Recurrent prostate CA after six years post surgery, radiation

Samsungtech1 said:

Waiting?

Not sure what procedure you had, but if it was RP then I would not wait.  Do not know what treatments you have had.  If you have been on HT and it is rising then you need to switch treatments.  What kind of Oncologist is he?  If he is a urologist get to a cancer Oncologist as quick as you can.  

Do not play with this.  Ask your Oncologist ,"if it was you what would you do?". 

You need someone who is better at treating this.  When it gets big wnough for him to see it, it will probably be too late to treat.  There are limits for treatments. I would be looking for someone else to treat me.

Good luck,

Mike

Thanks Mike very much for your response.

I had a RD by Da Vinchi followed by radiation. My oncologist at MGH will probably start me on some type of treatment (HT) when he sees me in March. He only treats patients with prostate cancer so I'm hoping he will have the right approach to this.

ralph.townsend1 said:

If

If HT does not work. Look at Zytiga it is on the market and you do not have to chemo first. I have been on a trial for a year and my psa is still under 1.0. I might make it another 6 months.

Thank you Ralph for your experience with Zytiga. Due to my rapid rise in PSA, I have moved my appointment up to next week with my oncologist. I will post what he recommend.

Glad that you seem to be doing well. Keep it up!

Jim

VascodaGama said:

A ride on Lupron

Grey Ghost (Jim)

 

Welcome to the “Libido-less Wonder”. The world of castration.

You can find many past threads here dealing with Lupron (and the hormonal treatment or hormonal blockade). Taking Lupron is easy but the side effects of hypogonadism may put you down.

I have been on HT with Eligard shots (similar to Lupron) since November 2010. I have experienced numerous side effects being fatigue the most pronounced. My body accepted well the castration status and I managed to tackle the worse effects with a fitness physical program and diet.

Libido and pubic hair disappears and the loss of muscle mass makes us fell ten years older.

The nicest thing though is that it all returns to a normalcy once we stop taking the drug and the testosterone gets higher to the normal levels.

 

I wonder if your doctor has prescribed you an antiandrogen (such as Casodex) to be taken (two weeks) before the Lupron shot. I say that because agonists (like Lupron) cause a flare (of testosterone) initially and such may cause pain in patients with metastases at the bone.

There have been paralyzing cases in patients with spinal metastases because of compression of the spinal cord. That may not be your case, but as a precaution to have a dose of antiandrogens is proper.

 

The hormonal treatment principle is to block the testosterone from reaching the cancer. In the process many cells will die by starvation (PCa feeds on androgens like testosterone). To avoid the feeding, Lupron takes the lead by causing the testicles to stop the “production” of testosterone (hypogonadism). For extra blockade, HT protocols can include an antiandrogen to block the cancerous cells’ androgen receptors (AR) so that they do not absorb the testosterone (dying in the process). Still some doctors include in their HT protocol a third drug to block the production of dihydrotestosterone (DHT) which is a tenfold more powerful form of testosterone. These are 5-Alpha Reductase Inhibitors (5-ARI) such as Finasteride or Avodart.

Triple blockade is usually more effective in cases of PCa with bone metastases. In these cases a bisphosphonates like Zometa or Fosamax are also recommended to treat or avoid any bone loss.

 

Recently newer drugs have been reaching “the market” and they target the intratumoral effect of the cancer when it starts to produce its own androgens. Other target drugs avoid the cancer from resting at the places it most likes to spread (Xgeva helps to reconstruct the bone loss).

In your case with apparent bone metastases, a drug called Alpharadin may be proper. This is a newer “wonder drug” that kills PCa at bone with its radioactive substance. You may want to discuss with your doctor about any possibility of getting involved in a trial for this drug. Trials are safe and the best way to get “special” drugs that otherwise would not be available to the general folks.

Here is a link about the drug and the trial;

http://www.youtube.com/watch?v=NwPbMDktMWc

http://advancedprostatecancer.net/?cat=818

http://www.fiercebiotech.com/tags/alpharadin

 

I would recommend you to research the net about the side effects of hormonal treatment. You can also order from Amazon used copies of the fantastic very comprehensive book of Dr. Charles “Snuffy” Myers named;

“Beating Prostate Cancer: Hormonal Therapy & Diet” latest edition.

 

One important aspect of the hormonal manipulations is to monitor the drug’s effectiveness not only through tests of PSA but with periodical tests of testosterone and DHT (if on triple blockade).

Lipids and bone densitometry tests should also be included in the periodical monitoring.

 

Here is a link about diets for cancer;

http://www.cancer.gov/cancertopics/pdq/supportivecare/nutrition/Patient/page1#Keypoint5

 

Best wishes for a successful “ride on Lupron” and the treatment.

 

VGama

Thanks for your very thoughtful and knowledgeable advice and counsel. So far I am on just Lupron (forever) and Casodex for 30 days. Starting to feel different, mostly more tired with, I'm sure, a bit of depression. Will have to shake out of it.

I was told to take Vitamin C and D suplements.

Jim

VascodaGama said:

Bone mets

Jim

Vitamin D is important for bone "manufacturing". You will need more than a vitamin to tackle cancer in bone.

Lupron will try to control the advancement of the cancer but it will not kill it. You need to take medications for the bone metastases.

Alpharadin kills cancer in bone. That is a chance of cure this drug provides in oligometastatic cancer cases.

I would recommend you to discuss with your doctor regarding your bone health. The cancer weakens the bone and HT causes bone loss. Osteoperosis will affect you much if you do not start take a bisphosphanate like drug. Zometa is recommended in cases of bone metastases but it may cause osteonecrosis of the Jaw so that you should check for any dental "repair" at this time. Just get second opinions on the above from a specialized oncologist.

How about having a DEXA scan now at the begining of your HT treatment?

Best wishes for "full control" in your drive.

VG

 

Thanks VG.

I will look into alphradin and the DEXA scan- both of which I had not heard of so I am thankful for your input. I am now on Vitamin D and Calcium supplements.

Best regards,

Jim

JSA406 said:

I outlined my experience

I outlined my experience before and got a lot of flack but I suggest you do some research on the university studies using Curcumin. It has been shown to prevent metastasis and inducee apoptosis. Read about it and you will at least make a more informed decision. It saved my life. It may help you.

Dear JSA,

I will carefully research your suggestion. Very thankful that you were greatly helped. Many thanks.

Jim

VascodaGama said:

Bad administration of Lupron is a possibility

Jim

The increase is very significant in such a short time and you need to stop the increase with all weaponry you can afford. You need to add other HT blockers, probably going on ADT3, to arrest back the PSA down to 0.05 levels.

I would recommend you to get a Testosterone test the soonest to check for castration status. Sometimes Lupron is administered erroneously causing it to lose its effects in the treatment. Casodex (and to a minimum extent Avodart) may be still effective in handling your case before you look for the second-line HT drugs, such as Zytiga, etc. Oncologists like Myers usually recommend patients to take a daily Casodex pill of 100 to 150mg in conditions as that of yours. You can verify its effect with a PSA test done at the one to two month mark, and then discontinuing it if failure is verified. 
At such point you should then look for drugs involving intratumoral activities like Xtandi or Zytiga but these cause other side effects and are expensive and not covered by most insurers if taken before a chemo protocol (that is still more nasty). 

Consult an oncologist specialist in targeted medication like Mark Scholz, Charles “Snuffy” Myers, Bob Leibowitz, etc. There are many reliable doctors with loads of experience in advanced cases but they should be the ones highly qualified that can pull you into a clinical trial. This is the way that you can avail of those “special” drugs like Xtandi (enzalutamide, MDV3100) Xofigo (formerly called Alpharadin), Zytiga, etc.

Read this link;
http://prostatecancerinfolink.net/tips-tools/finding-the-medical-oncologist-who-is-right-for-you-one-specialists-opinion/

Pain is associated with advanced bone metastases which is still not your case. However, the sudden spike is indicative of cancer activity and spread. You need to be vigilant with continuous lipids check up and XRs to the upper body (lungs, etc.). You can take your supplements if you trust them and if they do not interfere with the medications. D and calcium are controversial, some doctors recommend it and some don't, however, D is important and needed in the "work" of bisphosphanates. You can have it naturaly by going to sunbathing (where do you live, north?).

I believe you will manage to get your previous status if you handle things fast. Get tested and second opinions on the above.

I hope my insights are of help.

Best of lucks.

VGama 

A note on myself, I am doing fine. The PSA took a slower path and the testosterone is still increasing, now at the 460 mark. Libido is back and I am very active (nostalgia). I just returned from a visit to my doctor in Tokyo which gave me back my confidence. Surely I am worried about any spread while on this vacation period off-drugs, but I am vigilant with constant checkups and will "take an action" as soon as I get a spike or when I reach the "trigger" PSA level of 2.5 ng/ml. Thanks for inquiring about me.

Hi Again my good man. Glad you are doing fine. Many thanks for your informed comments.

I will find out very soon what my oncologist (who treats only prostate cancer patients at a large Boston hospital) recommends following my PSA rise. Will let you know. Had another PSA drawn last week as well as a testosterone. PSA rose again to 2.3. Don't have the Testosterone level yet. I am, of course, very anxious to get moving on this. Casodex has not been mentioned yet nor any mention of a clinical trial. To be clear I have bone metastasis in several areas. I expect bone pain any day now.

Will certainly follow up with second opinions you noted.

Best to you and all. Keep up the good fight.

Jim