Prostate Cancer starts to move to the bones

MrJingles
MrJingles Member Posts: 2
edited January 2020 in Prostate Cancer #1

Hello,

I am new here and have been scouring the internet looking for info. I am here looking for some help or information about what I can expect from my father’s prostate cancer situation.

I will start with some background. He was diagnosed with prostate cancer about 17 years ago and shortly thereafter he had the prostate removed. At the time the doctor said it was localized and had not spread. He underwent a course of radiation treatment after the surgery. As the years went on, his PSA scores would go up. Very slowly at first, and then about 5 years ago they shot up. I don’t recall the numbers, but it lead his doctor to put him on hormone therapy. Which he did for a few years, until earlier this year when his PSA levels started to go up again. They also did a bone scan and they said they found some early traces of spread to his bones. So the doctor put him on a combo of drugs Zytiga and prednisone. He has been on that combo for about 8 months and his PSA has dropped to 11. Sorry I should mention that he is 84 years old.

I have done some googling and found that this combo usually holds the spread of the cancer off for 33 months on average? Now to the questions I am hoping you can help with. Is 33 months an accurate estimate with this treatment? Will the PSA start going up eventually and that would be an indication that the combo isn’t working anymore? This is the question I really hope that you can provide some “hope” for us,  at that point what are the options as far as treatment goes?  

Any help you can get me I would really appreciate. I am thankful for all of you sharing stories and information on this site. You really do help.

Thank you

Comments

  • Georges Calvez
    Georges Calvez Member Posts: 547 Member
    #2
    How long?

    Hi there,

    You are right that 33 months is the average but some manage a lot less and others a lot more.
    Metastatic prostate cancer will get you in the end unless you die of something else first, that said some go on for years while others see quite a rapid progression.
    It looks like he has not got extensive metastases so his chances are quite good.

    Best wishes,

    Georges

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #3
    Second-line ADT

    Jingles,

    Zytiga makes part in the traditional sequential of treatments for prostate cancer. This is used when patients express refractory from the traditional hormonal drugs (such as Lupron and bicalutamide). Zytiga manages to avoid the metabolism of androgens which are now produced by orders from the cancerous cells. In other words, your dad's cancer still responds to hormonal treatment so that he may still try combining other treatments involving ADT second line drugs, keeping the immune system in shape. He may still have several years before starting chemotherapy. Surely these are linked with side effects that may lead to other illnesses, that will require still more drugs.

    Though treatments are still available, at his age the quality of life should take the main stage.

    Best wishes,

    VG  

  • MrJingles
    MrJingles Member Posts: 2
    edited January 2020 #4
    Apalutamide

    Thank you for your help. Your explanaitions were brilliant. I have another question of you dont mind. I have been reading about a drug called apalutamide. I am not sure if it has been approved in Canada for this purpose, but would this be a drug that could be given to a patient like my father after his current regime stops working?

     

  • Steve1961
    Steve1961 Member Posts: 625 Member
    #5
    Hmmm

    Odd the fella down the street from me ha PC that apread to hi hips ..h really didn't know lot ..at first he told me hi PSA was 29 ..then a few month later he told m it was 49 ..then after treatment combo radiation he said PSA went to 0 ..then it spread to hi hip theh he told  m had ha to take a pill a day i an assumin hormone treatment but he said they are 600 a pill ....then he said they told him 5 to 8 year ...I also aked ho mich cancer h he he is alot ...I can see him getting confused about a lot but when you ask how long ..big difference between 33 months and 5 to 8 years ..unless someone is fibbing ....

  • VascodaGama
    VascodaGama Member Posts: 3,707 Member
    #6
    Quality of Life has prime consideration

    Jingles,

    Apalutamide (Erleada) is a second-line antiandrogen (120$/daily) similar to the expensive Enzalutamide (Xtandi) (1,000$/daily). Both drugs work well in avoiding mutations of the androgen receptors at cancerous cells, performing well when bicalutamide stop doing its job properly (refractory). However these antiandrogens do not perform so well in patients that have been treated before with Zytiga. The reason seem to be due to certain genes that were modified by the effects of Zytiga. From trials, not all patients responded the same but in sequential treatments; both (Erleada and Xtandi) were recommended to be administered before Zytiga due to the findings. You may get a genomic test of your dad's case to verify if ADT will work well along his journey. 

    I am not a doctor but I believe that hormonal manipulations can extend the dependency of the bandit in androgens if one administers the treatment intermittently. ON/OFF periods on the drug can be regulated using the PSA as trigger thresholds. These actions should also be accompanied with immune therapy drugs to improve and balance the system. Surely a medical oncologist of the grade of Dr. Myers is the best physician to consult for advice and followup as such combinations of drugs lead to interaction with other medications that may be required in other illnesses, typical in 84 yo patients.

    Here is a comprehensive link explaining on trials with Apalutamide;

    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5905496/#__sec3title

    Let's hope that Zytiga works for many more years than what you think it will do.

    I think that your dad needs to consider quality of life. I admire you for the efforts to get the best to your father but keep in mind that quality living may be best to cure in his age.

    Best wishes,

    VGama

  • Clevelandguy
    Clevelandguy Member Posts: 1,206 Member
    #7
    Other drugs?

    Hi Jingles,

    Sounds like Apalutamide is another Testosterone reducing drug, you would have to talk to the doctors to see if they feel this would help.  You might also want to look into different chemo drugs that would be effective and still easy on your Dad.  Sounds like Apalutamide has some pretty nasty side effects.

    Dave 3+4

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