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Chemo-what to expect?

jmrodden
Posts: 3
Joined: Sep 2011

I have advanced CRPC with bone metatasizes. I've been on Lupron for a year and a half, Casodex for 2 months, clinical trial for 12 weeks and now on Ketaconazole (3 months). My doctor has indicated that when my PSA begins rising again she'll most likely be recommending chemotherapy. I'm not sure what to expect. I'm 51yo and work full time. What will the side effects be? Will I be able to continue to work? Is it an injection or infusion? Any guidance would be appreciated...thank you.

nowrest
Posts: 51
Joined: May 2011

Chemo is infused on a timed schedule. Mine is every three weeks. A port is provided under the skin in your chest so no needles in the arm.
Yes there are side effects, you need to read elsewhere on thi web site about it all. Also talk to your doctor. ASK QUESTIONS.

You may not be able to work depending on wherfe you work. The first week after infusio your immune system is rock bottom and you can not be around people and besides you will be very weak.

Come back on the board and ask morequestions. We will help.

VascodaGama's picture
VascodaGama
Posts: 1594
Joined: Nov 2010

JM

Welcome to the board.

I would appreciate if you share other information related to your diagnosis (Gleason, PSA, initial treatment, trial protocols, etc.) and the history which made your doctor to decide on the chemotherapy.

As you probably know, refractory prostate cancer cases (CRPC/HRPC) are usually handled with a second line of hormonal treatment before starting chemo. Ketoconazole is a drug used in the second line treatment but there are other drugs which have shown success in the control of intratumoral activity of the cancer in such class of patients. The most famous is the recent approved Abiraterone acetate (Zytiga) which in combination with prednisone has shown “wonders”. (Google the name if you want to read details)

This drug got FDA approval for treatment of CRPC cases after docetaxel failure; however, trials have shown successful outcomes when in use with an LHRH agonist like Lupron, before getting into chemo. (http://csn.cancer.org/node/199137) You could inquire with your oncologist about this drug.

I am not on chemo, but have a friend who I meet some times on the golf course that has been on the treatment in the last 18 months. I have been curious about chemo efficacy in the treatment of PCa and have read several papers too.
The overall side effects common to the drugs seems to be diarrhea, nausea and loss of appetite. These are more related to a lack of enzymes needed to metabolize both, the chemo drugs and the usual body routines. Fatigue seems to be a “continuous” symptom but it is probably similar to the experience you and I get while on hormonal drugs.

Just like on HT, it seems that fitness and proper diet improve the control of some of the symptoms. My friend told me that medication is usually taken with care because it interacts with the chemo drugs. He does not drink tea or coffee and only follows the advice of his oncologist when in need of over-the-counter medications.
I would recommend you to get timely blood analysis to check for any abnormal value related to immune deficiency (low white and low red blood cells) or liver.

My friend is older than you (67) but still works at his real-estate office 5 days a week. At the golf course he walks 9 holes and uses a buggy for the other nine. Sometimes we walk the full course. We usually have one or two beers before returning home.

In this site you have a list on the effects from chemotherapy;
http://www.prostate-cancer.com/chemotherapy/side-effects/chemotherapy-side-effects.html

Here you can read about the treatment;
http://www.california-impact.org/documents/Chemotherapy.pdf

Here you have a list of drugs;
http://cancerhelp.cancerresearchuk.org/type/prostate-cancer/treatment/chemotherapy/about-chemotherapy-for-prostate-cancer

A newer drug presented by Dr. Charles Myers in his video, named cabazitaxel (Jevtana), is provided in injections and has shown survival benefits in the treatment of advanced hormone-refractory prostate cancer.

Hopeful you will do well and stop the advance of the bandit.

Take care.
VGama

jmrodden
Posts: 3
Joined: Sep 2011

Vgama,
Thank you for taking the time to respond to my post and share your information. I got my initial diagnosis over 5 years ago, gleason score 4+3, had a robotic prostoctomy (sp) followed up by radiation. PSA stayed low until January 2010. Started Lupron injections (every 3 months) in March 2010. PSA started rising again in November 2010. Did Casodex for 2 months then a clinical trial (TOK-001 from Tokai Pharmaceuticals)Mar-June2011. Started on Ketaconazole in June 2011. Currently PSA is at 513 up from 388 last month. I don't have bone pain and feel fine. My doctor has decided to hold off chemo for now. Will see her again next month. When I start chemo it will probably be Taxotare or possibly a clinical trial going on at NIH.

JMR

jmrodden
Posts: 3
Joined: Sep 2011

Thank you for responding Nowrest. I spoke with my doctor this week and she gave me more information that has been helpful. When I have to get chemo, it will probably be Taxotore but I will also be looking at a possible clinical trial at NIH. For at least the next month, I will not be going on chemo. Good luck with your treatments.

VascodaGama's picture
VascodaGama
Posts: 1594
Joined: Nov 2010

JM

The Gleason score is considered intermediate risk even if yours got many cells of the grade 4. Do you recall your PSA chronology before RP?

Reading your post, you were 46 years old at diagnosis, and since that date you have committed to RP with adjuvant RT, and 4 years later you started HT with Lupron + Casodex. The trial TOK-001 was done while on Lupron and that did not manage to stop the advance of the cancer so that you started Ketoconazole which has not improved the situation either. Your hopes are now on the chemo to hold the bandit.

I read that the trial TOK-001was restricted in patients with radiation therapy completed less than 4 weeks prior to enrollment. The trial data do not comment on placebos but due to the restriction on the timing, I hope that your oncologist has not included you in the trial but in the group of the placebos. You could inquire about details.

I am not a doctor and you should not take my opinions to guide your instincts. I would recommend you to get a second opinion from a famous PCa oncologist, before deciding on your next step.
I believe that the newer drugs based on “targets” have demonstrated to be efficient in dealing with advanced cases. I have been following the researches on these drugs and have fallen in love with Abiraterone acetate which I trust it to be my future “saviour” when I become HRPC. It can be taken with Lupron substituting the traditional anti-agonist Casodex.
In fact it is applied similarly to the Tokai Pharmaceuticals’ 001 (phase 1 & 2 trials) drug but in a different context. TOK-001 is a combinations of three drugs aiming at three levels of action in one “goal” (decreasing the number of androgen receptors /mouths in tumor cells), whether abiraterone deprives cancer cells from needed enzymes (CYP 17) to produce its own testosterone and survive.

The plus on abiraterone acetate over the TOK-001 is that its success is proven (phase 3 trials are finished) and that it can be taken on several doses (mg) depending on each case reaction.
This is a strategic modality used by oncologists in the hormonal context. Similarly to the administration of anti-agonists (Casodex), where they change the daily dose from 50 to 150 mg, abiraterone is also administered with higher doses if patients do not respond to its initial dose.
Nobody can assure that abiraterone would be effective in your case but you could discuss the matter with your oncologist.

Here are three articles on abiraterone in 2009, 2010 and 2011;
http://scienceblog.cancerresearchuk.org/2009/05/26/new-results-for-prostate-cancer-drug-abiraterone/
http://www.medscape.com/viewarticle/722776
http://prostatecancerinfolink.net/2011/05/26/results-of-abiraterone-acetate-phase-iii-trial-in-todays-nejm/

Taxotare (docetaxel) is been in use for many years with established results. It is used in the treatment of various cancers aiming to interfere in its cells’ division. Even after a decade on use there is still controversy on the administration protocol regarding the periodical infusions (monthly, weekly, etc). You should be followed by an expert on PCa.

These type of drugs cause what I anecdotally call as “The War on the Enzymes”.
In our bodies the drugs starve for enzymes to metabolize. The first signal indicating that they are efficiently “winning” the war seems to be when one gets strong symptoms like diarrhea and nausea. The body is giving way for the drug to get all enzymes available.

Just as in hormonal treatment (ADT), chemotherapy got its own second-line medications too. Abiraterone is also recommended (got FDA approval) to cases of failed taxenes. Nevertheless I would prefer to get it before the chemo.

The famous oncologist Dr. Charles Myers has published videos on Taxotere and Zytiga (abiraterone) which you can listen in these site. You can scroll in his blog and listen to his other several videos on other drugs such as Ketoconazole and Carbazitaxel, etc. His clinic is treating advanced prostate cancer cases with those drugs;

http://askdrmyers.wordpress.com/?utm_content=amyson%40comcast.net&utm_source=VerticalResponse&utm_medium=Email&utm_term=here&utm_campaign=Cancer%20Recurrence%20After%20Radical%20Prostatectomycontent

http://askdrmyers.wordpress.com/category/hormone-resistance/page/2/

I wish you the best in your fight.

VGama

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