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genemyers's Message Board Messages

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RE: PSA levels ?

by genemyers - Thursday at 2:55 AM

This is not an uncommon situation where a family member has cancer but does not want to talk about it or tell other family members the specifics; but the other family members are frantic for information as to how the loved one is doing. Maybe your brother in law can authorize his wife to talk to the doctors and then talk to you about his situation. Short of that, you have to wait for your brother in law to change his mind, while you are in the dark. Sorry.

It is very difficult to guess as to a prognosis, because you need more information, which it sounds like your brother in law is not sharing at this time. Specifically you would need to know the Gleason score from the pathology report, and the cancer stage from the pathology report.

With a psa doubling time of a few weeks (from 10 to 20), my guess is that your brother was put on Taxotere (Docetaxel), which is chemotherapy, which is give on a cycle of every 3 weeks; usually given over 6 cycle’s of a total of 18 weeks. This is just a guess.

If true, a psa that doubled in a few weeks would indicate an aggressive form of prostate cancer, but the pathology report would clarify this.

These psa levels are indicative of someone who had surgery, and there was some cancer left behind after the surgery. Not an uncommon event, especially if the Gleason score was high. 

I do not consider a psa of 20 to be a high number.  To me apsa of 20,000 would be a high number.

Gene

RE: Help for a newbie

by genemyers - May 20 at 3:11 AM

Get the psa rechecked at monthly intervals to see if the psa stays at .05 on subsequent tests; or to see if the psa on the next tests go to .07, then .09, then 1.3. That will tell you what is going on. If it keeps rising, then it is likely that there is some cancer left. It would help to get your pathology report to know what might be going on. I would guess that the surgical margins were negative and there was no extra capsular extentison and the seminal vesicals and lymph nodes were negative. 

Sometimes after surgury the surgeon can leave a little bit of the non-cancerous prostate tissue behind and if that happens you will get a low but stable psa reading on each test. .05 is low. Undetectable psa (what you would like) is a result of less than .01 or less than .02.

Incontinence can take a little more time to heal so do not give up yet. Keep doing the Kegels. Mens side effects to incontinence can vary widely from just a couple of drops of urine per day to complete incontinence; so talking to your friend is not a good indicator of what your husband can expect as it varies quite a bit from man to man. 

I am not sure what the doctor told you that might be untrue, but almost all men have some level of urine control problems after surgury, compared to where they were before the surgury.

I would not worry at all about this. 

Gene

RE: Advance Prostate Cancer

by genemyers - May 15 at 2:21 AM

I do not know what drugs you have available in India, but in the US chemotherapy with Taxotere would not be the only option.

If you father has failed Zytiga, then before chemotherapy, I would talk to your doctors about enzalutamide or Xofigo as a more tolerable treatment.

If I am interpreting you correctly, your dad went off all Zytiga treatment for a month and did not go on another treatment right away? With a Gleason 9 and metastasis, this should not have happened.

Your father’s case is complicated and this is where the art of medicine comes in for the doctor to decide what is appropriate to give him given his abnormal blood tests: RBC count, hemoglobin, platelets. Will have to defer to the doctor about the next treatment option because of this. 

Prednisolone alone will not do anything on this cancer.

See if your father can be put on Denosumab for bone integrity. But it might be too late at this time.

Gene

 

So sorry to hear about your father with advanced disease. 

Not sure what happened with the annual psa blood test results as this should have been caught way earlier than a psa of 600. This is a medical mystery.

You will be able to tell a lot by the psa tests after your dad starts on the Firmagon. How fast the psa goes down and how low it goes will give you an indication of how good the drug treatments are going to be to keep the disease in check. Frequent psa tests are called for. 

Your doctor is right about the use of Docetaxel earlier rather than later. 

Agree with the head oncologist on life expectancy. See how he responds to treatment will say a lot about life expectancy. It could be many many many years.

With Firmagon and Docetaxel on the way, you dad is going to be getting two heavy duty drugs. Possibly helpful but lighter drugs that could be added to the mix are Casodex, Avodart, and metformin. Talk to your doctor as he/she will have an opinion on this.

A 75 year old in the hospital who cannot walk would be a little concerning on Docetaxel, because Docetaxel tends to beat men up with each successive round of the drug. You cannot wait, but hopefully you father will be up and around before he has to start the Docetaxel. The faster the physical therapy works the better. The more energy your father has and the more vital your father is, the better he will be able to tolerate the Docetaxel.

Be careful in giving your father supplements during chemotherapy, as they may interfere with the chemo drug. In my humble opinion, the supplements with the best activity specifically for prostate cancer that has some evidence behind them are:

Curcumin/(Tumeric)

Vitamin D3,

Pomegranate,

Resveratrol.

I will let other people on this site address alternative treatments, diet, iodine, baking soda, etc.

I think in general, you are in good hands and your doctors have made the right key decisions.

Hope this helps. Gene.

 

I am not aware of this test being used for prostate cancer.  Do you have prostate cancer?

RE: Overwhelmed

by genemyers - April 24 at 1:58 AM

Sorry for what you are going through, but your father is fortunate to have you help him. 

Would need some more information on your father to provide advice.

The best options depends on your fathers psa history, gleason score if he has that, psa doubling time, the results of the bone scan (if done), your fathers age, if your father has other illnesses, what other prostate cancer treatments he has already had, if any, what specialty is the doctor wanting to do injections, etc.

Would need to know what is in the “injections” that the other doctor is recommending.

Usually advanced prostate cancer means mets. If your father had advanced prostate cancer with no mets, where was the cancer and how did they know where it was?

I cannot comment on putting a pin in the femur for high fracture risk, I would defer to your doctor for that decision. 

Gene

RE: stage 4 prostate cancer

by genemyers - April 18 at 2:11 AM

Sorry about what you are going through. 

Your doctors are right in that if his psa rapidly increaseing and/or he has a lot of pain the next step would be Taxotere becasue it can act more quickly than other options to bring the pain under control.  Then you can look at other treatments.

Another option to start talking to your doctor about is Xofigo which is approved for bone mets and is very well tolerated.

“How effective can they be?”. They are not effective.

Dexamethasone/prednisone is not a stand alone treatment for prostate cancer. It is given with Zytiga and with other treatments. Prednisone does have a mild cancer suppression effect (5%), but I would not consider it a primary treatment, and I have never heard of a doctor giving it as primary monotherapy.

Are you sure you understood what your doctor was saying? Maybe your doctor is not up on all of the current therapies in the USA? 

Ask your doctor if you can first add casodex and Avodart to the Lupron and see if that helps.

Ask your doctor if you can next try enzalutamide before chemotherapy.

Ask your doctor if you can next try Zytiga before chemotherapy.

You might consider researching other therapies to propose to your doctor before chemotherapy.

RE: stage 4 prostate cancer

by genemyers - April 15 at 3:41 AM

Why do you not try Zytiga first instead of Taxotere? Why not try adding Avodart to the mix? 

What is the age of your husband? Taxotere tends to get harder on the man on each cycle that you are on, (with fatigue, peripheral neuropathy, etc.) so a healthy male is the best subject to withstand the chemo.

How do you know that the Xtanti was not working? 

How was his cancer diagnosed? Was it with a bone scan or with a biopsy? If biopsy what were the results? Gleason score, etc?

I probably should have clarified some things more in my original post.  Sorry about that.

There are no radomized controlled trials in your situation showing that metformin or statins have any effect on overall survival.  There are just some preliminary studies that suggest that they may help.  Suggestion is not proof.  Without proof a lot of doctors will not offer the drug, even if it has minimal or reversable side effects with the potential for benefit.  It is not that the drug may not work, it it that there have been no studies to prove that it does work.  So many doctors will err on the side of caution (do no harm).

The prostvac and ipilimumab was a small phase one trial that results were recently presented, but I do not know if there is a trial going on for this currently.  I would assume, based on the good results, in the near future there would be a phase 2 trial.  Also other trials were done with ipilimumab, but it had some significant side effects.  We do not know, but in this current trial  they may have lowered the dose or found a way to deal with the side effects.

The Prostvac alone trial has been going on for awhile now, and I do not know if they are still accruing patients.  Also immune therapy works better when the tumor burden is low, so doctors may not consider it for patients with large tumor burdens.

Leukine is a imune therapy drug that has shown some results in case studies.  Once again no large trials.  Also Thalidomide is a drug from the 50's that women took and then their babies had birth defects.  Do not take this if you plan on becomming pregnent.  A more updated version of the drug, Revlimid, was tested for prostate cancer and was not shown to be of benefit. 

So overall there are many many reasons for doctors not to offer any of these off label drugs or to push the envelope on unproven therapies, and just offer standard vanilla therapy (Taxotere, Jevtana, Xofigo).  Its really up to the patient to discuss these options with the doctor and to jointly come up with treatment that they can both agree upon.

Gene

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About genemyers

Patient
Prostate Cancer
Alternative Treatments, Chemotherapy, Diagnostic Imaging, Diet, Hormone Therapy, Radiation, Side Effects, Supplements, Surgery

RP for prostate cancer; Currently monitoring Ca status with psa tests, have undertaken diet changes and supplements to keep Ca in check. Interested in current diet and supplements that suppress cancer.

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