Hope??

This is the first post you use the word "Very positive". Congratulations. You have now two opinions to think about. One for hormonal therapy (the first doctor) and the second for a combination therapy of lupron plus radiation (from the oncologist).

I do not understand on the need fo a repeated bone scan in such a short time of the previous. Why was that requested? Is there any doubt about the results of previous scan?

I hope things move now in the right direction and that you feel more comfortable. You can also discuss with the oncologist to verify any possibility in participating in the clinical trial I provided the link above, that includes HT with Radiation (his suggection). You can also request for a multiparametric MRI to check lessions on soft tissue. The results would provide defined targets for radiation.

One trial involving radiation with Xtandi is here but there some adding Lupron. Just inquire;
https://www.cancer.gov/about-cancer/treatment/clinical-trials/search/view?cdrid=772357&version=HealthProfessional&protocolsearchid=6645739

Good luck,

VG

Sadie marie said:

What about 2nd bone scan in a

What about 2nd bone scan in a months time to confirm. What are the odds the 2nd one will show something?

It's impossible to determine the odds because we have far too little information. What kind of bone scan was the first one; was the scan done properly; how 'expert' was the radiologist? Similarly, we don't know anything about the second scan. I wrote earlier that there are at least two different methodologies for bone scans.

And even if we had more info, nobody here has done a comparative study to see if a second bone scan would yield another result. It just isn't a good question to ask under the circumstances.

Marie

The new finding on cancer in bone is not good news. This may restrict an option involving typical radiation treatment. In other words you have to think over again on the possibilities of each option. I am sorry for the situation.

I wonder if you have obtain a copy of the exam this time to compare with the previous. Most probably they are different exams (different machines, techniques, contrast agents, etc), if not the results are fake or the radiologist is not the same man that interpret the images. Cancer does not grow to such sizes in such short period of time (one month). From your shared information I think it to be very ambiguous.
Sincerely, in your shoes I would not trust the report and would look for a second opinion on the films from an independent radiologist, before proceeding further.

Cancer in bone sets your man in the stage 4 classification. These patients are treated differently and may be restricted in certain clinical trials. You need to discuss everything again with his physicians. Surely he can start the hormonal treatment but the intent at cure is not in jeopardy.

Get answers.

 VGama

Marie

Regarding your inquire on my comment; "You mentiones intent to cure not in jeopardy there is no cure right", it means that if your husband decides to have a radiation therapy in the future, the hormonal therapy he has started now it would not place the effectiveness of radiation into jeopardy. In other words, cure would be possible if one of the radical treatments (surgery or radiation) can be administered with success.

From the diagnosis you shared here before, we may have ruled out surgery because the cancer is not contained, but radiation was still an option. However, radiation success depends on the location of the cancer so that the last image study results become important in the final decision. In this respect I cannot trust the results provided by his doctor (your post of today) without a second opinion.

The Hormonal treatment with Lupron and Xtandi could be started at any time. These drugs will control the advancement/grow of the cancer, until the patient becomes refractory. The treatment is controlled via testosterone tests and the PSA. Once refractory is set in then the patient is moved into other set of drugs before starting chemotherapy. These are all palliative but allow the patient many years of life and enjoyment. Some guys with no other illnesses managed over 15 years.

The side effects are numerous (some mild others more accentuated) but can be controlled with a change in the life style, diets and fitness programs. He needs to be vigilant with bone health, the lipids and any heart problem along the therapy.

Best,

VG

Here is a link for nutrition that may be of help;

http://cancer.ucsf.edu/_docs/crc/nutrition_prostate.pdf

How can they tell if Xtandi helps when men react differently to Lupron some is very effective others don't last long.

Let's get this straight.

Lupron is generally very effective in driving down testosterone levels. What differs among men are the side effects. Also, some men become refractory (the cancer cells have changed and don't need outside testosterone any more to thrive) earlier than others.

Regarding the clinical trial:

Whether Xtandi 'helps' will take time to figure out. That's the reason for the trial. I haven't read the protocol (you should though), but it seems likely that the group will be followed for several years.

Did you ask whether this is a blinded trial? In other words, will your husband know whether he gets just Lupron or Lupron + Xtandi?

Sorry, but I am not able to answer your question about the spot radiation.

Sadie marie said:

Yes it is a blind trial. I

Yes it is a blind trial. I guess I meant if some become resistant faster will it matter if they have Xtandi with the resistance factor

Normally, Xtandi (enzalutamide) is used after Lupron (or a similar drug) has failed in patients with metastatic prostate cancer. At that point, Xtandi will still be effective since its site of attack is different (it binds to androgen receptors in the cancer cells). Unfortunately, resistance to Xtandi may develop after a certain amount of time.

The purpose of the trial is to find out if using the two drugs together from the start will extend the time to 'double resistance'. Even if resistance to both drugs develops, there are still other methods to control the cancer. And who knows, this is a very active field of research, perhaps another therapy will become available.

As an aside, Xtandi is VERY expensive, and getting the drug for free in a clinical trial is something to consider. Of course, it won't be known if your husband will actually get Xtandi, since you wrote that the trial is blinded. Suppose your husband gets just Lupron and if resistance develops, does the clinical trial offer some help?

Better info:

http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-treating-hormone-therapy

If your husband will get only the Lupron in the trial, it should still drive down the cancer. At least, that's what we hope. Once he becomes resistant to it after X number of years, Xtandi will still be an option.