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Iqi Singh and Raj live in India. He was 78 when he was diagnosed in July, 2010. His initial PSA was 25.33 ng/ml, his Gleason Score was 7, and he was staged T1c. His initial treatment choice was ADT-Androgen Deprivation (Hormone) and his current treatment choice is ADT-Androgen Deprivation (Hormone) (Monotherapy). Here is his story.

THERE WAS NO RESPONSE TO AN UPDATE REMINDER IN 2014 SO THERE IS NO UPDATE.

I am 78 plus and have been diagnosed with cancer of the prostate (Gleason 3+4).Cancer was detected by a biopsy done on the 13 July 2010. My PSA was 8.1 four years back and at that time the biopsy showed benign results.

Last month my PSA shot up to 25.33 and the gland volume was at 61cc which was 46 cc in 2006. I don't feel any of the symptoms barring one i.e. I have feel very tired after any physical movement. I am also a COPD (Chronic Obstructive Pulmonary Disease) and Diabetic and often go down with fever at least 3/4 times a year and have to resort to antibiotics for 5-7 days which has left me quite weak. My general health is not as good as it used to be last year when I could cope up with a fair amount of walking and other normal day to day activities of daily retired life. I have read all about the treatments options available and all seem to have serious side effects which frighten me. I have lost about 5 kgs since last year ,most likely due to my COPD bouts. At this stage and considering that I have stepped into my 80th year what should I do ?????

Do active surveillance or which type of treatment will be the best option for me ??? I am totally confused !!!! Can you please help me in arriving at a decision though the responsibility for any decision will be mine.

The cancer is in the right lobe of the gland while the left lobe is fine.

Many Thanks
IQI

UPDATED

November 2010

I took quite sometime to decide what would be the best option for me ,what helped me to make up my mind eventually was the result of my bone scan which showed some metastases through the MRI .The Oncologist, Urologist and the GP decided not to wait and start treatment.

Biopsy was done on the July 13 2010 and by the end of that month my PSA shot up to 36.91 from 25.33 at the time of biopsy - the volume of the gland also shot up to 90cc from 61 cc on the 13th July. So I was given one tablet of Calutide [aka Casodex] daily for two weeks. After two weeks, I was given a shot of Zoladex 3.6mg.

The PSA then dropped to 10.24. On the October 8, 2010 I got my second shot - this time a three months dose. Since then I have not suffered any significant side effects barring some weakness.

I try and stay active though the weakness bothers me.

Terry you are doing a noble deed for your fellow beings. Thank you.

With best wishes Iqi

UPDATED

February 2012

I was given last Zoladex (4.8mg) in first week of Jan 2011 after which I am on intermittent .It took sometime to regain my strength .The last two months or so I have been feeling stronger and don't get tired so easily which was the case during the treatment and the next 6 months. I have mentioned below the chart of my PSA levels . Also considering my age - 80 plus- should I plan to go on to the tablet form or again Zoladex injections?

2010
26th July - 25.33
1 Oct - 10.24
3 Nov 1.06
22 Dec 0.41

2011
25 Jan 0.42
2 March 0.28
1 June 0.10
3 July 0.08
4 Aug 0.05
7 Sep 0.10
9 Oct 0.19
27 Dec 1.42

2012
31 Jan 2.93

UPDATED

July 2012

As I mentioned my PSA did a rapid rise from 2.93 on 1 Feb 2012 to 8.83 on 10th April . I consulted an oncologist (my old one has been transferred to another hospital) . This young doctor wanted me to go back on Zoladex combined with Bicalutamide .After further discussions with him and keeping in view some of the side effects of Zolodex, I had experienced and my age (now 81) , he reluctantly agreed to put me on Bicultamide 50 mg once a day because I was keen to try out, so I have started this treatment from the 3rd of May with no side effect till today .We are going to try it out for two months, lets hope for the best though I know this is not the optional treatment for a person with bone metastases. By the way before going on Bicalutamide I had another PSA taken on 1st May and it read 14.01 a rapid increase.

Zolodax and most of the other drugs are available in India and luckily for me the cost will not pinch my pocket as the Army group insurance takes care of my expenses. I belive Lupron is in the same class of drugs as Zoladex , we can think of it as an option for Zoladex. Thanks for taking pains to suggest the various options . I think DES (diethylstilboestrol) oestrogen is out for me at this age because of its effect on the heart though I have no known problem of the heart.

There may be some DNA differences between you and I but we both want to survive with least changes in our lifestyles as far as possible, at least we are trying .There are some homeopathy medicines and Aryurvedic treatments but I do not want to step into unknown territory .My wife does not approve of me being on just one 50 mg tablet after having had Zolodex before but I pacify her by saying it is just a trial for two months only . I found Zolodex to strong for a man of my age but there was no choice left to the doctor as my bone scan had indicated possible Mets on the sternum and the 4th right rib . I had broken a rib in a fall playing polo some 30 yrs back.

I do not know if I have done the right thing to insist on only Bicalutamide and not mixed with Zolodex but these injections made me lose muscle mass and caused constant fatigue and wrinkling of the body which was not present two years back. I suppose it is a normal process of ageing! To my mind a man is middle aged at 70 and at old age at 80 and above, so Terry enjoy your middle age.

My optimism on bony mets comes from the fact that:

  1. I had so many injuries in my lifetime which can show up in the bone scans which are notorious for inaccuracies .At the same time I am not challenging its findings.
  2. The fact that when my injection started in Aug/Sep 2010 there was a rapid fall in my PSA levels which stayed low for almost one year after the treatment was stopped , is this normal?

Keeping in view these two factors I decided to give Bicultamide a trial but shall not go against medical advice.

I had a referral for a PSA test free of cost which would have expired on the 11th of May so I had another PSA taken on the 11th (Bicultamide started on the 3rd May) which read 7.54 -quite an encouraging result for 7 days being on the tablet and no side effects so far.

PSA taken on 4th July read 4.11 so from 14.01 on 1st May to 4.11 on 4th July with 50 mg of Bicultamide daily.

UPDATED

February 2013

I was diagnosed in 2010 , PSA 25 , Gleason 3+ 4 with suspected bone Mets which I feel I do not have but my Oncologist says that I might have on left remis bone not in the right and sternum which is indicated in bone scan. Anyway 14 day Callutide followed by 7 months of Zolodex injections, my PSA fell rapidly with the lowest being 0.08 - then had a break from Jan 2011 to May 2012 and PSA rose to 14.01.

Have been on Bicultamide 50 mg since 3rd May 2012 till date. PSA fell to 7.4 after first nine days of the tablet and then came down gradually and was .70 on 8th Oct 2012 and .72 on 8th Nov 2012and .80 on 13 Feb 2013.

This is the 10th month of this treatment. I feel fine except for tenderness of breasts and the disruption of thought process which is a disturbing side effect.

Do you think I can take a break again?

Iqi's e-mail address is: dushuin AT gmail.com (replace "AT" with "@")

NOTE: Iqi has not updated his story for more than 15 months, so you may not receive any response from him.


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