Ketaconazole As Second Line Hormonal Therapy?

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tatt2man
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Date Joined Jan 2010
Total Posts : 2845
   Posted 8/18/2010 3:41 PM (GMT -6)   
hiya-
This link was sent to me via our local support group - it is Dr. Myers website - since Sonny has us thinking HT - I thought this would be of interest - let's hope this link works !!


askdrmyers.wordpress.com/?utm_campaign=Ask%20Dr%2E%20Myers%3A%20Ketaconazole%20As%20Hormonal%20Therapy%3F&utm_content=tprocter%40hotmail.com&utm_medium=Email&utm_source=VerticalResponse&utm_term=herecampaign


BRONSON
Age: 54 -gay with spouse, Steve - live in Peteborough, Ontario, Canada
PSA: 10/06/2009 - 3.86
Biopsy: 10/16/2009- 6 of 12 cancerous samples, Gleason 7 (4+3)
Radical Prostatectomy: 11/18/2009
Pathology: pT3a- gleason 7 -extraprostatic extension -perineural invasion -prostate weight -34.1 gm
Post Surgery-PSA: April 8, 2010 - 0.05 -I am in the ZERO CLUB - hooorah!
Next PSA: October 8, 2010 -TBA

Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/18/2010 5:39 PM (GMT -6)   
bronson,

is there any place to read these reports without having to go through a video? I am better off reading things as opposed to listening.
i would like to know what was said. or if you are well versed, can you give me short summary of the topic? this goes to any of our resident whiz guys on the subject. thanks in advance

david in sc
Age: 58, 56 dx, PSA: 7/07 5.8, 10/08 16.3
3rd Biopsy: 9/08 7 of 7 Positive, 40-90%, Gleason 4+3
open RP: 11/08, on catheters for 101 days
Path Rpt: Gleason 3+4, pT2c, 42g, 20% cancer, 1 pos marg
Incont & ED: None
Post Surgery PSA: 2/09 .05,5/09 .1, 6/09 .11. 8/09 .16
Post SRT PSA: 1/10 .12, 4/8 .04, 8/6 .06 11/10 ?
Latest: 6 Corr Surgeries to Bladder Neck, SP Catheter since 10/1/9, SRT 39 Sess/72 gy ended 11/09, on Catheter #21, will be having Ileal Conduit Surgery in Sept.

el perro
Regular Member


Date Joined Mar 2010
Total Posts : 46
   Posted 8/18/2010 11:46 PM (GMT -6)   
Basically he says ketaconazole is an older drug, but can kill PCa by multiple pathways and may be worth trying in hormone-refractory patients before moving them on to chemotherapy. I usually watch his videos on diet and supplements, but he's had several on hormone therapy lately... intermittent therapy, transdermal estrogen patches, time to hormone resistance, etc., so might be worth checking out.
Dx 11/2008, Gleason 3+3
Active surveillance for now

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/19/2010 12:46 AM (GMT -6)   
To this day I have met about a dozen or so men who have been on "Keto" as it is commonly referred to. None have had more than a temporary effectiveness. All were informed that would likely be the result. I was also informed that taking the drug with certain citric drinks (grapefruit juice for example) would break down its effectiveness. All were able to tolerate it well but that there is a class of patient that does not tolerate it at all. I'll let the few guys here tell their stories with it. David E (FLHW), here at this site would best be able to describe his experience with it, but he was able to get about 12 months on it I believe before it became ineffective.. Davids case is very advanced but he is now on DES and having much better success.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

Post Edited (TC-LasVegas) : 8/19/2010 8:04:45 AM (GMT-6)


zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/19/2010 6:49 AM (GMT -6)   
Yep, you can read the short info version at www.hrpca.org (proven therapies), might not work that long as Tony just mentioned which seems to be the case in patients I knew of too. Some have even dropped it cause of side effect issues. It was not even made for PCa useage, it is cross useage drug that became found efffective for PCa...go figure.

Abiraterone acetate (also like keto use Prednisone with it they say), is in III trails, looks like it will make it here others in medical world are saying, in 2012 for useage. It is 10 times more potent than keto in effectiveness, not certain how the side effects compare, might be ok...I didn't read everything on this, yet. Just a quicky info.

It is just one of many possible choices in the arsenal, even short term effectiveness in dealing with hrpca can be worth looking at doing.
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35 normal, ct and bone scans appearing clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off for 1 yr., controlled so well, resumed, using intermittently, pleased with results

DanielleS
Regular Member


Date Joined Jul 2007
Total Posts : 57
   Posted 8/19/2010 3:00 PM (GMT -6)   
Please don't dismiss Ketoconazole - it has been effective for my husband for two years.  He was placed on low-dose Ketoconazole plus Hydrocortisone in July, 2008, when PSA began to rise on Lupron.  He later added Avodart to this combo.  PSA fell lower on this treatment than any prior.  He did recently see a PSA increase so has moved to high-dose Keto.  We are hoping to see a response, but if not, are very thankful for the past two years.  Side effects for him were very tolerable - mainly skin sensitivity.  (He was diagnosed in January, 2007 - PSA 174, Gleason 5+4). 
 
In my opinion it is very much worth a try before moving onto chemo or more radical treatments. 

zufus
Veteran Member


Date Joined Dec 2008
Total Posts : 3149
   Posted 8/19/2010 3:34 PM (GMT -6)   
I actually agree don't dismiss any decent duration on hormone or drug therapies and especially 1 or 2 years or more is considered excellent in hrpca. I posted on this drug a few weeks ago as a choice in 2nd line therapies. I think Abiraterone is going to give Keto real competition but that looks like 2012 they are talking about.

Do you have any plans towards a future drug protocol that you may be leaning towards?
What is the exact doseaged of each you are doing on HDK??
Dx-2002 total urinary blockage, bPsa 46.6 12/12 biopsies all loaded 75-95% vol.; Gleasons scores 7,8,9's (2-sets), gland size 35 normal, ct and bone scans appearing clear- ADT3 5 months prior to radiations neutron/photon 2-machines, cont'd. ADT3, quit after 2 yrs. switched to DES 1-mg, off for 1 yr., controlled so well, resumed, using intermittently, pleased with results

Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/19/2010 4:20 PM (GMT -6)   
Hi Dannielle,
I certainly don't mean to dismiss Keto at all. There can be varying responses to it. Some don't respond to it and some get years out of it like your husband. It is not a permanent fix, but it can be an important stepping stone for those that need it. It is just one of a series of second line hormonal therapy drugs that can push back on this disease. It can be discontinued for another protocol and reintroduced with renewed effectiveness in combination with other drugs in some cases, too.

So absolutely not, Keto should not be dismissed. but an understanding of it can help set expectations and keep the eyes focussed on various additional steps ahead.

Tony
Disease:
Advanced Prostate Cancer at age 44 (I am 48 now)
pT3b,N0,Mx (original PSA was 19.8) EPE, PM, SVI. Gleason 4+3=7

Treatments:
RALP ~ 2/17/2007 at the City of Hope near Los Angeles.
Adjuvant Radiation Therapy ~ IMRT Completed 8/07
Adjuvant Hormone Therapy ~ 28 months on Casodex and Lupron.

Status:
"I beat up this disease and took its lunch money! I am in remission."
I am currently not being treated, but I do have regular oncology visits.
I am the president of an UsTOO chapter in Las Vegas

Blog : www.caringbridge.org/visit/tonycrispino

JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 8/19/2010 7:07 PM (GMT -6)   
The usefulness of Keto is intensified because its cost is low (I imagine most insurers would consider it as "experimental"). I do believe that when one goes hormone resistant, one should consider all possibilities. With Arbireterone on the horizon, another quality alternative emerges. With some luck, one may be able to sustain life for several/many years after going hormone resistant...at least that would be the objective. Unfortunetly WE must be aware of all of these because there seem to still be many oncologists who want to directly go to chemo. In those cases, it is up to us to say...hey wait a minute!
Age -57; Diagnosed 10/05 PSA 13.4 GS 7 (4+3) Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09)
Doubled to 1.5 (2/10) YUCH!
Hoping to qualify for salvage cryo or radiation

DanielleS
Regular Member


Date Joined Jul 2007
Total Posts : 57
   Posted 8/19/2010 7:43 PM (GMT -6)   
My husband's onco. is also very positive about Abiraterone. Although prior Keto use was a disqualifier from many of the trials, if (hopefully when) Abiraterone is approved, she feels my husband will be a good candidate. We also have an appointment next month at the Masonic Cancer Clinic, U of Minnesota, to discuss Provenge. We will certainly be considering Taxotere if the PSA continues a steady rise.

My husband is basically asymptomatic and generally feels well. He has no mets visible yet on CT or bone scan.

His low-dose Ketoconazole consisted of 200 mg 3xday. After seeing the recent PSA rise, he recently began 400 mg 3xday.

Thanks everyone here for your support and sharing of knowledge.
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