Hi Bhavna,
I'm responding to your recent post.
It's so difficult when the approaches we use do not produce the results we need! (And vice versa, of course.) It's wise to get that second PSA check of course.
Here's another possibility, even if the second PSA confirms the first one, indicating an increase. While it is possible the Ketoconazole may no longer be working, it is also possible that it will work if administered in just the right way. I've heard two expert medical oncologists who make extensive use of it for prostate cancer patients both emphasize that it is vital that it be administered in a certain way. If it is taken a different way, apparently it will often be ineffective.
I am looking at the handout of key slides from a presentation by Dr. Mark Scholz on Ketoconazole at the National Conference on Prostate Cancer 2005 in Washington, DC. Here's the content of his slide: "Ketoconazole: Administration Guidelines":
- Acid pH in the stomach needed for absorption into the blood
-Take Ketoconazole with 1000 mg Vit C
-Aim to take Ketoconazole on empty stomach since food buffers the acid. - Antacids decrease absorption [of Ketoconazole]
-Avoid Zantac, Tagamet, Pepcid, Axid, Prilosec, Prevacid, Nexium, Protonix, Carafate.
As I understand it as a layman, the vitamin C is just to make the stomach acid and that other methods will work as well.
I've also heard that taking it every eight hours is important. In another slide, "Preventing Side Effects," Dr. Scholz mentions the eight hour schedule, and he advises starting with 1/2 the dose, then increasing it after seven days if there is no toxicity ("increase dose from 200mg every 8 hours to 400 mg every 8 hours"). Please bear in mind that this information was from 2005 in a handout, and sound professional medical advice in 2011 to a specific patient could be different. In the slide Dr. Scholz also advises that blood be monitored to ensure that Ketoconazole levels are above 1.0, with low levels for DHEA, Androstendione, and testosterone. He advises that liver tests be done monthly. He notes that stomach upset can be counteracted by eating food, but that in that situation blood levels are vital; I'm thinking that's because food can neutralize the needed acid environment, his concern in the earlier slide. He points out that hydrocortisone, 20 mg twice per day with food, is important while on Ketoconazole because the drug blocks normal production of necessary hydrocortisone. He recommends resistance training in a gym to maintain strength and muscle mass.
I believe Dr. Myers also presented on Ketoconazole, probably at the 2009 conference, but I cannot locate my file at the moment. I do remember him stating emphatically that Tylenol must not be taken with Ketoconazole. It also interacts with many other drugs; that interaction can be managed in most cases, apparently, but it needs active, competent attention.
I've heard more than one doctor express doubt that Ketoconazole was very effective, but I got the feeling these doctors just did not know that the drug had to be administered the right way (including monitoring and appropriate adjustment). It seems that many doctors do not know the ins and outs of Ketoconazole.
Dr. Eric Small of UCSF is the major researcher on Keto for prostate cancer, and he may have published about his own clinical experience with it. You would probably also find something useful published by the Prostate Cancer Research Institute, especially in its set of papers or in a back issue of its PCRI Insights newsletter.
As a final thought, is your dad still on a drug to hold down testosterone, like Lupron or Zoladex? That would be important, I think. Is he taking anything to prevent conversion of any remaining testosterone to DHT (finasteride or Avodart)?
Take care,
Jim
