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Re: Re: There is no treatment for localized disease
Frankly, when I asked my doctor about watchful waiting he said and I quote, "You'd have to be out of your f'n mind". It all comes down to choices. No one sold me down the river. If the word Cancer does anything it starts you reading and learning your options. We're all adults and we all have made our beds. Mine was Robotic Prostatectomy especially since my father died of PC. Yours might be to wait but for how long?
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Replying to:
Thanks for such a detailed post Terry.
I wouldn't dispute Henke's views on WW in the majority of men diagnosed with PSA. In my opinion, wherever it's possible, WW is the way to go.
Of course, in cases like mine and others where PSA is obviously soaring way beyond the norm and into the 100s or 1000s, we have no option other than deciding which treatment will be best for us.
I dearly wish all UK urolgists and oncologists would study the ideas of the doctors quoted above.
Day after day I see cases of men, many of them very young, having radical, sometimes damaging surgery purely because of a somewhat elavated PSA.
Just one point about PSA numbers. I for one am not too worried my levels if, and when, a rise occurs, they'll stay in double figures...(OK, I may be asking for trouble!) and I would most definitely take my time in decideing my next step...if I'm lucky enough to see just a gradual ascent.
Sudden surges over short periods of time, however, would definitely see me back on treatment.
Whichever way this wind blows me, I do WANT to live and will do all I can to survive.
Henk
Do you think there is any value in giving high risk patients(grade 3) chemotherapy taxotere immediately after prostate removal, appartently there are several trials taken place at the moment to see if this cuts the risk of cancer returning.
Re: Re: There is no treatment for localized disease
Hello,
(site name for those who can read dutch)
I don't know the history, but it might help in high Gleason cases. However Taxotere is a pretty heavy deal when you are at the beginning of the road.
This can also work (see below). I have experience with one patient who became hormone refractory. He had nearly side effects on this regime and it postponed Taxotere for 2 years.
You could discuss this with your doctor
Best reagards,
Henk Scholten
Metronomic therapy with cyclophosphamide and dexamethasone for prostate
carcinoma.Glode LM, Barqawi A, Crighton F, Crawford ED, Kerbel R.
Oncology Urology Department, University of Colorado Health Sciences Center,
Denver, Colorado 80262, USA. mike.glode@uchsc.edu
BACKGROUND: The current study was designed to evaluate the efficacy and
toxicity of the continuous oral administration of a combination of
cyclophosphamide (50 mg/day given in the morning) and dexamethasone (1
mg/day given in the evening) in patients with prostate specific antigen
(PSA) progression despite single or multiagent hormone therapy and
antiandrogen withdrawal. METHODS: The authors retrospectively evaluated the
medical records of all patients with prostate carcinoma who were treated
with dexamethasone and cyclophosphamide and who were unable to participate
in Phase II drug trials or had failed previous chemotherapy regimens.
RESULTS: Using clinical response guidelines set forth by the Prostate
Specific Antigen Working Group, 29% of patients were found to have a > or =
80% reduction in PSA, 39% were found to have a 50-79% reduction in PSA, 6%
were found to have a < 50% decrease in PSA, and 26% experienced disease
progression while receiving treatment. The duration of response was 8 months
(95% confidence interval [95% CI], 4-10 months). The duration of treatment
was 9 months (95% CI, 6-14 months). The treatment was reported to be well
tolerated with side effects being primarily bruising, Cushingoid facies, and
gastrointestinal distress. CONCLUSIONS: In the current study, low-dose
dexamethasone and cyclophosphamide demonstrated efficacy as salvage therapy
in the treatment of patients with hormone-refractory prostate carcinoma.
Copyright 2003 American Cancer Society.
PMID: 14534880 [PubMed - indexed for MEDLINE]
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Replying to:
Henk
Do you think there is any value in giving high risk patients(grade 3) chemotherapy taxotere immediately after prostate removal, appartently there are several trials taken place at the moment to see if this cuts the risk of cancer returning.
The only caveate I would raise re: WW is to pay attention to the slope...the rate of increase...of PSA readings. My was pretty significant (3.4 to 8.8 in just over a year) so I opted to take action. My first reading after PBRT is 0.77.
But that is not the reason I am posting today. The following is from the electronic edition of the Gainesville (FL) Sun:
New hope for fighting cancer
By Diane Chun Sun staff writer
You might describe Dr. Jorge Galante as the ultimate educated medical consumer.
The 73-year-old orthopedic surgeon has been dealing with prostate cancer for a decade. After two years of conventional treatment, including surgery and radiation, his cancer recurred.
The Chicago resident went searching for an alternative to undergoing more of the same treatment.
His search brought him to a clinical trial involving immunotherapy now under way at Shands at the University of Florida, under the direction of Dr. Johannes Vieweg, professor and chairman of the department of urology.
Galante flies to Florida once a week to receive an injection of an experimental vaccine that enlists his body's own cells in the battle against cancer.
Every year, 230,000 men are diagnosed with prostate cancer. The American Cancer Society estimates that Florida will rank behind only California and Texas in the number of new cases diagnosed this year.
Vieweg brought his studies of the potential prostate cancer vaccine with him from Duke University when he joined the UF College of Medicine faculty in 2006.
He says the customized therapy overcomes many of the obstacles and side effects of other forms of cancer treatment because it uses the patient's own cells.
Blood is drawn from the patient and the dendritic cells are isolated from the white blood cells. They are then genetically manipulated to detect the antigens that mark tumor cells before being reinjected into the patient.
Antigens are protein fragments produced by invaders such as viruses or bacteria that trigger an attack by the immune system. Vieweg characterizes them as "a red flag" at the surface of tumor cells.
The antigen telomerase is overexpressed in prostate cancer and other human cancers, Vieweg explained.
Dendritic cells activate the immune system by capturing the antigen - in this case, telomerase - and presenting it to the body's killer cells, called T cells.
The custom-made vaccine is prepared in a $4 million "clean room" in the UF Cancer and Genetics Research Building. It's not a vaccine in the traditional sense. A patient can't get a shot or two and prevent cancer. But it does enlist the body's immune system to battle against cancerous cells.
"We have something unique here," Vieweg said.
Because the dendritic cells can be programmed to seek out tumor cells with pinpoint accuracy, they can combat cancer without causing further harm to the body, unlike radiation or chemotherapy.
The strategy being tested in the current clinical trial is not limited to prostate or kidney cancer, but is potentially applicable to all cancers, in Vieweg's view.
"We just haven't done the studies to determine which forms of cancer respond best to this therapy," the researcher said. "I'd have to say we're almost there."
"Almost there" is close enough for Galante.
As part of the clinical trial, Galante is helping to prove that the vaccine is safe and effective for use by others.
But for him, the immediate benefit is that he is able to lead a normal life.
"I have a wife, children and four grandchildren whom I want to see grow up," Galante said. "I have been waiting for this vaccine to come on line."
Diane Chun can be reached at 352-374-5041 or chund@gvillesun
