How to delay hormone-resistant cancer ?? Intermittent or continuos hormone shots--which is better ??

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JohnK11
Regular Member


Date Joined Jan 2010
Total Posts : 25
   Posted 3/11/2010 5:38 PM (GMT -6)   
I'm debating whether to go to intermittent or keep on continuous
hormone shot and would welcome suggestions, comments, info, etc
(perhaps this have been discussed previously);
recent research suggest that intermittent might
be better --along with reduced side effects (see
http://www.businessweek.com/lifestyle/content/healthday/636870.html

If this evidence is correct, and applies to human, then the more contact
you have with hormone, the more likely hormone-resistant cancer will
develop.

3 choices :
(1) Continue on every 3 month Trelstar LA (Lupron surrogate)
(2) Stretch to 4-5 months
(3) Go intermittent (resume only when PSA > 10+)

I'm leaning towards (2) --4-5 month depending on test results due to

(a) Treatment almost always are over-treat (they have to be
effective for 99%/95% of patients, so the dosage is higher
than needed for the majority of people, especially if they
are not overly large in size) --I am a great believer on
under-treatment--so, by stretching to 5 months, the average
hormone dosage is reduced, and, if the article is right, the
chance of developing hormone-resistant cancer is reduced also.

Regular Every 3 months --
Jan 1--first shot;
March 29 PSA test,
Apr 1 2nd shot..
repeat

Stretched 5 months--
Jan 1 first shot;
April 1 PSA test (to confirm that hormone is still effective)
April 29 2nd PSA test (to see if hormone/PSA has gone up--if so,
get shot on May 1; if not delay shot till June 1)


----------more info on my advanced prostate cancer (PSA level did not
go down after prostate surgery)

5 months after Robotic prostate surgery update (3/11/10)

PSA trend
Pre-biopsy (Apr 09) 4.2 (this triggered the July 09 biopsy 4+3=7
Gleason prostate cancer)
Pre-surgery (Oct 09) 6.7
DaVinci surgery 10/9/09 (Gleason 4+3=7; T3c; right seminary vesicle
cancerous; has to remove that AND "way beyond the prostate" to get
negative margin)
6 weeks post surgery 7.0/6.4
10 weeks post surgery 9.2 (doubling time 2+ months)
13 weeks-taking Trelstar (Lupron surrogate)-12/16/09
22 weeks PSA (3/3/10) <.1 (testoserone 13)

Both the Bone scan and the Prostascint/MRI scans (12/09) were
negative (the uro says that most of the time, one would
not see cancerous modules in these scans until your PSA is ~40+.

March 11, 2010 update
PSA taken 3/3/10, and is <.1, so, hormone treatment is working
Getting frequent (1-5 times per day) hot flashes, though endurable
(have to take my shirt off to cool down on some occasions)--
often (perhaps 1/2) happens most frequently during meals.
This started occurring around end of Jan (6 weeks after shot) and
has become more frequent lately.
(note : my 3-year older brother since age 20's have frequent
sweating (face and chest--so, like hot flashes) while eating,
especially if he gets excited--so, this could be genetics--he
does not have prostate problem AFAIK)
Back to singles tennis (though I try not to run too much) with no
problems--and sweating (which I consider a success) --plus
frequent long walks (minimum 1000 steps in 10 min= 1 health point,
some longer)--target it 20 health points per week, but I am
managing only 10-15 these days. (1 hour singles tennis= 4-6 health
points, and I do 1-2 times tennis per week).
Incontinence --getting better--from 6-10 pads (+ diaper) for the first
month, now down to 1 pad + 1 diaper per day (could probably
get by without diapers, but I have plenty). Still steady dripping
(though small amount) plus more leakage when body is in unusual
position or during exercise. Only massive leakage occur during
sleep--if I sleep for more than 2-3 hours stretches (often, I still
wake up once per hour for peeing, and those nights, leakage is minimal)
Diabetes --Getting worse (prior to prostate surgery, I was pre-diabetic
with morning/fasting reading of 110-130); Early Jan, I'm getting
170 (3 days in a row; 150 wed morning after Tuesday's tennis
session). Fortunately, a few reading at 5PM before dinner shows
170-200, not too high--so, at least I'm still Diabetes II. Taking
2 metformin pills (one morning meal, one evening meal). Note that
I have been eating more than I should since I feel hungry--that
might have contributed--(also to weight gain--back to before surgery
weight--I was down 10 lb just after surgery--I'm on the margin between
overweight and obese)
so, I need to watch my diet and carbs.
Other problems :
Sleeping --getting some insomnia, but not too bad.
possible other items --feel lightheaded (this occur before surgery too)
and unsteady (especially climbing stairs). Night vision in dim lights
seems to be much worse than before--but driving at night is okay.

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/12/2010 6:32 AM (GMT -6)   
Alot of debate on this still goes on, in my own case which is high risky stats and bad prognosis's.  Found it way better to do intermittent and switch drugs, maybe morph with the cancer to something different to get to the receptors, this is manipulation in therapies and some leading oncologists do precisely such with their patients. John-Hopkins had an article suggesting or showing that longer term on LHRH type drugs, seemed to help the PCa morph to become more HRPCa or aggressive....call me dark...these drug companies are cashin big time on patients and how many docs would like to make no money on protocols or less office visits  vs.  $1000 profit per shot for Lupron and similar??  You don't have to like my opinion and are allowed to shoot the messenger. My uro-doc wanted me on Lupron for life, glad I fired him 5-6 yrs. ago now, he was a profit  lover and carpet bagger with no soul, never mentioned choices, options, never offered me casodex prior to zoladex or lupron to prevent flare (I had high stats)...that was wrong and unforgiveable right there...a few more strikes later and he was out, best thing I ever did. This is one reason among many why I question everything.
 
Try asking your doc what he thinks about using other items that he would make no money on, like these:
estradiol patch, DES, emcyt or maybe Ketoconzanole(might make money on this one).  Then listen to why he most likely says they are junk, then do some research on your own to see if he is totally correct??   Why do some of the leading onco-docs put patients on them??? Why does Dr. Fred Lee use emcyt on his own case of PCa?? Why does Dr. Premoli of Argentina use almost exclusively  estradiol patches on his patients, with much success???  This is PCa question everything and always is a good idea as you can see it ain't working well enough for all patients and failure rates are unacceptable levels. Not saying don't use those profittable drugs, just remember you have choices and can switch and go intermittent....even if expert doc says you cannot do intermittent...go research for yourself to know what is the truth in your scenario.


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 3/12/2010 10:51:28 AM (GMT-7)


tarhoosier
Regular Member


Date Joined Mar 2010
Total Posts : 487
   Posted 3/12/2010 10:25 AM (GMT -6)   
John:
What does your doctor recommend?
After responding to that question, then the issue of intermittent treatment, of any kind and for any condition, is to allow the body to recover from drug main and side effects and allow stasis to remedy any salient conditions created by the treatment. Thus a low psa may allow for a period of indeterminate length before re-starting whichever treatment you and your doctor decide upon. It appears that your treatment has reduced your testosterone sufficiently for the psa to be undetectible by a standard assay. The effects of low testosterone can only be reversed with a period of testosterone recovery. Going from a quarterly shot to one every 4 or five months is unlikely to allow for T recovery and thus will not alleviate side effects of treatment. Only a longer period with T recovery will accomplish this. Intermittance is rarely recommended after just 3-6 months of treatment for men in your situation. One year or more is generally the period. If you are trying to reduce the cost of your treatment then the 4-5 month period between quarterly shots may answer but this is not what you are seeking.
The psa re-starting threshold is entirely arbitrary depending on you and doctor, your history, your comfort with potential progression, emotional anxiety, expense of treatment and many other factors.

deer hunter
Regular Member


Date Joined Jan 2010
Total Posts : 246
   Posted 3/12/2010 10:40 AM (GMT -6)   
Hi Ihave hot flash 24-7 summer gets here i don't know what i'll do i work outside in the south also sleep insomia. sleep about 1hr and a half at a time go pee then back to bed then hot flash not on drugs last took 12-10-09 cassedex.Idon't think i will take anymore unless i have to to survive this diease. Ratiation and cassedex i clinical trial at EMORY in ATL GA
DEERHUNTER
dx age 57 01/06 open RP 4/06 psa in 01/06 8.1  surgery path report Gleason 3+4=7 poorly differentiated  tumor was 90%involved in both lobes surgical margins postive. in the right apex and right radial margins tumor grade G3  perineural invasion present high grade of PIN found  T2c NX MX PSA 0706  .01 10/06 .02 01/07 .03 04/07 .04  06/07 .05  07/07 .08 07/07 bone scans pelvic ct neg. 08/07 proscintic scan neg.9/07 psa.10 net with rad onc. wanted to do SRT but i did not do it 10/07  saw a new dr at Emory University [my old dr urg. suggested second opinion ]  bone scans negs ct scans pelvics neg. biopies of the bladder and adrinal glands neg.another proscintic scan neg.12/07 Psa .11 clinial trial Emory injected with protons to try and find the cancer cells no luck 3/08 psa .17 06/08 psa .23 psa 09/08 psa .32 12/08 psa .39 3/09 psa .39 6/09 psa .43  meet with medical onc. he said  i might have waited to long to start SRT 7/09 psa .50  another bone scan ct scan all neg.MRI neg. meet rad. onc. 7/09 started casdex 50mg 1 day for 30 days 2 shots of lupron started rad treament 10/09 40 treatments 75 gm 12 shots each time all aroud pelvic finished 12/09  psa .07 and psa 01/10.05 next dr visit 03/10 wait and see!!!!!!


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 3/12/2010 2:22 PM (GMT -6)   
JohnK11 'if' you are wishing to stay on Trelstar longer, which you have alot of choices, FDA just approved the 6 month shot on this today, it was not available before, looks like in May it will be offered to the public thru your docs.  *no endorsement from this budget messenger whom attempts to inform and tries to educate others on the real world of PCa, less sugar coated cause that is what this topic deserves.


Youth is wasted on the Young-(W.C. Fields)

Post Edited (zufus) : 3/12/2010 1:25:29 PM (GMT-7)


JohnK11
Regular Member


Date Joined Jan 2010
Total Posts : 25
   Posted 3/13/2010 4:22 PM (GMT -6)   
Further info from the original poster:

Thanks for all the comments,

(1) Article on Nature about the latest research on how
hormone-resistant cancer apparently comes about (at least
in mice)--which might suggest lymphotoxin-reduction drugs
should be administered at the same time as hormone treatment.

http://www.nature.com/news/2010/100310/full/news.2010.115.html

(2) I am not particularly concerned about cost (though I am
philosophically against wasting money or enriching drug companies)
since I belong to a HMO from work.

(3) My main concern is how to prolong the period while
hormone will keep my metastatic prostate cancer at bay
--my secondary concern is how to reduce side effects, which
is bothering me, though perhaps not yet severe enough for me
to drop hormone treatment (if my diabetes gets much worse, it
might be a reason).

(4) Re yesterday's approval of 6 month trelstar--the article
below seems to indicate that it will actually work for 12 months ???

http://www.docguide.com/news/content.nsf/news/852576140048867C852576E3007D7E3D

(5) I will be discussing with my uro tomorrow, when I will get my second
3-month trelstar shot.

Mbshine
Regular Member


Date Joined Aug 2008
Total Posts : 67
   Posted 3/13/2010 7:24 PM (GMT -6)   
John
  get all the opinions you can
 
about 2 months after my DX I iwent on 50mg of Casodex every day and the expensive (zoladex?) shots every three months for 13 months before prostate was removed at Sloan kettering...my local NM urologist was a big believer in the hormones and my PSA went to virtual zero....Dr. Guillonneau my surgeon at Sloan kettering (where my local urologist studied) was not a big believer in hormones and would not have suggested it but he had a neither here nor there view since I had started the treatment...I went off the hormones two weeks before surgery and intentially about my quarterly shot a month before surgery...one thing I learned is that it was difficult to do pathology work on the removed prostate because it had become "mushy" and easily damaged while they pull it out of your body because the hormones basically killed the prostate...which was their job...
 
I had hot flashes and wild mood swings every night....cried easily, and even some breast enlargement...obviously zero libido and they can fancy it up in any medical terms they like but basically you have been chemically castrated.....post surgery catheter removed in 9 days and incontinence for about 3 weeks and stopepd using any pads after about a month...the flashes and mood swings have lessened, but libido is still gone....both docs say there can be a residual dose of the hormones which in some people take a year or more to "clear" the body cells.....I am thrilled that my two poast surgery PSAs were virtual zero and the new mice studies say nothing about what systemic changed occur which even when you are "clean" with no sign of spreading, could result in a recurrence of other types of more aggressive cancer cells...I think, truly, this is a case where an informed layman asking good questions can spurn reseachers to "real world" consequences after a course of treatment...
 
 Also, I think these "new" findings were in theliterature, if you looked for more than two or three years...lots of debate on wheter on and off hormones worked better than sustained treatment.. other studies showed that the "average" zero PSAs after sustained hormone therapy lasted on average two years but in some cases many, many more years....
 
In my case at age 62 now, and five months after surgery, I  feel my personal priority to get rid of my prostate while Gleason scores were still 6 and 7 and pass up radiation and other measures was the right one....no one likes to go from a fairly macho guy to a eunich, but having friends who have died horrile deaths from various cancers made up my mind...the fairly normal urinary function is a bonus after reading many horror stories and there is a 50-50 chance that the libido issue is somewhat resolved over time...
 
Finally, I think your posting and the responses show the great  benefit of Healing Well and is the type of exchange which is a positive force for your future health and full life....
 
all the best
 
 
mbshine
 
--
 
I dontknow where I stgored all my DX stuff but you have tghe gist of it...LOL!
 
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