Is there a cure for Metastatic Stage IV PCa?

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JohnKeats
Regular Member


Date Joined Jun 2012
Total Posts : 209
   Posted 10/25/2012 11:07 AM (GMT -6)   
This article was a little hard to read, but the last two paragraph are optimistic. My oncologist has never given me the impression that there was a cure, but told me that in the next five years there will be new therapies and protocols that will extend life and perhaps I will benefit from that.

prostatecancerinfolink.net/2012/10/25/the-non-curative-nature-of-treatments-for-metastatic-prostate-cancer/
Diagnosed 9/14/2011; Age 47; PSA 5,000+
Metastatic Stage 4, spread to entire skeleton w/femur fracture
Current therapy: Lupron/Casodex/Aredia
June 4, 2012: PSA 2.2, doing well with little discomfort
June 27, 2012: PSA 1.42
July 24, 2012: PSA 0.69 !!!!!
September 25, 2012: PSA 1.2 (Oops)
October 11, 2012 PSA 1.4 (not good)

142
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Date Joined Jan 2010
Total Posts : 5904
   Posted 10/25/2012 11:23 AM (GMT -6)   
Wow.
 
I did not see anything optimistic about what we have to work with now. I did see a thread of hope held out that if we hang on long enough, they may come up with something in the future. Thus my doctor's emphasis that I reduce my heart attack risk factors.
 
What the article reinforces is that:
"curative treatment of metastatic prostate cancer can never be promised, and any physician who implies that any therapy for metastatic disease may save a patient’s life had better be talking about the exceptions"
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 6-mo injection 9/12

Raddad
Veteran Member


Date Joined Jul 2011
Total Posts : 1857
   Posted 10/25/2012 11:31 AM (GMT -6)   
John

Knowing one has a disease that is incurable is really hard to live with. When I first heard that I could not be cured - scary moment in my life

BUT - there are as the article mentions - a number of treatments currently available that can and do extend life - not just extend life but also allow for a somewhat normal life.

Focus on this excerpt from the article
The availability today of new forms of androgen deprivation (with enzalutamide and abiraterone) and chemotherapy (with docetaxel and cabazitaxel), not to mention drugs like sipuleucel-T and the dozens of other products in clinical trials.
New therapies are extending lives among men with stage IV prostate cancer; as we extend those lives, additional new therapies do come along with the capacity to extend lives further.

Hang in there brother, us Prostate Cancer Warriors have to battle this beast with every weapon at our disposal. More and more weapons are being added.

Right - I do wish science would move faster, BUT its amazing what treatments have been added and are currently in everyday use in the last few years.

Hugs

Bud

We will beat this crap
65 - April 2013
A Better Man tinyurl.com/28e8qcg
12 7 11 - 1447 (It's just a number! )
Scans showed active prostate cancer widespread in bones
HT treatments & Zometa for bone
31 10 11 - 46.6 Cheers!
25 1 12 - 75 - Crap
22 2 - 99
22 3 - 149 - Start Zytiga
25 4 - 113 | 22 5 - 66 | 19 6 - 38 | 19 7 -34
21 8 - 27.4 | 21 9 - 36.8 | 6 10 - 33 Down! Cheer

robertC
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Date Joined May 2011
Total Posts : 966
   Posted 10/25/2012 12:10 PM (GMT -6)   
No cures yet. But a lot of treatments in the pipeline or in labs.
They are working on cancer from so many angles that something or a combination of treatments could keep the cancer in check for a long time.
There are things in trials now that look promising but it takes so long for them to become available. And they are so expensive.
Gleason (3+4) 7, PSA 5 in November 2011 age 63
cryoablation in January 2011.
April 29 2011 psa undetectable.
January 2012 psa .05 detectable

ziggymonster
Regular Member


Date Joined Aug 2010
Total Posts : 377
   Posted 10/25/2012 12:17 PM (GMT -6)   
While a cure may be years away if ever ,however, we may not be to far from turning this disease into a chronic condition......if many of had been diagnosed 15 years ago...things would indeed be extremely bleak , but now using so many new agents we are able to extend life by many years and that trend continues today.

Somedude
Veteran Member


Date Joined Jul 2011
Total Posts : 3393
   Posted 10/25/2012 1:42 PM (GMT -6)   
Well, can't you just remove the prostate if you're diagnosed with prostate cancer? My co-worker had prostrate cancer and he had it removed. He's ok now.
DX Ulcerative Colitis (panchocolitis) - May 2011.

"Life is like a box of chocolates; you never know what you' gonna get. " by Forrest Gump

142
Forum Moderator


Date Joined Jan 2010
Total Posts : 5904
   Posted 10/25/2012 1:59 PM (GMT -6)   
Somedude,
 
Removal of the prostate is the so-called "gold standard" of treatment, although it comes with a lot of potential side effects.
 
If your friend actually had an organ-confined cancer, he may well be fine, but there is no way to know that with current technology. We all live under a small cloud called the PSA test. Since there is no way to know that it was contained, you either choose to believe that it is, and potentially get slammed 10, 20, more years later with a recurrance, or expect that it is not, and be ready for it when it comes. The odds are, generally speaking, that you will die of something else first (heart attack, traffic accident, ...). I do hope for another 10 or 15 years.
Moderator - Prostate Cancer
(Not a medical professional)

DaVinci 10/2009
My adjuvant IGRT journey (2010) -
www.healingwell.com/community/default.aspx?f=35&m=1756808
HT (Lupron) 6-mo injection 9/12

SpecialLady
Veteran Member


Date Joined Nov 2011
Total Posts : 869
   Posted 10/25/2012 2:04 PM (GMT -6)   
I have not heard of a metastatic PC complete remissions, but once you get MS or diabetes or asthma or any other chronic illness, it is about keeping it under control, rather than curing it. Having said this, I did hear of metastatic breast cancer complete remissions (e.g. mentioned in a movie Forks over Knives), so it leads me to think, that perhaps it can be possible with PC, as they are somewhat similar diseases. But the key, imho, is to be always one step ahead of the disease.
Father (69 now) diagnosed with PCs in Jan 2011:
DRE positive, PSA 7.5, biopsy Gleason 6, second expert opinion: Gleason 7 and 8.
two inconclusive bone-scintigraphies, MR scan showed 2 bone mets
Feb 2011: Started hormonal therapy (Trelstar+Casodex) in Jan 2011
Jan 2012: Added Zometa
Mar 2012: went "off" hormonal therapy after PSA reached 0.055

JohnKeats
Regular Member


Date Joined Jun 2012
Total Posts : 209
   Posted 10/25/2012 2:14 PM (GMT -6)   
The article was clarifying the study that a large percentage of the patients in the study who were receiving chemo for lung and colon cancer didn't understand that their therapy wasn't curative. The Info Link sitemaster was both emphasizing that treatments for mPCa are not curative either but also telling us that there is indeed hope for significant life extension because science is advancing.

There are so many different pathways being investigated that slamming the cancer from multiple pathways with a combo of therapies seems to be the future.
Diagnosed 9/14/2011; Age 47; PSA 5,000+
Metastatic Stage 4, spread to entire skeleton w/femur fracture
Current therapy: Lupron/Casodex/Aredia
June 4, 2012: PSA 2.2, doing well with little discomfort
June 27, 2012: PSA 1.42
July 24, 2012: PSA 0.69 !!!!!
September 25, 2012: PSA 1.2 (Oops)
October 11, 2012 PSA 1.4 (not good)

Post Edited (JohnKeats) : 10/25/2012 1:17:44 PM (GMT-6)


JohnKeats
Regular Member


Date Joined Jun 2012
Total Posts : 209
   Posted 10/25/2012 2:19 PM (GMT -6)   
Somedude, the cancer can eventually leave the prostate and spread all over the body (particularly the bones). At that point, it is inoperable.

My PCa is so advanced that removing the gland would be a futile gesture with no benefit.
Diagnosed 9/14/2011; Age 47; PSA 5,000+
Metastatic Stage 4, spread to entire skeleton w/femur fracture
Current therapy: Lupron/Casodex/Aredia
June 4, 2012: PSA 2.2, doing well with little discomfort
June 27, 2012: PSA 1.42
July 24, 2012: PSA 0.69 !!!!!
September 25, 2012: PSA 1.2 (Oops)
October 11, 2012 PSA 1.4 (not good)

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3137
   Posted 10/25/2012 4:20 PM (GMT -6)   
The only examples I currrently remember of people with PCa whom were incureable cases, but have done exceptionally well are:
Dr.Fred Lee (cyro inventor) like 33 yrs. now since diagnosis and failed cure within 2 yrs., (drug of choice he did was 'emcyt'), still living and working
Ralph Valle (forum member, PCa advocate w/website) had significant case of PCa and might be cured, like around 20 yr. mark approx.
Dr. Myers (PCa specialist) what is he now like year 15 or so????

If anybody has anyothers to add to the list of way over 10 yrs., and found with uncureable status, please elaborate, might be a some listed at yananow.net
 
Dr. Fred Lee story told by close doctor friend:   http://www.rochesterurology.urologydomain.com/images/uploaded/rochesterurology/drleestory.cfm

Post Edited (zufus) : 10/25/2012 3:25:33 PM (GMT-6)


Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 2424
   Posted 10/25/2012 6:37 PM (GMT -6)   
Bud,

I agree. We don't like to hear words like teminal and incurable. Words that we can live with (no pun intended) are chronic, remission, or "under control".

John is in the same boat as I am. We are both 47/48 and we'd probably take the second group of words, but we need to keep it at bay for like 30 years. And thus the great challenge we face.

Things have shifted in the last few years towards more treatement options. I remain confident.

Jerry L.
11/09 Dx at Age 44 ----------- 4.03
12/09 DaVinci Surgery
1/10 T3b, G9 ------------------ <.05
2/10 Adj. Radiation ----------- <.05
3/11 PSA Rise/Scans/Spot ---- .09
on Pelvic Bone
4/11 HT / XGEVA --------------- .06
5/11 Spot Radiation ----------- <.05
12/11 - 10/12 ------------ <.01
On IET (Intermittent Everything Therapy)

Be part of something good; Leave something good behind.

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24271
   Posted 10/25/2012 6:53 PM (GMT -6)   
For some of us here, we will be lucky to be around in 5 years if some of these miracle means ever come to frutation and to market, that's just the reality of it. I think things will be very different for the group of men diagnosed with PC say 10 years from now.

The 28k to 30k of PC deaths a year in this country alone each year is evidence enough to me, that there are still a lot that won't make it regardless of treatments available now.

Always pays to have hope, big believer in that, but I am not one that likes smoke blown up my a**. I appreciate having an oncologist that gives it to me straight. I want to make decisons based on my true reality, not on wishes. Just another way of looking at it, I prefer to know the truth, and hope that I can beat the odds.

david in sc
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

Southernstar
New Member


Date Joined Aug 2012
Total Posts : 9
   Posted 10/25/2012 8:20 PM (GMT -6)   
Somedude,

My husband had his surgery 16 years ago without radiation afterwards. A year ago this month his PSA started rising after
being @ .0, .1 for all those years! Then is went from a .2 to 2.1, then 3.3 at which time radiation was started ( 33 treatments) with first PSA being 8.38 about 4 months out, second PSA done last week came back 17 and this is not good!
But his general health is fairly good with no current symptoms at this time.
So yes it can be removed but I would like to think a follow up rather than just PSA run every 6 months for a few years that a person would consider radiation at least after surgery. I certainly wish my husband had done this but it was not recommended at that time back in 96. I may not have changed things but we will never know that now.

JohnKeats
Regular Member


Date Joined Jun 2012
Total Posts : 209
   Posted 10/25/2012 9:26 PM (GMT -6)   
David, I can certainly relate to your words. My feelings about it all is a roller coaster ride, some days I'm fired full of optimism, other days I'm cleaning out my filing cabinets and looking at relics from my youth as if I'm looking at them for the last time, other days I'm just choosing to ignore it and focus on enjoying what's before me. Other days I'm frantically Googling hoping that some new study or trial released it's results and is making some headlines.

On the days I'm optimistic, I'm thinking about genetic therapies and target chemo. And I think about combos of therapies. I know I may just be fantasizing, but can you imagine the following combo:

1) Something like Lupron or Zytiga to suppress T-level
2) Provenge to prime the immune system and get that going
3) Some form of protein inhibitor to prevent hormone resistance
4) Casodex or Xtandi to stop the cancer from processing Testosterone
5) Targeted chemo like BIND-014.
6) Healthy diet and exercise
7) Stress reduction to lower adrenaline levels
8) Some form of bisphosphonate to protect the bone
9) Some form of genetic therapy (in my case the PARP-inhibitor for BRCA mutation)

If the body could tolerate it, wouldn't that be a powerful combo, instead of taking them one at a time? Don't you think that would kill the ******s and don't even give them a molecule of anything to live on?

But think about a) How enormously expensive that would be and b) What doctor on earth would give that combo and c) would the combined side effects be too much for the human body to bear?

Also, how discouraging it would be if even that didn't work? But we can only hope that some protocol is on the horizon that puts all these pieces together.
Diagnosed 9/14/2011; Age 47; PSA 5,000+
Metastatic Stage 4, spread to entire skeleton w/femur fracture
Current therapy: Lupron/Casodex/Aredia
June 4, 2012: PSA 2.2, doing well with little discomfort
June 27, 2012: PSA 1.42
July 24, 2012: PSA 0.69 !!!!!
September 25, 2012: PSA 1.2 (Oops)
October 11, 2012 PSA 1.4 (not good)

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 2424
   Posted 10/27/2012 6:53 PM (GMT -6)   
JohnKeats,
 
I have the same emotions you do and do some of the crazy things you do also.  I'm right there with you.
 
I like your cocktail of therapies....just for kicks, let me put on my green accountant's visor on and find an old fashioned adding machine and let me try to answer part of (a).
 
$66,000 (Zytiga; 1 year @ $5500/month)  
$90,000 (Provenge)
$89,400 (Xtandi; 1 year @ $7450/month)
$19,800 (Xgeva; bisphosphonate, 1 year @ $1650/month)
---------
$275, 200
 
plus 3,5,6,7, and 9.
 
(b) Most doctors would try one at a time.  Insurance companies would throw red flags all over the place I'd imagine.
 
(c) The above 4...I think the body would do fine with that combination.  I've used Xgeva and I still have a jaw.  Several people I know have been Provenged, Xtandi is supposed to have minimal side effects, Zytiga probably has more side effects than any of the 4.  Not sure on the other items you mentioned.
 
The question is, if all this was paid by your insurance company and your doctor prescribed it, would you do it?
 
 
 

 
 
 
 
 
 

MsWorryWart
Veteran Member


Date Joined Aug 2011
Total Posts : 1343
   Posted 10/28/2012 3:56 AM (GMT -6)   
Thanks for this topic.

It's comforting to see that my husband's roller coaster rides are not that far off from you guys.

Or from mine, for that matter! I'm a researcher by nature and if not careful, this beast can easily consume my time and thoughts.
Husband DX 49 yrs old - T4,N1,M0
07/11 - PSA 57.0 - BX -7 of 11 cores positive - all 80% -G7 (4+3)
8/4/11 - MDA - G8 - 8/11 - Positive LN, SV, & Bladder - BS Clear
8/12 - Degarelix & Casodex -9/8-1st Lupron
01/12 - Taxotere 3 cycles
01/12 -PSA .1
06/12 IMRT Complete -09/12- Extreme Fatigue
09/24/12 - Zytiga

don826
Veteran Member


Date Joined May 2008
Total Posts : 763
   Posted 10/28/2012 8:38 AM (GMT -6)   
John, good article. I am at a crossroads myself as my PSA is rising and I have failed both radiation and HT. Still no symptoms so that is good. I am uninsured so I look closely at the cost/benefit of the current batch of treatments (not cures). Jerry L's summary is right on the mark with what I find. I saw another posting here on government sponsored insurance that is encouraging as I have been turned down and placed in an assigned risk at $1000/mo. I pay less than that out of pocket now.
 
I have my next follow up with my Uro next Friday to review the blood draw from last Friday. I do not expect any different news. I am inclined to pass on the Provenge, Xtandi, Zytiga, Keto/pred, and chemo treatments at this time as none appear to provide a life extension worth the cost. I am inclined to just sit on it until I start to have symptoms.
 
I did ask my doctor and an oncologist about the "emcyt" that Zufus speaks about and I just got a blank look. Either not aware or not intersted. By the way the office visit to discuss my case was $400 with the oncologist.
 
One other note. I read an article sometime ago that stated that the majority of medications approved by the FDA in the last ten years had no curative intent for the diseases they are aimed. Only paliative. I do not have the numbers but it was like 97%.  
 
Don

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24271
   Posted 10/28/2012 9:26 AM (GMT -6)   
Don,

That's what is sad about some of those "new" approved meds. For what they cost, there really isn't any curative hope to them, and the palative value often is low, averaging just a few months here and there. For those with great and willing insurance policies, I guess trying them all would work, assuming the risks, side effects and QOL issues make it worth it. But for those like you, and others, without an insurance network, many of them won't be options at all.

Looking at the prices above on one of the posts, that is absurd what some of these treatments cost per month. Absolutely nuts, regardless of the justification by the drug makers. Got to be a better way or system. You deserve the same access to same meds as the next guy. Your life is worth as much as mine or anyone else, insurance or no insurance. I feel strongly about this. Wish I could help.

David
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

robertC
Veteran Member


Date Joined May 2011
Total Posts : 966
   Posted 10/28/2012 9:30 AM (GMT -6)   
Just thought I would add a few off-label things that have been in studies (many are cheap). Getting a prescription for any of these is another matter. Some are not USA available:

OFF-LABEL MEDICATIONS FOR PC - NOTES
metformin diabetes / weight med cheap and safe FDA approved insulin/weight/cellular targets
itraconazole / Sporanox fungus med may help pca now generic hedgehog target
Vermox / mebendazole parasite med VEGFR2 target
Rilutek ALS / anxiety med in an early study glutamate blockade
Digoxin heart med
Artesunate malaria drug
hydroxychloroquine (HCQ) malaria med plus chemo

Robert C

Post Edited (robertcool) : 10/28/2012 8:36:39 AM (GMT-6)


don826
Veteran Member


Date Joined May 2008
Total Posts : 763
   Posted 10/28/2012 10:33 AM (GMT -6)   
David, that is my assesment on the newest bunch as well. High cost low benefit and possibly no benefit. I will be eligible for medicare in 2014 just about the time the new health mandate comes on line. Right now I would pay the fine as it is still cheaper.

Robert, I have seen some of those you mentioned in other articles but, as you say, getting a doctor to prescribe them off label is difficult. And I do not fault them for this given the propensity in out society to sue and blame others for our misfortunes.

Don
Diagnosed 04/10/08 Age 58
Gleason 4 + 3 DRE palpable tumor on left side
100% of 12 cores positive for PCa range 35% to 85% Bone scan and chest x ray clear CT scan shows potential lymph node involvement in pelvic region
IGRT/IMRT with adjuvant HT (lupron) 2yrs
PSA:
02/08 21.5 at diagnosis
07/10 0.10 nadir
06/11 3.47 HT (Lupron started again in late July)
09/11 0.70

Jerry L.
Veteran Member


Date Joined Feb 2010
Total Posts : 2424
   Posted 10/28/2012 10:59 AM (GMT -6)   
don826,
 
$400 for a visit with an oncologist?  Holy crap.  Even though the first visit is outragious, Dr. Myers charges $700 after that.  I see him twice a year.  Some of the $1400/yr gets reimbursed by my insurance company, but it is minimal.  I can tell you that he would not give you a blank look on anything you bring up.  He will certainly explore all options and he has been around the block a few times.  As a patient, you also get a few phone consults in between visits and he has a portal available for questions for him and his staff.  Just wanted to throw that out there as a comparison.  I saw Metformin mentioned.  He just put me on that.
 
Jerry L.
 
 

don826
Veteran Member


Date Joined May 2008
Total Posts : 763
   Posted 10/28/2012 11:08 AM (GMT -6)   
Jerry,
 
I was a bit taken aback by the cost as well. The doctors here team up with the hospital to provide office and clerical assistance. They then bill independently of the hospital where they are officed. The hospital then sends a separate bill for "facilities". Not a very good system even if you are insured. Plus they absolutely refuse to tell you the cost in advance. Really frustrating.
 
I am out in the northwest right now but will be moving back to coastal Georgia later this month. It may a bit easier to see someone like Dr Myers from there. In fact it will be closer to several providers I have seen mentioned here.
 
Don

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 24271
   Posted 10/28/2012 11:44 AM (GMT -6)   
The only fortunate part about me becoming disabled, was being put on Medicare at age 59. Couldn't imagine not having it right now. So far, not a single problem with doctors, labs, testing, meds, or anything else. That part is good, but I sure had to pay the price to be in the early Medicare club. Would rather been healthy and still able to work, would trade for that in a heartbeat.

david
Age: 60, 56 at PC dx, PSA 16.3
3rd Biopsy: 9/8 7 of 7 Positive, 40-90%, 4+3
open RP: 11/8, Catheter in 63 days
Path Rpt: 3+4, pT2c, 42g, 20% tumor, 1 pos margin
Incont & ED: None
Surgery Failed, recurrence within 9 months
Salvage Radiation 10/9-11/9, SRT failed within 9 months, PSA 4/12 = 37.x
Spent total of 1 ½ years on 21 catheters, Ileal Conduit Surgery 9/10,
7 other PC-related surgeries
Member of Prostate Cancer & Chronic Pain HW Communities since 10/2008
“I live in the weak and the wounded” – Session Nine (Movie)

robertC
Veteran Member


Date Joined May 2011
Total Posts : 966
   Posted 10/28/2012 4:12 PM (GMT -6)   
As far a the off-label meds, they were safe enough to be approved for other uses. But oncologists say they won't prescribe for cancer.
For example, metformin has been prescribed for acne and abdominal fat beside diabetes. But most oncologists won't prescribe it for cancer yet. They will in 10 years. There are about 50 clinical trials going on concerning metformin and cancer.
I don't see why oncologists would be more defensive about off-label than primary doctors. One in five prescriptions in the USA are off-label. I'm working myself up into a John Belushi rage. lol
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