So confused, worried and clueless about my dad's prostate cancer and Zytiga

I helped a friend dying of PCa through Zytiga and Jevtana two years ago. Both have the usual chemo-like side effects: fatigue, weakness. The Both often cause severe diarrhea. Jevtana can cause hair loss, but I don't think Zytiga ordinarily does.  Zytiga is not a "true" chemo, but works more as a second-line form of HT. Zytiga is a pill, whereas Jevtana (which is a "true chemo" ["cytotoxic"] itself) is given as an IV drip.

Both are, as you know, for metastatic, hormonially resistant, end stage PCa.  But note this: they are for use AFTER Taxotere (Taxotere is another name for Docetaxel, the most common chemo for PCa) or similiar chemotherapy has been used and failed.

Has your dad run the course of chemo yet ?  Doctors can alter this sequencing if they see fit, and I have read at this board of more than one guy starting these two drugs before conventional chemo, but that is not the ordinary chain of events. (See the info I have linked below. FDA approvial for both was initially for post-Taxotere use, but was later expanded to include basically any use that an oncologist wants to put them to.)  The drugs are advertised to give incremential extensions of life expectancy.  What I read then was one could expect (if I remember correctly) about a three month (or more) life extension from each, but the studies that these estimates were based on had relatively few patients to analyze back then, since both drugs are (relatively) new.  It may be that since then the estimates are for more time. I have also read accounts of guys here being on one or the other of these for well over a year.

Doctor estimates of survival time are more educated guesses than anything else.  My friend had fought the disease over 13 years, and his PSA was at 1,000, so the disease was just ravaging his body.  But he died less than a year after beginning those two drugs (which are given sequentially, not at the same time).  But his was just one example. And be aware that he also had benefited from about a year of conventional chemo before stating Jevtana or Zytiga. It may be that at his age your dad will get another five years, but, like you, that number to me seems improbable.

Your dad is fortunate to have a son like you working for his well-being, trying to determine what the truth is, and what, if anything, can be done for him.  It is difficult for him, but for you as well. 

A personal note: I have done huge amounts of chemo myself (five drugs, at 140% of recommended lifetime dose) for lymphoma.  Any chemotherapy drug is hell; it is a miserable feeling. I felt like I had lighter fluid in my veins, not blood. Gary felt like hell on these drugs.  It is a judgement every patient must make, whether or not to use them. Some have an easier time with a given drug than the next guy might; it is basically the luck of the draw. Chemo side-effects are mostly unpredictable. There are around 200 FDA approved chemo drugs in the US, and virtually every one of them has at least 20 possible side-effects. They differ drug to drug, but nearly all cause extreme weakness. Most skew numerous blood counts, and most weaken the immune system.  Some are curative, and some are not. One guy will get one side effect, while another man won't.  Chemos used for advanced, metastatic PCa are never regarded as curative, however, but rather pallative -- they extend life, and usually mitigate symptoms, such as tumor pain, by shrinking tumors, sometimes very significantly. But they do not cure.

max

Jevtana:  http://chemocare.com/chemotherapy/drug-info/Jevtana.aspx

Zytiga: http://chemocare.com/chemotherapy/drug-info/zytiga.aspx

Taxotere (conventional chemo for PCa) http://chemocare.com/chemotherapy/drug-info/Taxotere.aspx

samuel01 said:

Max, thank you.  You helped

Max, thank you.  You helped me tons.  I am so sorry for all you have gone through.  The fact that you are here helping others is amazing.  My dad has not had any other chemotherapy drugs.  He just became hormone resistant.  He and his doctors are hesitant to throw any heavier drugs at him because of his nueropathy which is very disabling.  I went loaded for bear with pages of information and questions and the doctor answered them all.  But I did not think it was realistic for him to tell my dad he would live another five years.  I will get another opinion.  I am not sure some doctor being more realistic with my dad will be helpful for him.  And I am not advocating that.  I am just trying to gage his true situation.  I am thinking of taking a leave at work if this starts to take a turn for the worse.  But it is hard to plan.  I guess that is the ugliness of cancer.  Thank you again, so much.  

While it sounds like chemo is still called for, did you and your father discuss the possibility of physical castration w/his doctors as final attempt to stem testosterone production?  If not, it may be something worth talking about in conjuction w/his chemotherapy.

Good luck!

Samuel,

Be aware that the US Federal Family Medical Leave Act (FMLA) protects immediate family caregivers from termination of their employment while attending to a catastrophically ill loved one. My wife filed for it in 2009 when I was diagnosed with the lymphoma.

I too have neuropathy, which is usually caused either by diabetes or chemotherapy. There are FDA approved drugs for diabetes-induced neuropathy, but not for neuropathy caused by chemo.  I was part of a clinical trial for chemo neuropathy treatment, and was given a lot of information regarding it by the hospital running the study (the drug under study was a cream, and judged a failure).

max