2nd line Hormonal Therapy vs. Chemo

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New Member

Date Joined Jan 2009
Total Posts : 5
   Posted 11/4/2009 11:32 AM (GMT -6)   
Just found out that my Prostate cancer has entered my chest area as latest CT scan shows new and larger pulmonary nodules and larger mediastinal adenopathy. PSA taken this week was 49.7 up from 29.8 two months ago despite continual Lupron injections. Had a choice of Chemo or Ketoconazole + Hydrocortisone and decided on the hormonal therapy as not mentaly ready for Chemo. wondering if anybody on this board has been in this situation and if so, what was your experience and outcome.
Age 69, d'xd 10/02 with PSA of 42.7 and Gelason of 7 (4+3). Started Lupron/Casodex 11/02 and Radiation (37 treatments) in 2/03. After two years of Lupron/Casodex PSA was <.01 so treatment was stopped. PSA started rising 2 years later so started back on Lupron/Casodex but Oncologist stopped my Casodex early this year but continued Lupron.
cool  Al

Tony Crispino
Veteran Member

Date Joined Dec 2006
Total Posts : 8128
   Posted 11/4/2009 11:53 AM (GMT -6)   
Hi Al,
I would like to introduce you to David Emerson ~ FLHW (David E). He has been specifically down this road. Here is his blog site:


He also started a foundation at www.flhw.org and has an email address there as well.

You and I are close but I have not progressed to a rising PSA and I believe that your were further along when the disease was discovered. Still I stay hopeful and positive, and send the same well wishes to you. You can find more guys like yourself at the Infolink social network, as well as the the Prostate Problems Mailing List found at www.ustoo.org.

Second line drugs like Keto or Nilandron will work for a limited period. Moving to chemo sooner may have it's advantages in that many clinical trials require failed chemo to enter the trial. Abiraterone is one such trial. Also note that Provenge may be an option for you as early as summer next year. So maybe looking into how that will be available might be a good move for you now.

May peace be with you and your family. Never lose hope!

Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Gleason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
Hormone Therapy May '07 to September '09 ~ Currently off.
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (October 7, 2009): <0.1

My journey is at: www.caringbridge.org/visit/tonycrispino

My InfoLink page is at Tony's Prostate Cancer InfoLink Page


Regular Member

Date Joined Jul 2007
Total Posts : 57
   Posted 11/4/2009 2:17 PM (GMT -6)   
Hi, Al.  My husband's onco. advised not moving to chemo until all hormone therapy options had been exhausted.  He started low-dose Keto plus Hydrocortisone in July 2008 and had a very good response.  We were hoping this would continue but unfortunately his PSA has now risen from 1.7 to 6.5 in three months.  We have added Advodart to his meds and will retest PSA next week.  Will probably be looking at starting chemo in the near future.
He felt very well on the Ketoconazole and had no side effects other than some skin sensitivity and dry lips. 
Stay strong and good luck to you.

New Member

Date Joined Jan 2009
Total Posts : 5
   Posted 12/8/2009 3:28 PM (GMT -6)   
Just got my latest PSA taken Nov 4 and the number came up as 19.8, well over a 50% drop in one month.
It looks like Keto and Hydro does a good job of controlling.

Elite Member

Date Joined Oct 2008
Total Posts : 25355
   Posted 12/8/2009 4:33 PM (GMT -6)   
AL, that a huge drop in the right direction. Hope it stays that way for you. Good luck.

David in sC
Age: 57, 56 dx, PSA: 7/07 5.8, 7/08 12.3, 9/08 14.5, 10/08 16.3
3rd Biopsy: 9/08 - 7/7 Positive, 40-90% Cancer, Gleason 4+3
Open RP: 11/08, Rht nerves saved, 4 days in hospt, on catheters for 63 days, 5th one out 1/09
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos margin
Incontinence:  1 Month     ED:  Non issue at any point post surgery
Post Surgery  PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Latest: 7/9 met 2 rad. oncl, 7/9 cath #6 - blockage, 8/9 2nd corr surgery, 8/9 cath #7 out  38 days, 9/9 - met 3rd rad. oncl., mapped  9/9, 10/1 - 3rd corr. surgery - SP cath/hard dialation, 10/5 - began IMRT SRT - 39 sess/72 gys ,cath #8 33 days, Cath #9 in 35 days, 12/7/9 - Cath #10 in place

James C.
Veteran Member

Date Joined Aug 2007
Total Posts : 4462
   Posted 12/8/2009 6:11 PM (GMT -6)   
Al, any change to the better is something to be grateful for. I am glad to read that you have moved in that direction. Continued best wishes and hopes for you... smilewinkgrin
James C. Age 62
Co-Moderator- Prostate Cancer Forum
4/07 PSA 7.6, referred to Urologist, recheck 6.7
7/07 Biopsy: 3 of 16 PCa, 5% involved, left lobe, GS 3/3=6
9/07 Nerve sparing open RRP 110gms.- Path Report: GS 3+3=6 Stg. pT2c, 110gms, margins clear
24 mts: PSA's: .04 each test since surgery, Bimix .3ml PRN or Trimix .15ml PRN

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