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Old 06-01-2012, 10:44 AM   #1
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durable response

I have achieved a .005 psa after 7 months of triple blockade through Dr. Lam. Is there anyway to know how durable this response may be.

 
Old 06-01-2012, 01:13 PM   #2
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Re: durable response

That's a great response! Are the side effects manageable for you?

In men with PC that I have come into contact with, 2 of whom are treated by Scholz/Lam, there seem to be as many variations in response to hormone therapy as there are individuals. There are some interesting studies that attempt to mathematically model and predict response based on the individual's mix of cell types and their response to androgen deprivation. I think this will improve the scheduling of hormone therapy in the future.

How long do you plan to stay on the current cycle before you get a vacation? What did you set as the trigger PSA for ending that vacation and starting the next cycle?

- Allen

 
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Old 06-01-2012, 02:23 PM   #3
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Re: durable response

The SE have been mild. Of course I get hot flashes but they don't keep me from sleeping. I have gained about 15 lbs but I am now holding steady. My energy level is good. I do the elyptical 5 days a week for 1/2 hour and play golf 1 day a week always walking the course. Dr. Lam has me on a 1 year plan so I am looking forward to August and my hormone vacation. I certanily can't complain and wont being a gleason 9 and being a 38 month survivor.

FIGHT ON

 
Old 06-03-2012, 02:20 PM   #4
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Re: durable response

Hi rhome,

What an excellent response you have had to ADT3!

I have been following this practice's reports and comments for years, though not so closely recently. They found, as you may know, that achieving a PSA nadir of <0.05 was a strong indicator that the patient would have long-term success with triple blockade; in fact, their research results about that were published in a major journal. Your PSA has been documented at the triple digit level, and I'm not sure whether the Scholz/Lam team has learned whether such a low documented PSA has added significance. I have heard Dr. Myers say, at least a year or two after the published report - maybe several years later, that it is desirable to get the PSA lower than 0.01, which you have obviously done.

Therefore, while men have a variety of responses to ADT as Allen noted, you are on ADT3 managed by a practice with many patients on that approach, intermittently when possible, for long periods, rather than ADT1 or ADT2, often under continuous therapy. That alone narrows down the range of responses for you, putting you in a more favorable group. Moreover, you have succeeded in joining the group with strong responses rather than the group that usually does not do well on ADT3 alone (those who are not able to achieve that nadir of <0.05, the key finding in the published report). That means you have further narrowed down the likely range of responses to an even more favorable group. My impression is that staying on ADT3 for a year is superior to staying on for less than 9 months, though the research on that is likely still incomplete.

As you likely know, this practice has had many men stay on vacation for years after a year on blockade. One of their reports, long ago, documented a large proportion of IADT3 patients who were still on vacation at the 5 year point. My own experience, with a challenging case, is that I get somewhat more than a month off for every month on blockade, though that is with the help of low-dose thalidomide and some other supporting drugs, as well as lifestyle tactics. For instance, I was on ADT (mostly ADT3) for 31 months during my first cycle, and I was on vacation for 34 months. This third time I was on ADT3 for 19 months and my current vacation is nearly 26 months and continuing (with the aid of Avodart, Celebrex, Super-Bio Curcumin, resveratrol and other lifestyle tactics).

I'm curious whether Dr. Lam would be able to give you a range of likely success for your Gleason 9 case that has responded so well to ADT3. Have you asked?

Here's another success you have achieved: you are buying time for research to advance while you enjoy success on ADT3 with current technology. For instance, at some point drugs like abiraterone (Zytiga) will likely become available for those of us on ADT3 (rather than just for patients considered no longer responsive to ADT, etc.), and some combination involving the new drugs will probably give us even better results, hopefully at reasonable expense. (I just saw a report indicating a price of $5,500 per month for abiraterone. Ouch!)

Take care,

Jim

 
Old 06-04-2012, 07:52 AM   #5
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Smile Re: durable response

Jim,

Thank you for your response. That was the information I was looking for. If you know where I can see these reports please let me know. I will certainly ask Dr. Lam as I had planned to about prognosis after acheving <.05 psa.

Howard

 
Old 06-05-2012, 05:34 AM   #6
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Re: durable response

Hi Howard,

Here's the citation for the report about a PSA nadir >0.5 versus <0.5:

Urology. 2007 Sep;70(3):506-10.
Prostate-cancer-specific survival and clinical progression-free survival in men with prostate cancer treated intermittently with testosterone-inactivating pharmaceuticals.
Scholz M, Lam R, Strum S, Jennrich R, Johnson H, Trilling T.
PMID: 17905106

You can find the full abstract easily by going to www.pubmed.gov, a site we can use here because it is government sponsored, and searching for " scholz m [au] AND strum s [au] " (without the quotation marks). That will also pull up the other work published by key team members of this practice and associates. Just click on the blue hypertext to see the abstract (unless the citation information says there is no abstract).

Their report that was published in December 2011 is also very interesting. I have just seen the abstract but am looking forward to the full report. Here's the citation:

Clin Genitourin Cancer. 2011 Dec;9(2):89-94. Epub 2011 Oct 10.
Primary intermittent androgen deprivation as initial therapy for men with newly diagnosed prostate cancer.
Scholz MC, Lam RY, Strum SB, Labarba DJ, Becker LK, Chang P, Farhoumand N, Jennrich RI.
PMID: 21993252

Take care,

Jim

 
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Old 06-05-2012, 11:08 AM   #7
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Re: durable response

Jim

Thank you very much for the leg work and finding this for me it is well appreciated. Keep up the good fight with your on going battle. You ave been an inspiration to us all.


FIGHT ON

 
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