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CML and Prostate Cancer - Need Wisdom

Dx June 14, 2018 with CML.  qPCR score as of March 11, 2019 = .0109% 

Dx yesterday with prostate cancer - 2 cores out of 12.  Gleason score of 6 (3+3) and Gleason score of 7 (3+4).

Any wisdom about this double whammy and what it means for treatments for both?  I have been taking 400 mg Imatinib since July 5, 2018 with one interruption for 2 weeks due to low counts.   

I'll hang up and listen.  Thank you.

 

 

Hi Rick, very sorry to hear this, and hope your prostate responds as well as your CML has. I have a vague memory of prostate cancer/CML being discussed on the forum a few years ago, but the search function doesn't seem to be working so can't find any posts. I'll try again later. Best wishes. Alastair

Thank you.  These things I do know.  Having CML increases the chance of having prostate, lung, thyroid, melanoma, and some other cancers.  One study shows that taking Glivec increases the chances of having prostate cancer by 4.  

This is indeed bad news for you, Rick. I see conflicting studies on this issue. I am rather concerned that this could be my next port of call for although my PSA is low I have symptoms which could be consistent with prostate difficulties.

Next week, a prostate charity visits the village in which I live to provide PSA testing for the gentleman in the locality. I will have the opportunity to ask a retired consultant a question about CLM and prostate cancer.

Thank you.  I will anxious to heat what you learn.

... For what it’s worth, I’ll forward you this link. The information on this is consistent, always positive and certainly can’t hurt. (If you have any doubt, check with your doctor). I fill my blender with broccoli and watercress sprouts, a bit of clean filtered water. I drink a cup right away and pour the rest into an ice tray. I take 3 or 4 frozen cubes to work every day in a zip lock, drink it down as soon as they melt. Refreshing and the nutrients are powerful cancer fighters. I was looking for substances to help kill leukemia stem cells and these came up in reference to prostate cancer also. 

http://www.foodmatters.com/article/these-vegetables-can-kill-cancer-stem...

Unfortunately, Rick, I did not learn a lot from today's meeting that I didn't already know. The opinion is that pre-existing cancers, save for bladder cancer, are unlikely to be a significant cause of prostate cancer. Only bladder cancer is of the same pathological type.

The most aggressive form of prostate cancer is linked to family history (often hitting younger men). Otherwise it appears not to be caused by "bad behaviour": smoking, drinking, drugs, sex. There is a strong racial link with blacks being hit the worst while Asians get off realtively lightly.

Tomato is the only known food type that helps to stem postate cancer.

This consultant is very supportive of PSA testing albeit that it doesn't have universal popularity in the medical profession.

I did Google and read a number of papers myself. The findings of various studies are far from consistent. What does you oncologist think?

Thanks.  I have my urological review on May 29th followed by my CML hematologist on June 3rd.  I will know more then.  

With gratitude.

 

I feel very sorry for you, Rick. It rather adds insult to injury suffer this double whammy.

I do wonder whether patients with CML and under oncological/haematological supervision gets diagnosed for other conditions more quickly. In my case, the investigation of hand pain (ultimately diagnosed as osteoarthritis) led to a diagnosis of diabetes. Then I had six monthly reviews and blood testing which led to a diagnosis of coeliac disease and eventually CML.

In your case, do you think it possible that the prostate cancer pre-existing the CML? Was your PSA elevated?

The proposition that CML might lead to secondary cancers appears not to be proven but I note that there does seem to be a strong argument that CML patients are more vulnerable to being diagnosed with non-Hodgkin's lymphoma.

The path to both diagnoses began with February annual physicals that showed abnormalities.  In 2018 it was in the CBC.  In 2019 it was an elevated PSA.  My PSA when diagnosed with CML was below 4.  

Hello Rick,

I can’t help with any information unfortunately but I just wanted to add some support for you. It must be difficult with the new diagnosis and the additional stress it brings. I do hope you are given some effective treatment soon and this too becomes a manageable condition. It is only my opinion but I believe keeping as fit as possible not only does the obvious for your physical wellbeing, but it helps with the mental aspect of things as well. Whatever you can manage is worthwhile even if it is just a short outdoor walk, up to something more strenuous if you feel able without over doing it. I always feel better after a visit to the local gym.

Good advice.  Right now I swim 2 to 3 times per week and try to get in a good walk for the other days.  It does help with the stress.

Hi Rick,

I am going to resurrect the discussion on this topic if I may because I am going to join you in that within the last few days following biopsies we now have to develop a treatment plan for prostate cancer.My Gleason score is similar to yours 3 +4 and this indicates that it might not be too aggressive and should be possible to treat it (apparently 4+3 is different and indicates it would be faster growing).Mine has not yet broken out into other organs or the lymph nodes so is more easily treatable.Early diagnosed prostate issues have a 90% chance of a cure;later more established ones are difficult to treat and of course over 11,000 men in UK die of this condition every year.

I have trawled the literature on co-malignancies and CML and  whether the tkis and in particular imatinib (on it for 13 years with great success) causes prostate issues but there are no real definitive studies out there to back up a firm association.Various medics have in the past advised me to raise the bar higher and be more suspicious of any small indication of a secondary malignancy and this is why about two years ago I was advised to have regular PSA tests-as we know these are not always helpful but now with the use follow up multiparametric (with contrast using gadolinium) MRIs of the prostate are extremely helpful as a further real indicator of inflammation that might be malignant that might  suggest a need for a biopsy.

I have been advised of 3 options from radical prosectomy which even under robot surgery is still quite an event with side effects;radiation beam therapy and 4D brachytherapy. So because one of the worlds centres of excellence for brachytherapy  is  very near to me and because it has a proven record we will go for that;having health insurance means that it will be done very soon.Brachytherapy involves the implantation of tiny iodine chips into the prostate to disseminate and dissolve targeted radiation to kill off cancerous cells-I will be radioactive for about 9 months! It involves a general anesthetic but only a one night hospital stay so it is a quick and a relatively non-invasive procedure.

Has anyone seen any studies of so called adjunct radiation therapies on CML patients with co malignancies  and would this radiation and some follow CT scans  be an additional risk for CML to return in a more aggressive form? I have seen some studies of breast cancer patients that were subjected to radiation therapy who went on to develop CML but only a small number of cases.

Are there any CML patients out there who have developed co malignancies with stories or advice or other CML patients with prostate cancer as well?

My conclusion is that if you are over 50 and male with CML be more suspicious of developing co-conditions and the PSA test might be somewhat useful as a starter because often prostate issues have no early symptoms.

I wish you well,

John

John,

One more thing.  My counts - rbc, wbc, etc. - are low, and my hematologist/oncologist tells me that it is probably my new normal.  I too had an MRI 5 days ago and an multi-disciplinary team, including my top-flight urological surgeon, will go over the results and options next week with me.  For what it's worth, my hematologist says that a good part of our blood is manufactured in the bone marrow of the pelvic bone.  She would not rule out radiation for me but would be concerned if I chose that route.  I am heavily leaning towards a radical prostatectomy.  

Best,

Rick

 

Rick,

Thanks for the reply as you have given me the impetus to look up further studies and to undertake some more risk analysis.Work has been done on the link between prostatic radiotherapy and second malignancies and the main risks seem to be with the bladder,rectum,and colon.One key issue was that of tissue volume treated by radiation and for instance with brachytherapy there is a high radiation dose to a small volume of tissue  and here there was a shift towards no additional perceived risk.Older radiation techniques were more unreliable in terms of targeting perhaps.

Hematologists are going to have differing views anyway.The real risk analyses for either of us might be different so I suggest we make a list like-

age at diagnosis of CML and now;existing blood counts and PCR s;general health and other co morbid conditions

risks of each procedure such as infection side effects and future quality of life.

So for me I have already been told that prostate removal given my age is not a good option and the side effects might lead to a poor quality of life;my judgement is that radiation beam therapy is not an option as the effects are too fragmented across the pelvis but a targeted controlled amount of iodine seeds on a limited tissue area may well offer the best outcomes.If my future PCRs degrade then I can go on to high dose imatinib or another tki.I will discuss this with my medical professionals and the prostate team that will treat me .

Please keep in touch

Best wishes

John

A good friend of mine has big problems with the prostate. He was also operated. As a secondary treatment, it uses the following: zinc, selenium, vitamin D3, lycopene, resveratrol and LOT of curcumin. He feels very good with this treatment and PSA values are good.
As a happy coincidence, all of the above also helps you VERY much in CML.

Hi Rick,

Just to update you I have now received my Histopathology Report and in total 7 out of 31 biopsy cores taken of the prostate were positive representing 4%of the biopsy tissue and of the six zones all were positive with Gleason scores varying  3+3 and 3+4.

I sent all the reports to my hematologist and he has sent back a statement to me to the effect that he is quite happy for me to go ahead with my proposed prostate treatment and that there should be no interaction with  the existing CML or its treatment.He has published 160 articles in peer reviewed medical journals so I will take his advice which I regard as experienced wisdom.

So as soon as I am fully recovered from the 31 stabs on my prostate we will be talking with the team that will treat me with the appropriate level of targeted iodine radiation to kill the multifocal nature of the beginnings of small tumors in my prostate.

Let me know how you proceed

Regards

John

John, 

Great to hear.  My multi-disciplinary consultation is tomorrow.  Will have your fine info as input into the discussion.

Best,

Rick

John,

It looks like I am proceeding with proton beam radiation therapy, subject to my insurance agreeing, which seems likely.  Several reasons:  1)  Unlike external beam radiation, the proton beam enters from the hips area does not attack more than the prostate itself.  2)  Reduced side effects.  3) The concern over radiating the pelvic bone and the marrow is attenuated.  4)  It avoids the risk of having surgery while having CML.  5) The outcome will be the same as if I would have a radical prostatectomy, except it is non-invasive and I will still have a prostate (albeit, a dead one) inside me.

Because I will be 70 next month, the risk of a secondary cancer developing as a result of the radiation is greatly reduced.  My radiology oncologist has said that I will die from something else.

As with a radical prostatectomy, there is a 30% chance of prostate cancer reappearing down the road, 5-10 years out, but by then, there will be great advancements in medicine.

Cheers!

Rick

 

 

Hi Rick,

Please see my latest posting on Forum asking if anyone has had any radiation therapy whilst on imatinib -the oncologist whom I saw yesterday is talking with my hematologist re any risks of side effects or other dangers when combining the two treatments.I suspect absolutely no one would have had proton beam therapy whilst on a tki like imatinib  !

I wish you well

John

The very best of luck to you, Rick.  When are you having this done?  The successful treatment of this is just getting better and better, and there are plenty of men out there who are going to beat it.  I think you'll be one of them!

 

Thanks for asking.

Insurance has signed off, and my proton beam therapy starts September 12th and will last 6-8 weeks, excluding weekends.  I have a procedure on August 23rd to place some small markers in the prostate and a spacer between the prostate and bowel.  Then on August 29th, I go through a couple of hours of simulation with CT and MRI to get my positioning for the treatments precise.   The reason that the actual treatments don't start until September 12th is that the gland needs time to heal after the August 23rd procedure.

I value the support and know-how on this site.

Peace!

 

 

Hi Rick,

Just to update on the safety of combining imatinib and radiotherapy I have come across a short article that suggests that a combining a targeted agent such as imatinib with radiation therapy might heighten the effects of the radiation bringing about increased anti cancer effects but possibly increased toxicity to the body.

Both treatments given concurrently might lead to greater mylosuppression and in particular affect the neutrophil score as well as the white blood count-I am going to ask my hematologist if he has a strategy for dealing with this such as an additional intervention in terms of  further medication.I would be happier if I had greater surveillence of my blood count during the period when I would be receiving my radiation treatment.

I trust that all of this makes good logical sense and there is a need for close cooperation between the medical oncologist (the hematologist) and the radiation oncologist.

With best wishes

John

My PSA is always in the order of 0.45. My next test is in November. I have symptoms including severe nocturia that would point to prostate difficulties . I was prescribed with oxybutinin and tamsulosin which helped marginally. Nonetheless, I have still been getting up five or six times a night.

Now here is the very odd thing. My diabetes is well controlled but the diabetic nurse decided that I should increase my Metformin dosage from 1000 mg a day to 2000 mg a day. After a week on this increased dosage, my not nocturia has almost completely vanished.

I wonder whether this is the result of an unusual drug interaction.

Hi,

The normal range for the PSA test is 0.0 to 4.40 but with age the upper limit is sometimes raised because as we grow older into our 70 s and 80 s the prostate gland becomes enlarged anyway. There are varying opinions as to the usefulness of the PSA test but for me it was a signal for further investigation and because of that am very fortunate that things have been indentified in an early stage and now can be treated.My urologist and I agreed to be more vigilant and suspicious as he was unsure of any links between CML and further co malignancies

Some studies have indicated that the long term use of tkis lead to a greater prevalence of urological issues (and a lesser incidence of breast cancer);whether imatinib itself may lead to greater incidence of prostate cancer has not been researched in much depth it seems.

Nocturia as you describe has all the hall marks of an enlarged prostate gland or a condition called BPH-benign  prostatic  hyperplasia -chances are that with a low PSA it will not contain any malignancies but it has not been unknown in some patients. My advice would be at some stage to ask if the size of your prostate could be established;anything above 25 cu cms might be termed moderately enlarged and 60-70 cu cms will certainly explain your symptoms.There is the multi parametric MRI (uses a contrast dye) that will establish the size and also give a PIRAD score on the nature of any inflammation-a score of 1 or 2 warrants little action, 3 careful watching and 4 or 5 further detailed investigations such as biopsies.

On biopsies I was fortunate to have template or trans- perinnial approach as opposed to a trans-rectal process which is quite invasive and more risky in terms of potential infection;as a general anasthetic is involved it helps if general health is good.

As you say there are drugs to reduce the size of the prostate but we perhaps  dont know how they interact with a tki or with your diabetes therapy or all together?

In my case vigilance and suspicion paid off especially as I had few early or substantial symptoms.

I trust that this helps

John

Thank you, John, for your kind response. I feel for Rick and yourself in having to contend with two cancers.

Whilst my PSAs have been very low with frequent measurements over the course of about six years, I am by no means complacent having regard for the various hallmarks. There are both proponents and dissenters from PSA testing. I am scheduled to have a discussion with my GP in November. I am further conscious that CML or imatinib could be accelerating factors here.

Both the haematologist and my GP think that the noctuia and related daytime symptoms are likely to be related to prostate. However, a "miracle" has occurred since the diabetic nurse doubled my dosage of metformin. Having been used to getting up 5 to 6 times per night during the past two years, suddenly I am managing to sleep through a night without interruption. Abruptly, most the symptoms seem to have disappeared. This is all quite curious and unexplained.

I will continue to read this thread with great interest. Best wishes, Stephen

I need to have a discussion with my GP next week. For over two years I have been suffering from nocturia (having to get up six time a night) and otherwise a weak urine stream.

The doctor assumed a prostate problem and prescribed tamsulosin and oxybutynin. I do not think that this medication helps very much.

Then my diabetic nurse increased my metformin from 1 g per day to 2 g per day. Suddenly, like a miracle, my problems have disappeared.

I rather think there is some synergistic effect in taking metformin alongside imatinib.