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My father was diagnosed with PC in March of this year. His initial PSA was 11 at the time. His gleason scale was 9, but it had not metastasisized. His doctor advised him to receive hormone treatment (injections into his midsection - I am not sure of the drug but will find out). After the first course of the hormone treatment, his PSA was 0.75 (around June). The doctor advised that he should undergo radiation treatment (42 treatments daily external beam), which he completed at the beginning of September. He had his PSA tested by this doctor October 23, which resulted in a PSA of 29. The doctor said that this was a PSA bump which is not unusual after radiation and they would retest in a few months. My father's treatment had been performed at another hospital (he lives in a rural area and the lead doctor was in New York), and went to the doctor providing the treatment the next week where his PSA was taken again, and it was 33. The second doctor advised him to have a bone scan and a CT scan, which were done on November 4th (as well as another PSA test). The bone scan showed multiple metasteses in the spine and pelvis. The CT scan showed unknown spots
including a 5mm density on the right lung and a 1.5 cm density in the liver. He received these results on Friday and will have an ultrasound on Monday to further examine the unknown spots on his liver and lung. Based on these developments, this second doctor said a second line hormone therapy was unlikely to help and that chemo is the next step. He recommended a
treatment using Taxotere injections once every three weeks, in addition to Decodron/steroids every 3 weeks. In addition to the chemo, this second doctor suggested that my father take a bone medicine called Zometa every 6 weeks. My father also has advancing Parkinson's disease and there is concern about what the chemo might do to make the Parkinson's worse because of the loss of additional muscle (which would make the Parkinson's worse). The PSA also came back at 60. Finally, this second doctor said that a second round of hormone treatment would not likely be effective, and for my father to stop taking Lupron and Casadex.
I am in the process of trying to find other doctor's to give him a second opinion, but based on my research (a) Taxtrone as a stand alone therapy is not that effective (50% of patients have a PSA reduction of more than 50%) and the median survival is 9.4 months. I wanted to see if anyone had advice on whether chmo is the next step, or if there are alternatives. In addition, what the chemo may do to extend his life. The statistics above are from a Bill Aishman write up and could be from an insufficiently large sample population.
I have not been intimately involved in my father's treatment to this point, and am trying to learn about the disease and options as quickly as I can being as the chemo is scheduled to start on Wednesday. Any advice that anyone could provide, would be greatly appreciated.
I was sorry to read of your father's problem, Hank.
As you probably know by now, there are many varieties of prostate cancer - this article suggests that there are at least 24. It seems clear, from what you have said, that your father has one of the very aggressive forms.
Chemotherapy would seem to be his best option at this stage since it seems clear that the disease is now androgen independent - which simply means that the Androgen Deprivation Therapy (ADT) often referred to as hormone therapy is unlikely to be effective.
I believe it would be in his best interests to find the best oncologist specialising in prostate cancer that you and he can afford. You should be able to get good advice on this subject if you go to the Advanced Cancer Mailing List
Re: What are my father's choices (more than you will immediately know)
Don't know if you can travel, but in this case would be worth doing so for quality of life and possible best control of the PCa. There are many possible protocols even for mets type patients, personally I am not a fan of chemo..but there are many types of chemo/combo drugs and the newer Cabitzitaxel(jevtana) and this one out performed taxotere in studies. Many choices of chemo combos to consider if going that way.
Specialized onco-docs in PCa like Dr. Scholz (Calif.), Dr. Myers (Virginia) and others are the best at super high risk patients, they have the experiences and independence on drug protocols.
Dr. Scholz & Myers, using like: leukine+cytoxan+celebrex (maybe even with adding Revlimid) the results were superior over chemo therapies (same found by Dr. Myers). Chemo may have 40-50% response rate in your case, this would have around 60-70+% response rate)and side effects less than chemo. I know a guy using such and claims like about almost nothing in complaints for side effects.
Estrogenic drugs could help kill hrpca cells to some degree and DES even goes through your liver directly when being processed. Other drugs in this category are estradiol patches or gels, emcyt (used by Dr. Fred Lee on his uncureable PCa, still alive 30+ yrs. later using that drug). They also help bone density.
Stuff you could look into: Sandostatin (drug), or Zytiga, Provenge (vaccines), XL-184 (phase 3 trials)- (good on bone lesions), and still other drugs.
Radiological pharmaceuticals: Strontium-89 (Metastron), Radium 223 (in trials), Samarium-153 (Quadramet) These get into your system and can fight bone issues/mets to some degree also.
Just trying to add to the possibilities of things. There also are 'unproven' and novel therapies for all kinds of cancers, that would be up to the patient to contemplate. There are no simplistic answers here.
I am the patient of Dr. Bob Leibowitz since 13 years starting with PSA 32, 4 of eight biopsies were 100% interspersed with PCa, Gleason 7.
Primary therapy was Androgen Deprivation Therapy according to Dr. Bob for 13 months followed by a maintenance therapy which was not Chemo nor ADT. I spend 12 years in good overall QOL. In 2010 PCa was back (PSA 16, Gleason 8) and second line therapy was the so called "Three Prong Approach" according to Dr. Bob. Please get information from www.compassionateoncology.org.
All the best,
Christian
