PSA<0.012) Pre-Avodart 9/16/11 Total T = 344, Free T = 40.3, DHT=25, PSA<0.013) Start Avoodart on 9/17/114) Post-Avodart 11/14/11 Total T = 557, Free T = 74.6, DHT = 7, PSA = 0.045) Post –Avodart 12/24/11 Total T = 442 Free T = 43.3, DHT = 8. PSA = 0.05 What does this mean? What’s the significance of Free T ? --- Rich From: ProstateCancerSupport [mailto:ProstateCancerSupport ] On Behalf Of dtcSent: Wednesday, January 25, 2012 10:13 AMTo: ProstateCancerSupport Subject: Re: Avodart after treatment Rich,What did your free T do after starting Avodart?

[Guest guest]

Rich,

Not sure about the significance of Free T.

There is some debate as to what the role of T/ Free T is in PCa.

In general, men diagnosed with PCa have low T/Free T. So some

argue that they are protective.

On the other hand, many go on ADT which knocks down T and DHT and

PSA.

Esradiol is also an issue, with many thinking it is a cause of

PCa.

Some say take Avodart and some say not to.

I think others on the list may have a stronger opinion than I do.

I'm still trying to figure it out..

Doug

..

[Guest guest]

Re: Avodart after treatment

Thank you for your responses to my question. One of the few good things about

having PCa is the informed, intelligent support given by guys like you.

To answer a followup question re details of my PCa: My PSA was 3 at diagnosis in

2006. I had three positive cores, all on the left, with 70% cancer in the

lateral base, 75% in the mid and 15% in the lateral apex. All of it was grade 3

except for 15% grade 4 in the mid. A Prostascint suggested seminal vesicle

involvement but biopsy of the left vesicle found none. Prostascint also

suggested a positive left iliac node. It was not biopsied. There was capsular

involvement and a question of, but no agreement on, extracapsular extension. I

was treated at Dattoli's with seeds and radiation, including radiation of the

iliac chain. Dr. Myers added a year of triple androgen deprivation as an

adjunct. Avodart continues.

I do feel a bit over-treated but it's easy to say this after 4 years of <.01

PSAs. Nevertheless, less breast and more erectile function would be nice. Thanks

again.