prostrate cancer stage 4

VascodaGama said:

Which one do you choose?

Freinhard

A very important piece of data in your case is the Gleason rate and score. Stage 4 is a classification given in cases with metastatic cancer in bone and/or far places.

Commonly, doctors do not perform prostatectomies in Stage 4 patients but some believe that by debulking the bigger tumour (the gland) it will provide a better way for controlling the spread and symptoms. Surely this practice provides longer periods of survival in guys with fewer numbers of metastases but it is not related to cure. Just control.

In very advanced cases of Stage 4 patients, some doctors prefer to treat firstly with hormonal drugs to hold the bandit as much as it is possible, attacking the metastases with spot radiation when pain becomes unbearable. This is also a way for assuring longer survival periods but not cure.

However, the aggressivity of the cancer cells turn around all these judgements. Gleason rates up to 3 are more manageable, Gleason rates of 4 and 5 are difficult to control. Gs 9 and Gs 10 guys need to treat more aggressively. There are cases of Gs9 patients where it has been possible to attain miraculous results leading to remission. In one particular case I have followed, the patient did the whole set of treatments in series, starting with Surgery, then chemo, then the combo of HT plus RT. His PSA become undetectable and now he is waiting for the results from image studies to try and locate the bandit in the lymph nodes. Bone metastases if fewer than 5 may classify the case as oligometastatic which has higher rates for successful attack.

In the case above, as you may think, this was not achieved easily. The patient now surfers a series of conditions cause by the treatment and its side effects. He is a winner but at a cost of quality living. He is older than you and has not so many young kids to worry about. Probably in your case quality of living weighs more in the decisions’ process.

I am glad to know that the Lupron this time is friendlier. In any case from your descriptions I am not sure about your real status, in particular with regards to the coughing and your love for cigars. This is a serious condition that could be worse than the prostate cancer. I would do more investigations on the matter. Probably you could go for a C11 PET/CT scan of the whole body that could identify both cases.

In your next visit to the doctor you may ask if he would administer a triple blockade that is more effective in stage 4 patients. The triple blockade is a combination of three attacks on the cancer with three drugs to try blocking totally the ways for feeding the cancer. Typically the combination is made off: Lupron plus Casodex plus Finasteride. In your case is just to add Casodex because you are getting the other two. Casodex could be increased to 150 mg daily because you did take it before. These drugs are cheaper and cause lesser side effects than chemo type.

The tests to verify the effectiveness of the HT treatment are the PSA together with the Testosterone. You got previous results taken before Lupron so that the T should now be close to the 20 mark (from 687 to 20 ng/dl).
In close future, if T is low and PSA is high then you got a “refractory” case which requires a second-line of hormonal drugs such as Zytiga or Ketoconazole. Your pain symptom may be due to bone lesions in which cases it is recommended to take bisphosphonates. An older drug administered with the triple blockade is Zometa. This bisphosphonate has been a wonder drug that apart from pain reliving, it has managed to invert the progress of the metastases in bone. (Still more time to add to the survival period).

MD Anderson is famous to be reliable in the treatment for PCa. You are in good hands but you are the one to make decisions. You or your wife should discuss with your doctor about what your real wishes.
The trials suggested by your doctor are good if one gets the real thing. Not the placebo group. Surely you may aim at cure but in a stage 4 you need to believe in a miracle to happen (those exist for some).

Now answering your question;
                “Does all this sound like my time is short?“

My lay opinion: It all depends on you. Treatments for prostate cancer are not a walk in the park. They may provide control during long periods but at the cost of the quality of life. Which one do you choose?

Best wishes

VGama

Freinhard

I write here my answer to your mail. It may help the ones interested in your story.

I am sorry to know about your suffering with back pain. This is typical in PCa metastases in bone. I heard of guys using marijuana to alleviate the symptom. Regarding the decrease in PSA (from 11.8 to 5.0 in 3 months) is just super. It demonstrates that you are not hormone refractory yet. Lupron is working and you may need to add additional blockades to the HT protocol. Maybe the Xtandi (a refined antiandrogen) would provide you better and enough control on the cancer allowing you to proceed with another treatment for the bone metastases such as Xgeva (for the cancer and the pain).

Cabozantinib is a chemo treatment for Thyroid Cancer, but it has demonstrated antitumor activity in several other cancers trials, as reported in the American Society of Clinical Oncology’s annual meeting.
It is undergoing clinical trials for the treatment of advanced prostate cancer and your doctor is suggesting you to enter in this trial. Here are details and facts;
http://clinicaltrials.gov/show/NCT01428219

The National Cancer Institute says this about the drug:

“…The drug was approved with a boxed warning alerting patients and health care professionals that severe and fatal bleeding and perforations and fistulas in the colon occurred in some patients.
The most common side effects included diarrhea, inflammation or sores of the mouth, hand-foot syndrome, nausea, fatigue, new or worsening high blood pressure, and abdominal pain and constipation. The most common laboratory abnormalities included increases in liver enzymes, low calcium and phosphorus levels, and decreased white blood cells and platelets.”

As you commented in your mail, it seems that “it doesn't sound like a joy ride”. I am not so sure if this trial is proper for you because in my lay opinion, I cannot see in your descriptions that you are a real hormone refractory patient, and do not know much about the benefits of the drug in our cancer. I take your case as stage 4, Gleason score 7 (4+3), bone metastases and a hormone dependent case. I would exhaust every possible avenue in the hormonal treatment before risking the effects of Cabozantinib.

Here are more links to Cabozantinib;
http://prostatecancerinfolink.net/2012/11/30/fda-approves-clinical-use-of-cabozantinib-but-not-for-prostate-cancer-yet/

http://prostate-cancer.org/PDFs/Is14-2_p12-14.pdf

http://www.cedars-sinai.edu/About-Us/News/News-Releases-2013/Prostate-Cancer-Researchers-Begin-Clinical-Trial-to-Evaluate-Cancer-Fighting-Drug-Therapy.aspx

I would get a second opinion from a medical oncologist on your present status before deciding on the trial. Please note that I have no medical enrolment. I have a keen interest and enthusiasm in anything related to prostate cancer, which took me into researching and studying the matter since 2000 when I become a survivor and continuing patient.

Best wishes in your journey.

VGama