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DIAGNOSIS
To properly diagnose the condition of the gland, a transrectal ultrasound (TRUS) utilizing the most advanced equipment should be undertaken (preferably by a Doppler Color Enhanced unit which can obtain a superior image, enhancing the hypoechoic echogenicity in suspicious tumor areas that permits a needle GUIDED biopsy rather than the blinded multiple random biopsies).
Should a positive biopsy result, further confirmation of the extent of the disease by CT scan and/or a MRI in conjunction with an imaging enhancing agent such as CYT356 should be undertaken. Further blood tests, such as PSA-II, will more clearly define the extent of the disease.
Additional data should be obtained for the patient’s personal records. A ploidy analysis to determine the aggressiveness of the disease and the dimensions of the gland will help to determine the presence of BPH, which along with prostatitis can create a rise in the PSA unrelated to PC.
Once the diagnosis has confirmed the presence of the disease, treatment should be commenced with CHT. Monotherapy, the administration of only one of the LHRH agonists without the antiandrogen medication, most likely will cause a tumor flare that would increase the volume of the disease and provide an exacerbation of the disease. In either case both the gland size and tumor volumes are reduced, making secondary therapy, if needed, much more effective. Low stage disease should be treated with a minimum of twelve months of CHT followed by a reevaluation to determine the possibility of the disease being confined to the gland. In this case the patient would be a proper candidate for secondary, localized therapy. More extensive disease should also be treated with a minimum of one-year CHT and metastatic disease with eighteen months CHT, before another reevaluation. PSA should be monitored at regular intervals, initially at 1-month intervals followed by 3-month intervals. Intermittent Hormonal Therapy (IHT) should be adhered to after 12-13 months of CHT. You stop taking the LHRH agonist and the Antiandrogen and monitor your PSA on a regular basis. When your PSA elevates to 5.0 - 10.0, or has two consecutive rises of .75 or more, you should begin CHT therapy once again. You take the Antiandrogen one week to 10 days before receiving your LHRH shot to prevent a tumor flare then continue on both drugs for another 12-13 months before stopping and beginning IHT. Do not stay on hormonal therapy for extensive periods of time (years) without going on IHT. You cannot become refractory to hormonal therapy unless you are on it for too long of a period of time.
Recent studies have shown that the addition of Proscar or Avodart with CHT will possibly increase your time off CHT 3-4 times longer when taken. If this protocol is followed, you continue taking Proscar or Avodart during the intermittent period or time off from the LHRH Agonist and Antiandrogen.
The ignorant conclusion that an LHRH agonist alone suffices because under normal conditions the testes produce 90-95% of the body’s hormones, indicates that the physician is ignorant of the endocrinological changes that take place in the body when a foreign substance is introduced.
Monotherapy, when administered, can cause a severe tumor flare and an exacerbation of the disease. When monotherapy or the introduction of the LHRH agonist without the administration of an antiandrogen medication 7-10 days before starting the LHRH occurs, the adrenal androgens are routed through the hypothalamus to the pituitary gland. There, by a 5 alpha reductase alteration they are converted to the powerful Dihydrotestosterone (DHT) which elevates the hormone production from this source to 50% - a ten times increase from the body’s normal conversion.
When properly administered, the first three months the PSA count should be rapidly reduced to undetectable levels, which only indicates that the disease activity has been halted. Continued CHT administration will reduce the gland and tumor volume and on reevaluation may permit secondary therapy such as cryosurgery or brachytherapy. It is not until the seventh month on CHT that cancer cell death actually begins to occur. The first three months of CHT primarily lowers the PSA level. It is recommended by some physicians to alternate antiandrogens when restarting CHT, after IHT, to give the cancer cells that survived the first round of treatment exposure to a different antiandrogen.
Whatever the choice of therapy, it should always be preceded by a minimum of 12-13 months of CHT. |
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“Let’s Conquer Prostate Cancer In OUR Lifetime” |
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PAACT Inc. (Patient Advocates for Advanced Cancer Treatments) PO Box 141695 Grand Rapids, MI 49514
1143 Parmelee Ave NW Grand Rapids, MI 49504 |
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