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Old 07-16-2009, 09:18 PM   #1
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Triple Hormone Therapy Research

I need to start planning ahead for my next quarterly check-up (in August), and could sure use any suggestions you might have. Here’s the basic situation: I was diagnosed in November of 2007 (T3bN1M0) and put immediately on Zoladex. (In March of 2008, I also underwent radiation therapy for eight weeks.) At the end of one year of hormone therapy, my PSA had dropped from an initial 66.04 to .54 … a nice drop, but my doctor says that it should have gone below .05. He wasn’t too thrilled by my response to the Zoladex, so decided to take me off for a bit to see if he could figure out what was going on.

I’ve been off hormones for over seven months (since December of 2008), and my PSA continues to drop – now standing at .26. The doctor thinks it’s because the radiation therapy did a good job of cleaning things out. We’re awfully pleased with the news, but I want to plan ahead a little to what we should do if/when the PSA starts to rise again. (Chances are pretty good according to some of those tables that predict recurrence.) My concern is that if I didn’t respond well the last go-around with Zoladex alone, it wouldn’t be too bright to go with it alone again. So during my last check-up, I tried to feel out what my doctor thinks of triple hormone therapy. (I showed him Dr. Charles Myers’ book, and gave him the basics as I understand it.) Let’s just say he was pretty resistant to the whole idea. Said that if our goal was to get my PSA down all the way, he could give me DES. I figured that was enough seed-planting for the day, so backed off. But with my upcoming check up, I feel I need to be better prepared to plant some heftier seeds. So here – finally – is my question: Do any of you know of any reports, research papers, or books from other well-respected sources that make a case for triple-hormone therapy? (Something I can actually leave with my doctor that might help open him up to the idea.)

I know it might seem easier to find a doctor who’s already on board with triple-hormone therapy, but things aren’t quite so simple here in Taiwan with regards to PCa treatment. (My doctor is considered one of the top two PCa doctors here – and the other one isn’t seeing new patients. As I understand it, things fall off quite a bit after that.)

Thanks for any suggestions you might have! I sure appreciate it!

Gregg

 
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Old 07-17-2009, 01:20 PM   #2
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Re: Triple Hormone Therapy Research

Hi Gregg

There is a lot of good information on this website
* link to commercial website removed by hb-mod, moderator *

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Old 07-17-2009, 03:53 PM   #3
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Re: Triple Hormone Therapy Research

Hi Greg,

Congratulations on that recent decrease in PSA! I'll insert some comments in green regarding your other comments.


Quote:
Originally Posted by greggeva View Post
I need to start planning ahead for my next quarterly check-up (in August), and could sure use any suggestions you might have. Here’s the basic situation: I was diagnosed in November of 2007 (T3bN1M0) and put immediately on Zoladex. (In March of 2008, I also underwent radiation therapy for eight weeks.) At the end of one year of hormone therapy, my PSA had dropped from an initial 66.04 to .54 … a nice drop, but my doctor says that it should have gone below .05. He wasn’t too thrilled by my response to the Zoladex, so decided to take me off for a bit to see if he could figure out what was going on.

I’ve been off hormones for over seven months (since December of 2008)

[must be 2009, right]
, and my PSA continues to drop – now standing at .26. The doctor thinks it’s because the radiation therapy did a good job of cleaning things out.

That looks right to me as a savvy layman but with no enrolled medical education.

We’re awfully pleased with the news, but I want to plan ahead a little to what we should do if/when the PSA starts to rise again. (Chances are pretty good according to some of those tables that predict recurrence.) My concern is that if I didn’t respond well the last go-around with Zoladex alone, it wouldn’t be too bright to go with it alone again.

That's my impression too - that Zoladex probably cannot do enough of the job on its own in your particular case. It does get the PSA below 0.05 for some men apparently, but also apparently not for others. I don't know the odds off hand.

So during my last check-up, I tried to feel out what my doctor thinks of triple hormone therapy. (I showed him Dr. Charles Myers’ book, and gave him the basics as I understand it.) Let’s just say he was pretty resistant to the whole idea.

Triple blockade even throws many doctors off in this country, mainly because of the third element, either finasteride (formerly Proscar) or Avodart (both in the 5-alpha reductase inhibitor (5-ARI)class). However, there is an abundance of research on what is known as "combined hormonal blockade," or "combined androgen deprivation therapy," or similar names, and that two-drug combination is fairly widely accepted in this country, and my impression is that that is true internationally as well. That second drug, the 5-ARI, mainly blocks the docking of the testosterone and DHT (derived from testosterone) to the cancer cell. It is especially useful in men for whom the adrenal glands step up indirect production of testosterone when the body senses a shortage. For those men, using one drug alone, such as Zoladex or Lupron (the LHRH-agonist class), just is not enough. The Japanese recently did a very nice paper on the various forms of hormonal blockade as used at many institutions in Japan. It showed rather dramatically that combined blockade was superior to single-drug blockade or surgical castration alone.

Here's the citation for the study. Current status of endocrine therapy for prostate cancer in Japan analysis of primary androgen deprivation therapy on the basis of data collected by J-CaP.

Hinotsu S, Akaza H, Usami M, Ogawa O, Kagawa S, Kitamura T, Tsukamoto T, Naito S, Namiki M, Hirao Y, Murai M, Yamanaka H; Japan Study Group of Prostate Cancer (J-CaP). Jpn J Clin Oncol. 2007 Oct;37(10):775-81. Epub 2007 Oct 26.

You can search in www.pubmed.gov and find the abstract. While you can't learn much from just the abstract, PubMed also provides a link to a free copy of the entire paper. It's interesting. The rather large number of men getting each variety of hormonal therapy also adds to the credibility of the study for me. Unfortunately, they did not have a triple therapy group.


Said that if our goal was to get my PSA down all the way, he could give me DES.

That suggestion alarms me as a now-savvy layman. DES was used heavily in the US, and it is not much used any more because of cardiovascular risk and better alternatives. On the other hand, "transdermal estrogen," in other words, estradiol delivered by skin patches, has a good safety record (in comparison to estrogen by mouth, which is what DES is). However, it is an emerging approach with much less evidence behind it than is behind combined hormonal blockade.

I figured that was enough seed-planting for the day, so backed off. But with my upcoming check up, I feel I need to be better prepared to plant some heftier seeds. So here – finally – is my question: Do any of you know of any reports, research papers, or books from other well-respected sources that make a case for triple-hormone therapy? (Something I can actually leave with my doctor that might help open him up to the idea.)

Dr. Strum's book "A Primer on Prostate Cancer - The Empowered Patient's Guide," Strum & Pogliano, has an outstanding long section on hormonal therapy that features triple blockade, but it is essentially based on the experience in his former practice with Dr. Scholz, and it has not gone through peer-review in a major medical publication. On the other hand, Dr. Strum still collaborates with Dr. Scholz and his new partner Dr. Lam, and that group, with their colleagues, has had their work published in an impressive peer -reviewed journal.

Try this PubMed search (without the quotation marks): " scholz m [au] AND strum sb [au] AND prostate cancer ".

You will get several hits, including this key paper. While the phrasing is awkward, this study lines up two-drug versus three-drug blockade (using finasteride) in their practice.

Intermittent use of testosterone inactivating pharmaceuticals using finasteride prolongs the time off period. Scholz MC, Jennrich RI, Strum SB, Johnson HJ, Guess BW, Lam RY. J Urol. 2006 May;175(5):1673-8.

The abstract, which you can read by clicking on the hypertext authors list, is interesting and informative, but there is a lot of additional valuable detail in the full paper. Perhaps you can get public access to a medical library that carries the journal.

Unfortunately, not a lot has been published recently about triple blockade. I think that will change, but you need a good crystal ball to tell when. I know that Dr. Robert Leibowitz of the Compassionate Oncology practice in the Los Angeles area and colleagues are trying to have their work published, but I'm not sure whether they have submitted their paper yet, and of course it is hard to say whether it will be accepted by a major, peer-reviewed journal. Dr. Leibowitz and his then partner Dr. Tucker did publish research as follows: Treatment of localized prostate cancer with intermittent triple androgen blockade: preliminary results in 110 consecutive patients.
Leibowitz RL, Tucker SJ. Oncologist. 2001;6(2):177-82. If you find this with a PubMed search, you will be offered free access to the entire paper. This paper was highly encouraging to me when it was published, but the results were fairly preliminary, and Oncologist is not a major journal from what I've heard. Dr. Leibowitz has published many articles informally, many appearing in the free newsletter Cancer Communication published by PAACT (Patient Advocates for Advanced Cancer Treatments), an organiztion that is focused just on prostate cancer despite its name.


I also believe the Strum-Scholz-Lam and colleagues group will be publishing additional information sometime in the future.

I believe there is at least one study of triple blockade, a clinical trial as I recall, to be launched somewhere, but that does not help now.

There are also other studies, some major studies, that focus just on finasteride, proving its effectiveness against prostate cancer, though it is certainly not a heavy hitter against the disease. Still, in the role of giving the coup-de-gras after drugs like Zoladex and Casodex, it appears quite useful. Try searching www.pubmed.gov for " prostate cancer AND finasteride AND thompson i [au] " to get some of the papers.


I know it might seem easier to find a doctor who’s already on board with triple-hormone therapy, but things aren’t quite so simple here in Taiwan with regards to PCa treatment. (My doctor is considered one of the top two PCa doctors here – and the other one isn’t seeing new patients. As I understand it, things fall off quite a bit after that.)

Thanks for any suggestions you might have! I sure appreciate it!

Gregg
Congratulations again on your success with radiation. Here's hoping you won't need this information about hormonal therapy.

Jim

 
Old 07-19-2009, 08:33 PM   #4
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Re: Triple Hormone Therapy Research

Hi Jim,

Thanks for coming through again! It's exactly what I was looking for. I so appreciate your taking the time and effort to help out guys like me walk through these things.

Tons of blessings!

Gregg

 
Old 07-23-2009, 08:33 AM   #5
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Re: Triple Hormone Therapy Research

I thought I would share a bit on my path to triple blockade.

I ran into similar resistance where I live and was limited to one oncologist locally who was not open to much in the way of outside input.. During my first 4 !/2 years I underwent a radical prostatectomy, salvage radiation and hormone therapy. My lowest PSA was .1. I went off hormone therapy for a year and my doubling rate was 3-4 months not entirely unexpected given a 4+5 Gleason. However I felt I needed a change.

I was fortunate to have a primary physician who agreed to work with an off island oncologist. Initially I went back to UCLA where I had the radical and radiation but was turned off by the greeting I received. basically when i wanted to talk about options I was told "You do understand you are terminal. there is nothing more we can do at this point except put you back on hormone therapy.

At the beginning of this year 7 months after going back on hormone therapy Lupron followed by the addition of casodex my PSA finally broke .1 and dropped to .8.

I also started on this board in February 2009 and was introduced to some new concepts including triple blockade. After doing my own due diligence I thought this might be an option for me.

I visited Dr Myers whose book and work I first found referenced on this site. I don’t think my local primary was thrilled by my choice because he did not know anything about Dr Myers and the protocol is not accepted by many. Still he agreed to work with him which was the main thing. After all it is my life and I should have input on the treatment plan

Dr Myers put me on triple blockade. In addition I have adopted his recommended supplement regime and diet. He also added transdermal estrogen with logic along the lines described by Jim. He suggested we monitor with monthly ultra sensitive PSA tests, testosterone, dihydrotestosterone, and vitamin D levels.

I am now awaiting the results of my July blood test but my June blood test showed a still dropping PSA then at .03. I had been told by my other Drs that my PSA would not get down to this level, in fact they were more than pleased that it went down to .1 and I should be satisfied at .08.

Of course I am anxiously awaiting the last results to see if they drop down again, Dr Myers believes there is a good chance they can get to .01. Just given the drop I have experienced in the last few months has given me a very good feeling.

I guess you could say I am now a believer in triple blockade and although I could wish to have started it sooner we must as Dr Myers says in his book, play the ball where it lies. So for now I will continue along this path and leave the results in God’s hands.

If you think triple blockade is could be a solution for you I would encourage you to continue trying to educate your Dr about its benefits.

 
Old 08-19-2009, 01:11 AM   #6
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Re: Triple Hormone Therapy Research

Well, I just returned from a very discouraging doctor’s appointment. My PSA rose from .26 on June 3 to .77 today (August 19), and my doctor said he’ll start me again on hormonal therapy in three months regardless of what my next PSA reading is. During my last visit, he said my .26 reading – a drop from the previous visit – was the result of successful radiation treatment. (I’d been off a year-long stint of hormonal therapy for six months at that time.) Today, he said that my last reading of .26 was still under the influence of the hormonal therapy and that the present PSA rise just reflected a move to the post-radiation nadir. No need to worry. (Except I don’t know which version of his take on things to believe.)

After the doctor told me of his decision to start me again on hormonal therapy in three months, I asked him what he thought of the recent Japanese study on combined androgen blockade. He was not a happy man. Lectured me on how worthless the study was, and how worthless the whole idea of CAB was. (According to him, western doctors had “closed the book” on this whole idea 10-20 years ago, and he refused to even think about it.) I tried to ask him a couple more questions, but he was only in the mood for lecturing. (Needless to say, I’m looking for a new doctor here in Taiwan.)

Gotta say, the whole thing was frustrating and discouraging. And confusing. I don’t have a clue what to make of my PSA rise. Any thoughts? I’d also appreciate any ideas about how to approach my search for a new doctor. I really don’t want to go through this kind of thing again.

Thanks for letting me vent a bit … and for any suggestions you might have.

Gregg

 
Old 08-19-2009, 04:56 PM   #7
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Re: Triple Hormone Therapy Research

Quote:
Originally Posted by greggeva View Post
Well, I just returned from a very discouraging doctor’s appointment. ...After the doctor told me of his decision to start me again on hormonal therapy in three months, I asked him what he thought of the recent Japanese study on combined androgen blockade. He was not a happy man. Lectured me on how worthless the study was, and how worthless the whole idea of CAB was. (According to him, western doctors had “closed the book” on this whole idea 10-20 years ago, and he refused to even think about it.) I tried to ask him a couple more questions, but he was only in the mood for lecturing. (Needless to say, I’m looking for a new doctor here in Taiwan.)

...
Thanks for letting me vent a bit … and for any suggestions you might have.

Gregg
Hi Gregg,

I'll get back to this post of yours again later, but here's a quick thought, though it would involve coming to Los Angeles, and it certainly is a great distance from Taiwan to Los Angeles.

I'm sorry you had that rough experience with your former doctor. His comments are way off the mark.

Several of the leading experts in triple therapy will be presenting and answering questions at the Prostate Cancer Conference 2009, which is primarily for patients but presented by leading experts, at the Marriott Los Angeles Airport Hotel on September 12-13. (At least Dr. Mark Scholz, Dr. Stephen Strum, Dr. Charles Myers, and Dr. Lam will be there - all experts in triple blockade.) The main sponsor is the Prostate Cancer Research Institute, PCRI, a non-profit organization; they have all the details. Registration through September 10th costs $85, but you can also pay $100 at the door to register. A very special hotel rate of $89 per night is valid through August 21, two days from now, if you mention group code PROPROA. American Airlines is offering a 5% discount on AA flights to and from Los Angeles, with Discount Code 5499AH.

I've been to four of these conferences and have benefited greatly. If you cannot make the conference, PCRI will probably have DVDs of the conference available as they have had in the past.

Unfortunately, this will not help you find a cooperative doctor.

Dr. Steven or Stephen Tucker, MD, was formerly the partner of Dr. Robert Leibowitz, one of the pioneers and leaders in triple blockade therapy, and Dr. Tucker recently spent time practicing in Indonesia, I think in Singapore. If you can contact him, he might know of doctors who would be willing to manage triple blockade therapy in Asia.

Take care,

Jim

 
Old 08-21-2009, 03:37 AM   #8
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Re: Triple Hormone Therapy Research

Thanks for the info, Jim. Doesn't look like I'll be able to get to L.A. for the Conference, but I hope to find some of the sessions online. I already stumbled on a few videos from the 2006 conference ... really enjoyed a talk by Dr. Lam on dealing with the side-effects of ADT. Good stuff!

I was able (I think) to track down Dr. Steven Tucker and send him an e-mail request for help as you suggested. Maybe that will turn up a name or two of doctors in Taiwan who are willing to treat PCa with combined or triple hormonal therapy. Hope so.

Thanks again, Jim. Sure appreciate your input.

Gregg

 
Old 08-21-2009, 04:08 PM   #9
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Re: Triple Hormone Therapy Research

Hi again Greg,

Here is one more thought on your second post back. And a brief comment on GUAMJOHN's post - great results! Jim

Quote:
Originally Posted by greggeva View Post
Well, I just returned from a very discouraging doctor’s appointment. My PSA rose from .26 on June 3 to .77 today (August 19).... During my last visit, he said my .26 reading – a drop from the previous visit – was the result of successful radiation treatment. (I’d been off a year-long stint of hormonal therapy for six months at that time.) Today, he said that my last reading of .26 was still under the influence of the hormonal therapy and that the present PSA rise just reflected a move to the post-radiation nadir. No need to worry. (Except I don’t know which version of his take on things to believe.)

It's still possible that the doctor is right about that move to a post RT nadir that is no longer being held down by the beneficial influence of HT, which you stopped last December. I think you are very wise to be looking toward a better form of hormonal therapy, but there's still a chance you may not need it.

...Gregg
Good luck on finding that new doctor and on your next PSA result.

Jim

 
Old 08-21-2009, 04:50 PM   #10
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Re: Triple Hormone Therapy Research

Hi GUAMJOHN,

CONGRATULATIONS on your terrific PSA success in getting to 0.03 and falling!!!

It's great to have another triple blockade buddy on the board!

Your post brought to mind a few thoughts and memories I thought you might like to see. I'll insert them in green below. Jim


Quote:
Originally Posted by GUAMJOHN View Post
...

I ran into similar resistance where I live and was limited to one oncologist locally who was not open to much in the way of outside input.. During my first 4 !/2 years I underwent a radical prostatectomy, salvage radiation and hormone therapy. My lowest PSA was .1. I went off hormone therapy for a year and my doubling rate was 3-4 months not entirely unexpected given a 4+5 Gleason. However I felt I needed a change.

I was fortunate to have a primary physician who agreed to work with an off island oncologist. Initially I went back to UCLA where I had the radical and radiation but was turned off by the greeting I received. basically when i wanted to talk about options I was told "You do understand you are terminal.

I know UCLA does some great prostate cancer research, and they are certainly well known for treatment, but your story is the second I've heard where they basically gave up on a patient with a challenging case who did much better under other care. I'm trying to figure what's going on there.

...
I visited Dr Myers whose book and work I first found referenced on this site. I don’t think my local primary was thrilled by my choice because he did not know anything about Dr Myers and the protocol is not accepted by many.

We really need some more research published on triple blockade results!

Still he agreed to work with him which was the main thing. After all it is my life and I should have input on the treatment plan

...

I am now awaiting the results of my July blood test but my June blood test showed a still dropping PSA then at .03. I had been told by my other Drs that my PSA would not get down to this level, in fact they were more than pleased that it went down to .1 and I should be satisfied at .08.

Of course I am anxiously awaiting the last results to see if they drop down again, Dr Myers believes there is a good chance they can get to .01. Just given the drop I have experienced in the last few months has given me a very good feeling.

I too am very optimistic in view of what your results have been.

I guess you could say I am now a believer in triple blockade

There is nothing like solid and soul gratifying results to make believers out of us!

and although I could wish to have started it sooner we must as Dr Myers says in his book, play the ball where it lies. So for now I will continue along this path and leave the results in God’s hands.

Great plan!

If you think triple blockade is could be a solution for you I would encourage you to continue trying to educate your Dr about its benefits.

Thanks very much for sharing your experience.

Take care and congrats again,

Jim

 
Old 08-25-2009, 06:22 AM   #11
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Re: Triple Hormone Therapy Research

Hi Jim,

Just thought you'd like to know that I heard back from Dr. Tucker today, and am already working on the possibility of flying over to Singapore for a consultation with him. (He's not real high on prostate cancer care here in Taiwan.) He sure seems like he knows what he's doing, and a pretty nice guy, to boot.

Thanks so much for the recommendation, Jim. I'll let you know how things turn out.

Bless you,

Gregg

 
Old 09-23-2009, 02:40 AM   #12
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Re: Triple Hormone Therapy Research

Just a quick update ... I went to Singapore last week for a consultation with Dr. Tucker, and everything went great! In two days, he spent more time with me (2 1/2 hours) than my previous doctor did in almost two years. He was positive, personable, very encouraging, and mapped out a good plan for my future treatment. Such a relief to be in good hands.

Thanks so much for your story, GuamJohn ... and Jim, for your recommendation of Dr. Tucker. What a godsend!

Blessings!

Gregg

 
Old 09-28-2009, 04:16 PM   #13
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Re: Triple Hormone Therapy Research

Hi Gregg,

I'm so glad to hear that your consultation with Dr. Tucker went well! It's also good to learn that he has a good manner in working with patients.

Please keep us updated on how you are doing.

Take care,

Jim

 
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