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Metastatic Prostate Cancer

g12in_vancouver
Posts: 1
Joined: Dec 2015

My husband (age 73) was just diagnosed October 30, 2015.  His PSA was 1804.  He was hospitalized briefly for two blood transfusions (severe anemia) and to get his pain under control.  He received his first hormon therapy injuection (Firmagon) while an inpatient.  His PSA 2 weeks after was 83 and this week it is down to 20.  Tests confirm cancer spred to hips, legs, shoulders and spine.  No surgery is recommended. Gleason score 9 (5+4) although I don't know what it means.  The Oncologist is recommending chemotherapy, saying that studies show longer survival rate if done early.  The Urologist thinks we can wait to see if Hemocrit and Hemoglobin inprove after 3 months of hormone therapy.  Any suggestions from those who have been there already?

VascodaGama's picture
VascodaGama
Posts: 3016
Joined: Nov 2010

I am sorry for the diagnosis and advanced cancer status of your husband. All the data you shared refers to an aggressive type of cancer to which treatments are limited (systemic case). His case of anemia is of concern and puts in jeopardy the possibility of having chemotherapy, though there are medications working as erythropoiesis-stimulating agents that may help in the production of red blood cells. In fact, this may have been the basis for the urologist’s comment. Firmagon will lower cancer activity which could be the cause behind the low red blood cell count.
In any case I would recommend further investigation and testing (lipids, heart health, kidneys and liver, etc) to pinpoint the real cause of the anemia status.

Here is a link explaining in detail the anemia risks in cancer patients, causes and problem with the chemotherapy;
http://www.cancer.org/treatment/treatmentsandsideeffects/physicalsideeffects/anemia/anemia-in-people-with-cancer

The good aspect of the diagnosis is that your husband’s type of PCa cancer responds to hormonal treatment (ADT). The decrease in PSA is very significant. Probably his best choice will be a combination of ADT together with a Chemo protocol. Radiotherapy may be reserved for spot radiation of cancer in bone to alleviate pain. Surgery would be palliative in his status and at his age may not be recommendable.
ADT is administered in several blockage protocols to avoid testosterone from “feeding” the cancerous cells. Typically Gleason 9 patients are treated with an LHRH agonist (Lupron, Firmagon, etc) plus an antiandrogen (Casodex, Xtandi, etc). These may be administered together with chemo drugs. When those fail doctors recommend Zytiga, which should be taken after the chemo. For the moment he may wait for improvements before starting chemo, as recommended by the urologist.

Bone loss may be evident for the spread you indicate. Oncologists usually add to the treatment a protocol of bisphosphonates like Zoladex injections (or IV) and Fosamax.
Nutrition pays a big role in the control of treatment side effects. Here is a link I recommend you to read;

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

Please note that I am not a doctor. You should try consulting a medical oncologist for second opinions. A good book explaining all about systemic treatment is : Beating Prostate Cancer, Hormonal Therapy & Diet, by Dr. Charles “Snuffy” Myers.

Best wishes and luck in his journey.

Welcome to the board.

VGama

 

JMS58
Posts: 22
Joined: Jun 2015

Thanks for that Nutrition Link VGAMA

nepol
Posts: 29
Joined: Feb 2015

G12 just read about early  chemo on another site ( trials only in US ) they are doing it alot over seas with some life extending results ..10 months ... there a man posting on site ..set up for it US   WILL TRY TO GET BACK TO YOU  as more info comes in he said he would post as it happens  NEPOL

nepol
Posts: 29
Joined: Feb 2015

g12 EARLY CHEMO is approved in Canada... the 10 months is as far as there trial has extented so far could be more.. will let you know as i get more info.  NEPOL

Rakendra's picture
Rakendra
Posts: 198
Joined: Apr 2013

Here is a contrary opinion.  You can check my posts for my history.  It is probable that there will be some very unpleasant side effects from the Hormone Therapy.  And these can be a lot worse than you can imagine.  When I was diagnosed with Stage 4 and severe bone mets, I did alot of reasearch.  I felt I had to do the Hormone Therapy, but I decided to get castrated because I felt it was more natural and I did not want to put meds in my body.  Next, I checked out all the chemo and other treatments that my docs had for me.  I found that there would be side effects from anything I did.  I also found that not everyone has success, and even those with maximimum success only gained less than a year, and in some cases only fourmonths.  And these treatments are highly toxic and have side effects as well, and they surely will hurt your immune system.  Also, the docs donot telll you the some patients die earlier because of Chemo.  I chose not to  do anything medical other than castration.  I wanted to live the rest of my life as comfortably as possible without the added sickness that chemo would bring.  

   For me, length of life being ill all the time was not as important as quality of life.  I did not want to live for ten more months feeling ill from the effects of the poison the docs wanted to pump in my body.  That was three years ago.  I am fine now.  Please check my last posts.  Your husband is 73.  Be careful of torturing him with toxic treatments that are expensive and will make him sick.  It is NOT about how long you live.  It IS about how you live.  I would very carefully consider doing nothing but castration.  IMHO, The docs are slicksters selling expensive treatments and false hope.  Please do your research and DO NOT be fooled by false promises of  successful treatments that are toxic and relatively unproven.  If this happens to be the end time, then so be it.  But leave with dignety, gratitude, joy in your heart, and make the time you have left the most valuable time of your life.

    Love, Swami Rakendra 

     

Swingshiftworker
Posts: 1013
Joined: Mar 2010

I haven't had to have hormone or chemo treatment yet but I agree with Rakendra.  For me, survival for survival's sake is not a good enough reason to take any medication.  Quality of life matters as well.

After reading the horror stories posted by men who have suffered through hormone treatment with all of the different HT drugs offered and doing some research on the topic, I too would opt for castration over HT, especially since I am older and, as much as I'd still like to be able to "do it, I can manage w/o "doing it" IF it means surviving on this earth a bit longer WITHOUT the almost certain ill effects of HT drugs.

As for chemo, the choice is more difficult.  We all know the horror stories about chemo.  So no need to go into great detail about them here. For me, it would all depend on how pervasive the cancer is (ie., how far it has spread).  If the speading has been minmal and is likely to be suppressed w/chemo, I'd try it.  On the other hand, if the cancer has spread beyond all possible control, I would opt out, ask for as many pain meds they could give me w/o making me a total zombie and work on completing my "bucket list" before I check out.

Each is an individual choice each man must choose if placed in the unfortunate situation of having to make such choices.  There is no right answer.  Choose the one that suits you best.

lindi1432
Posts: 1
Joined: Jan 2016

It has been approved in the US  my husband was on one of the first to do this after the approval. He had 4 treatments and it had worked so they did not do the last two.

DMB2H's picture
DMB2H
Posts: 1
Joined: Feb 2016

My husband was diagnosed with metastatic prostate cancer that spread thorughout his skelton. He is 49.   We received the unfortuante news after docs had been chasing his auto immune disease but turns out it was the prostate cancer.  PSA 145. He is on hormone reduction / lupron and doxy for chemo.  PSA now 1.

He just finshed his 4th round of chemo.  Scans on the 24th.  Round 5 scheduled for 25th.  oncologist working diligently to keep him healthy from the side effects.  Doing well.  Time will tell and have better understanding after scans.

Will Doran
Posts: 207
Joined: Sep 2015

g12in_vancouver

I was diagnosed with an early Stage 4 Prostate Cancer in the fall of 2013.  I had a Robotically Assisted Radical Prostatectomy in December of 2013.  My PSA was 69 when diagnosed.  My Gleason Score was 7.  Surgery was followed by two years of ADT using Lupron, and 8 weeks, 5 days per week of radiation.  My PSA dropped to <0.010 within a month or so for the completion fo the surgery.  It has stayed a "0" up to this point.  I am now off the Lupron. The side effects of the Lupron, even though it has worked, were pretty hard for me to accept.  I was a very active, athletic person, riding road bicycles for up to three hours per day.  .  It was the muscle weakness and bone discomfort that hit me the hardest.  The normal side effects of the Medical (Chemical) Castration are the same as a Surgical Castration.  Those side effects, I have accepted and am dealing with them fine.  We are going to watch and see if my PSA stays at a low level.  I will have more blood work done in May.  As long as the PSA stays at or below acceptable levels I will remain off any form of ADT.  However if the PSA starts to come back up, then we have already talked about what is next.  My Urologist & Oncologists have made no hesitation in telling me that the probability of the PSA coming up and the cancer becoming active again are not in my favor, but they are hopeful we might be in remission for now.  Next steps would be either Chemo or Surgical Castration.  I have already agreed to have the surgery done if needed.  I watched my mother die while being on Chemo, and I will not put my wife through that.   

At this time I continue to ride my indoor Spinner Bike up to 100 minutes per day, plus I do my daily Physical Therapy for the muscle problems left by the Lupron, and my weight lifting.  I work out at the Gym two days per week for 1 1/2 hours at a time, on the weight machines. I am re-building muscle mass at this point, under the supervision of the Physical Threapists and Trainers at my Physical Therapy and Training Gym.  Exercise and the person's state of mind are a very important part in staying ahead in this battle.   As Swami Rakendra and Swing Shift Worker have said, look at the quality of life for your husband.  We are all different and all of our cases are different.  There is "no one right" way of fighting this battle.  Make sure a study all options / treatments and decide what your Husband  and You want and are comfortable with.  The best thing you can do is be the best Support and "Cheerleader" you can be.  My wife has been wonderful and continues to support me in all that I do.  Try to enjoy everyday and the small things in life that make you smile.  Things in Nature are especially good.

My best wishes to You and your Husband.   Fight hard.

Peace and God Bless

Love,

Will Doran

HeatherHa
Posts: 22
Joined: May 2011

Were you stage 4 when diagnosed and had the prostatectomy? My father was just diagnosed and I want to understand what the options are for stage 4 adenocarcinoma of the prostate are. He already had another cancer and overcame it with tough treatments, so he is willing to be aggressive.

Where were you treated? 

Lupron I understand is a hormone?

 

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