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Old 07-12-2010, 07:18 AM   #1
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Prostate cancaer hrpc

My Father aged 81 is being diagnosed for Prostate Cancer Multiple Metastasis on 25/06/08 His PSa is 398. Orchitomy is being performed emediately next day & followed by inj. HONVAN 4mg Daily for 10 days which is then converted to Honvan Tablet /day upto 10/07/08 when DVT in Right leg is Diansoed and treated with Haparin.Biclutamide was started after DVT i.e from 17/08/08.His PSA is 7.16 on 23/07/08
.83 0n 03/10/08
.43 on 02/03/08 Bicalutamide Stopped
.77 on 30/06/09
3.36 on 30/09/09 Bicalutamide Restarted
4.47 on 29/12/09 LUPRIDE Depot 11.5 Mg given on 08/01/10
6.16 on 08/02/10 Zoladronic Acid 4 Mg monthly started on 15/02/10
29.65 on 10/05/10
73.00 on 23/06/10 Bicalutamide Stopped
95.00 on 30/06/10 95
88.00 on 07/07/10
His Hemoglobin level is almost maitained at 11 & Cretnine is 1.26
Physical condition is Ok with increase in Pain in Left leg which restrict the agility but is doing her own things himself in Home.

The opinion of consulting Doctors veries from each other

First UROLOGIST - Is of Opnion for Palliative Radiation

ONCOLOGIST - He is against Radation due to Bone damage & other side
effect. He is Suggesting for Autologus Immune Therapy
(Dendvex- Delhi)
SeconD UROLOGIST - He is in Opinion for CHEMOTHERAPY. Whants to include in the running trial of DOCETAXEL +PREDNISONE & Along with it MICROBACTERIUM W in second wing.

As I oserved in most of the Posts from you experinced people for II Line Hormonal therapy etc or 150 Mg of Bicalutamide then Ketoconzole etc before Chemo

But our consulting Doctors have not in same line of action

SO I REQUEST YOU PRACTICALY EXPERINCED PEOPLE LIKE Respected JIM sir (IADTSince2000) to Pleace comment & SUGGEST WHAT I SHOULD DO NEXT to make my father a Bit more Comfortable against pain.

WAITING TO HERE QUICKLY FROM ALL THE KNOWLEDGEBLE EXPERINCECED FRIENDS FROM ALL OVER THE WORLD.
PKABRA

 
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Old 07-14-2010, 06:30 PM   #2
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Re: Prostate cancaer hrpc

Hello pkabra,

Welcome to the board! I hope we will be able to help you and your father. I am a survivor for the past 10 1/2 years of a challenging case of prostate cancer, treated with some of the drugs or drug classes used for your father. That gives me some knowledge to pass on, but please remember that I have had no enrolled medical education and cannot write with medical authority. I'll insert some comments in green, and I'll convert your dates to a form I can think with more readily.


Quote:
Originally Posted by pkabra View Post
My Father aged 81 is being diagnosed for Prostate Cancer Multiple Metastasis on 25/06/08 [June 25, 2008] His PSa is 398.

So about this time two years ago he was diagnosed with a challenging case of metastatic prostate cancer; this kind of diagnosis is like many in the US before the PSA test came into use and before screening became widespread.

Orchitomy is being performed emediately next day

I believe you mean, orchiectomy or orchidectomy; however, I see that Lurpon or your equivalent is being used below, which is confusing. Orchiectomy makes sense in an older man of 81 with a high PSA and bone metastases. It brings an abrupt plunge in testosterone, and that quickly knocks back the cancer. I'm assuming the orchiectomy was complete, meaning both sides, rather than partial. Partial would not make sense here.

& followed by inj. HONVAN 4mg Daily for 10 days which is then converted to Honvan Tablet /day upto 10/07/08 [July 10, 2008]

I'm not sure what HONVAN is equivalent to in the US.
when DVT in Right leg is Diansoed and treated with Haparin.

DVT, deep vein thrombosis, is fairly common for advanced prostate cancer patients, and "Heparin" would often be used in treatment in the US.

Biclutamide was started after DVT i.e from 17/08/08 [August 17, 2008].

Combining bicalutamide, the main drug in the "antiandrogen class", makes very good sense.

His PSA is 7.16 on 23/07/08 [July 23, 2008]

It looks like this PSA of 7.16 was before the bicalutamide was started on August 17, 2008. It shows a very nice and profound plunge in PSA in just a couple of weeks due to the orchiectomy.

.83 0n 03/10/08 [October 3, 2008]
.43 on 02/03/08 [March 2, 2008 I'm thinking you meant March 2, 2009, which fits the time sequence. Right?] Bicalutamide Stopped

This is a very nice continued drop in PSA due to one or more likely both of the operation plus bicalutamide. I guess the doctors stopped the drug, which is expensive even in the generic form, to see how your father would do on the basis of just the orchiectomy.

.77 on 30/06/09 [June 30, 2009]

I would not have stopped the bicalutamide based on my limited experience as a layman, but I'm very impressed that your father's PSA rose only a little from March of 2008 until June of 2009 - over a year, or at least three months if my correction to March 2009 is right!

3.36 on 30/09/09 [September 30, 2009] Bicalutamide Restarted

In view of the substantial increase in PSA, by September of last year, restarting bicalutamide made sense.

4.47 on 29/12/09 [December 29, 2009] LUPRIDE Depot 11.5 Mg given on 08/01/10 [January 8, 2010]

Giving Lupride (Lupron I assume) to a patient who has had a complete orchiectomy puzzles me as it is redundant. I've never heard of this being done. I don't understand that it would accomplish anything more for the patient, since no testosterone would have been produced from the testes due to the orchiectomy. Did the doctors explain this apparent issue? Based on the redundancy, I would not have expected any benefit to the patient.


6.16 on 08/02/10 [February 8, 2010] Zoladronic Acid 4 Mg monthly started on 15/02/10 [February 15, 2010]

I'm not sure why Zoladronic Acid (Zometa in the US) was not started earlier, but it's good that it was finally started. In the US, your father probably would have been given Zoladronic Acid near the time of the orchiectomy. This drug helps protect bone density, which tends to decrease after an orchiectomy or Lupron (or equivalent). Zoladronic acid also helps hold back, stabilize or reverse bone metastases. In the US it is often given every three weeks for wide spread bone mets, but frequent dosing like that creates a small but serious risk of jaw bone trouble ("ostenecrosis of the jaw"). There has been at least one thread about that on this board.


29.65 on 10/05/10 [May 10, 2010]
73.00 on 23/06/10 [June 23, 2010] Bicalutamide Stopped

It's hard for the doctor to know what to do when the PSA is increasing fast while the patient has no testicular testosterone and is on bicalutamide. It's possible that a higher dose of bicalutamide is needed; on the other hand, its possible the cancer has mutated so that the cancer is then able to use it as a fuel. Withdrawing the bicalutamide should result in a reduction in PSA, or at least a decrease in the rate of increase, if a mutation is involved, as I understand it.

95.00 on 30/06/10 [June 30, 2010]

There is no obvious reduction as of a week later on June 30, but perhaps it was too early.
95

88.00 on 07/07/10 [July 7, 2010]

There we see the decrease. It may only be 7 units of PSA, but, based on the trend, we would have expected the PSA to be a good bit above 95. Therefore, the real decrease from what otherwise would have been is almost surely substantially greater than 7. To me as a layman, that suggests that the cancer had mutated and had begun to use the bicalutamide as a fuel. Therefore, stopping the bicalutamide appears to have helped.



His Hemoglobin level is almost maitained at 11 & Cretnine is 1.26

That hemoglobin level is pretty low, and that could be the result of a lack of testosterone, which helps maintain red blood cells. Anemia, which is basically low hemoglobin as I understand it, is mentioned in the book "A Primer on Prostate Cancer - The Empowered Patient's Guide" as a potential side effect of orchiectomy or Lupron type drugs ("LHRH agonists"). Some expert doctors use drugs like Aranesp to counter the problem, but that is an approach I've just heard of; I'm in no position to evaluate it. I'm just providing this information as a lead to you.

I think the Cretnine is what is called creatine in the US. It's important, but I do not know much about it. I hope someone else may comment on it.


Physical condition is Ok with increase in Pain in Left leg which restrict the agility but is doing her own things himself in Home.

It's good that his physical condition is basically okay, but that pain in the leg could be DVT again. Has that been evaluated? DVT is potentially serious, as you probably already know.

The opinion of consulting Doctors veries from each other

First UROLOGIST - Is of Opnion for Palliative Radiation

The expert doctors I follow in the US would want to do something other than palliative radiation at this point.

ONCOLOGIST - He is against Radation due to Bone damage & other side
effect.

The expert doctors I follow would also be concerned about these things. Palliative bone radiation definitely has an important role to play at the right time, but it seems to me to be too early.

He is Suggesting for Autologus Immune Therapy
(Dendvex- Delhi)

I am not familiar with Dendvex. In the US, an autologus immune therapy known as Provenge has just been approved (April). Leukine is a roughly similar kind of immune system therapy but is not as targeted as Provenge. However, Provenge is extremely expensive and is hard to get at the moment.

SeconD UROLOGIST - He is in Opinion for CHEMOTHERAPY. Whants to include in the running trial of DOCETAXEL +PREDNISONE & Along with it

Many US oncologists would use that approach, but I think the experts I follow would instead use some milder approaches first. I believe they would try ketoconazole plus hydrocortisone as a substitute for the bicalutamide. That often works. I'm confident they would also want your father on one of the mild drugs finasteride or Avodart. If the keto did not work, they might switch to estrogen patches. Some of them also like to try the drug Lukeine.

MICROBACTERIUM W in second wing.

I'm not familiar with that.

As I oserved in most of the Posts from you experinced people for II Line Hormonal therapy etc or 150 Mg of Bicalutamide then Ketoconzole etc before Chemo

But our consulting Doctors have not in same line of action

Using ketoconazole is a bit tricky. It's not too difficult to do, but it needs to be done right or it does not work well. Keto also interacts with many drugs, which could be a problem in using it for your father.

SO I REQUEST YOU PRACTICALY EXPERINCED PEOPLE LIKE Respected JIM sir (IADTSince2000) to Pleace comment & SUGGEST WHAT I SHOULD DO NEXT to make my father a Bit more Comfortable against pain.

There are some good medications that can help with pain. However, the usual treatments themselves often reduce pain when they start working.

WAITING TO HERE QUICKLY FROM ALL THE KNOWLEDGEBLE EXPERINCECED FRIENDS FROM ALL OVER THE WORLD.
PKABRA

I wish you well, and I hope you get helpful responses. Please follow up if you have questions.

Take care,

Jim


 
Old 07-18-2010, 11:07 AM   #3
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Location: New Delhi, India
Posts: 12
binu HB User
Re: Prostate cancaer hrpc

Dear pkabra,

Thanks, for writing.
I am simply looking after my father who is suffering from prostate cancer. Therefore, most of the technical term you have specified in your post is beyond my level of understanding to interpret. Although, I also wrote similarly, so that other knowledgeable people understand it, and provide me help.

However, what I am writing here is my own experience with respect to prostate cancer of someone near and dear, who is leading a good and decent life with no regret of cancer.

Firstly, treatment of prostate cancer varies from place to place and doctor to doctor. In your case, I strongly feel, it is beyond the level of treatment by Urologist. This is the time; kindly find a suitable Oncologist for a suitable treatment.

The opinion provided by one Oncologist for Chemotherapy with DOCETAXEL +PREDNISONE is the same treatment, which was provided to my father. DOCETAXEL is considered one of the best Chemotherapy medicine (You will find enough research papers in Internet to support my saying).

In my father’s case the above combination helped the prostate to remain within limits. But sooner the chemotherapy was stopped; the prostate started enlarging within no time. He had to undergo chemotherapy time and again thrice. Subsequent Chemotherapy is called as ‘Salvage Chemotherapy”. So far, he has undergone 46 times Chemotherapy.

Thalidomide (Thalix) is a good medicine to keep the PSA level under control after it is brought down by chemotherapy. It worked perfectly fine with one patient from Saharanpur (Uttar Pradesh). But it failed in my father’s case. Infact, Casodex had earlier failed to keep the PSA under control after Orchiectomy. Ravlimid is considered to be a better substitute of Thalidomide.

After 46 Chemotherapy, my father’s body no longer tolerates DOCETAXEL +PREDNISONE. Somehow, he’s body has started tolerating oral Chemotherapy (ITOSID). Similarly, for bone thickening instead of Zoladronic Acid 4 Mg monthly, the substitute oral medicine is IDROFOS 50 mg daily one tablet.

Apart from this, a good and conducive environment at home and having him to feel that he is very important to everyone at home is a medicine which cannot be prescribed by any doctor. Secondly, at the age of above 80, a person starts behaving like a child. Therefore, you need to inculcate to ‘continue to respect him and simultaneously provide facilities as is proved to a teenage child’.

Good diet helps tremendously to improve the HB and platelet count during Chemotherapy. I should be able to provide advice on Indian diet.

Kindly feel free to write again. With good wishes.
binu

 
Old 07-28-2010, 07:47 AM   #4
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Posts: 2
pkabra HB User
Re: Prostate cancaer hrpc

Quote:
Originally Posted by IADT3since2000 View Post
Hello pkabra,

Welcome to the board! I hope we will be able to help you and your father. I am a survivor for the past 10 1/2 years of a challenging case of prostate cancer, treated with some of the drugs or drug classes used for your father. That gives me some knowledge to pass on, but please remember that I have had no enrolled medical education and cannot write with medical authority. I'll insert some comments in green, and I'll convert your dates to a form I can think with more readily.
Hello JIM Sir,
I am really very sorry for Delayed response,
I am trying to clearify douts raised by you in Bold Black fonts.

I believe you mean, orchiectomy or orchidectomy; however, I see that Lurpon or your equivalent is being used below, which is confusing. Orchiectomy makes sense in an older man of 81 with a high PSA and bone metastases. It brings an abrupt plunge in testosterone, and that quickly knocks back the cancer. I'm assuming the orchiectomy was complete, meaning both sides, rather than partial. Partial would not make sense here.

I meant orchidectomy & it is complete.

& followed by inj. HONVAN 4mg Daily for 10 days which is then converted to Honvan Tablet /day upto 10/07/08 [July 10, 2008]

I'm not sure what HONVAN is equivalent to in the US.

HONVAN IS FOSFESTROL equivalent to DES
.
.83 0n 03/10/08 [October 3, 2008]
.43 on 02/03/08 [March 2, 2008 I'm thinking you meant March 2, 2009, which fits the time sequence. Right?] Bicalutamide Stopped

Yes it is March 2, 2008

Giving Lupride (Lupron I assume) to a patient who has had a complete orchiectomy puzzles me as it is redundant. I've never heard of this being done. I don't understand that it would accomplish anything more for the patient, since no testosterone would have been produced from the testes due to the orchiectomy. Did the doctors explain this apparent issue? Based on the redundancy, I would not have expected any benefit to the patient.

JUST a try for controlling remaining Testosterone of body.



It's good that his physical condition is basically okay, but that pain in the leg could be DVT again. Has that been evaluated? DVT is potentially serious, as you probably already know.

Previous DVT is mainly in Right Leg which is being cleared previously. Pain is in Left leg.
The opinion of consulting Doctors veries from each other

He is Suggesting for Autologus Immune Therapy
(Dendvex- Delhi)

I am not familiar with Dendvex. In the US, an autologus immune therapy known as Provenge has just been approved (April). Leukine is a roughly similar kind of immune system therapy but is not as targeted as Provenge. However, Provenge is extremely expensive and is hard to get at the moment.

It is DENDRATIC CELL THERAPY. Site address is dendriticcellresearch.com you may have better idea by visiting the site & What exactly it is.?

Now I want to give details of current development

Given DOCETAXOL + Prednisol on July 27, 2010 Tolrated well so far
Goning to Binu’s Post has given we a lot of confidence for above as his father has taken more then 46 cycles.
His current PSA after my previous post is
151 July 27, 2010 (Before Docetaxol)
Jim sir , What are other things that we should be keep watching and keep monitoring – Please guide

Thanks.& wating to here from you
PKK

 
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