Hi Board participants, and especially Rhonda,
I'm responding to your post #5 at 06-07-2012, 01:46 PM under the topic "Intermittent hormone therapy inferior to continuous therapy ?" (started by Baptista) in which you asked about Celebrex for prostate cancer and experiences with it. I thought Celebrex deserved its own thread, so here goes. Background.
For years now, probably the better part of a decade, some medical oncologists who have large practices dedicated to prostate cancer patients have been impressed with favorable prostate cancer responses to Celebrex, an NSAID drug known for its anti-inflammatory effects and especially for its role in combating arthritis discomfort. They have emphasized effectiveness when the drug is used at a dose of 200 mg twice daily, a large total dose. The range of response varies. While some patients get little benefit, others have substantial responses. Concerns about side effects.
On the other hand, there has been a well-publicized concern about side-effect dangers from this class of drugs, the COX-II inhibitors. In fact, two other drugs in this class, Vioxx and Bextra, were withdrawn a number of years ago because studies indicated too great a risk with these two specific drugs.
There was concern about Celebrex because it was in the same class, but good evidence indicated a much lower risk.
Even so, my medical insurer withdrew coverage of the drug, which I had been taking at the time for prostate cancer, and I dropped the drug. That made my oncologist more comfortable as he had become less and less enthusiastic about this class of drugs as evidence of risk accumulated.
However, as I understand it, later research on Celebrex indicated the risk was mainly for patients who had cardiovascular health problems and not for patients who did not have such problems, or at least the risk was much lower. This past fall of 2011 my PSA was beginning to rise again during a period when I was (am) using low-dose thalidomide to extend my off-therapy vacation period, and my oncologist had again become comfortable with the safety of Celebrex for patients with good cardiovascular profiles like me. My insurer (the same one) had also regained comfort and was again willing to cover the drug for me. For months now I've been taking two 200 mg Celebrex pills a day. I now credit Celebrex with holding my PSA virtually steady since December 2011. Monitoring.
Monitoring is probably important in my oncologist's comfort level with my taking Celebrex. I have a Complete Metabolic Panel and a Complete Blood Count every two to four months, so any issues will be caught early. I'm not sure how important monitoring would be, or how often it would need to be done for other patients. Minor aches, pains and soreness.
I'm going to be 69 this month, and minor soreness is typical after workouts and intense physical chores. Normally after such activity I would be taking an Aleve in the evening to keep the soreness from interfering with sleep. (The low-dose thalidomide I'm now taking is an excellent sleeping aid, but it is not enough to keep soreness from interrupting my sleep.) However, I have no trouble sleeping at all when I take the Celebrex. Like the vigorous older lady in the Celebrex ads on TV, I'm enthusiastic about this drug! Masking pain.
I learned one lesson the hard way: Celebrex can mask pain that is a signal you are overdoing it. Years ago I was on a ladder sawing limbs off a tree. I kept at it so long that my shoulders would hardly function, and near the end I had to throw my upper body back and forth to move the saw. Well, I injured my shoulders, especially my left shoulder, which substantially reduced my range of motion and shoulder strength for a year. I'm nearly fully recovered now, but recovery was gruadual and has taken a number of years.
The lesson is that we need to be aware of overdoing physical activity when taking Celebrex. Effectiveness in controlling prostate cancer for me. My first cycle of Androgen Deprivation Therapy (ADT)
. I was not impressed with Celebrex when I first was on it back in 2003, though I overlooked some important favorable evidence of how I was doing. I started taking Celebrex on 4/13/2003 during the tenth month of my first vacation from Lupron and Casodex, while maintaining with Proscar (and lifestyle tactics throughout, as well as a bisphosphonate drug for bone density). My PSA had increased to .7 from < 0.01, and the dose of Celebrex was just 100 mg once a day. While that dose was lower than what some experts were recommending, my oncologist was concerned about the safety of a higher dose because of the publicized concerns about COX-II inhibitor drugs.
I did not see any decline or even stabilization in my PSA, as the next months saw it climb from .7 on 4/15/2003 to .80, to 1.1, to 1.3, to 1.6 etc. I overlooked the fact that my PSA doubling time (PSADT) went from a range of 1 - 3 months (partly due to regrowing healthy prostate cells as well as cancer cells) to 5.1 months for the first month after starting Celebrex, then above 3 months until October, when my PSA stabilized for a while before resuming a slow upward climb. I'm not sure how much of a role Celebrex played in that. In part, it could be that the rapid earlier growth was due mainly to regrowing healthy cells in my prostate (no prior surgery or radiation).
When my PSA hit 4.0, with my oncologist's support as I was tolerating it well, I increased the Celebrex dose to 200 mg twice a day (3/10/2004). Once again, there was a marked lengthening of my PSADT per the test a month later, with the PSADT going from 5.22 units per month for the previous PSA test to 10.59 units. Overall, my PSADT while on the higher dose was substantially longer than it had been previously. It took me from 4/12/2004 until 10/13/2004 to go from a PSA of 4.3 to a PSA of 8.44, with a confirming PSA of 8.99 on 10/13/2004.
However, when the PSA hit 11.15 on 11/1/2004, I started low-dose thalidomide (with 300 mg of vitamin B6 to guard against neuropathy and an 81 mg aspirin to help prevent blood clots). The thalidomide shortly reduced the PSA and held it more or less steady for a number of months. In essence, this combination of thalidomide and 2 X 200 mg of Celebrex during a vacation period is the program I am on now for my third vacation period.
My reduced PSA was roughly steady for a number of months, but on 2/27/2005 I stopped taking Celebrex because my medical insurance would no longer cover its cost (with my copay of course), and I was not as aware, as I should have been, that it actually was making a difference.
My PSA about a month before stopping was 8.9, and it resumed a steady climb, notching 9.60 a month later, followed by 10.46 for the following month. At that point I stopped thalidomide and resumed Casodex and Lupron (while staying on Proscar throughout). In hindsight, I believe I could have extended the vacation for months if I had continued taking Celebrex. Second cyle of ADT.
Due to the lack of insurance coverage and what I mistakenly considered sub-par results, I did not try to get a prescription for Celebrex during my second cycle of blockade or for the vacation period. I was on full therapy for 19 months and off for 21 months. Again, I'm now convinced I could have extended this vacation if I had taken two 200 mg Celebrex pills a day. Third cycle of ADT.
For this third cycle, I have been on vacation for 26 months (starting 4/15/10) following 19 months on full therapy (Lupron - "ran out" on 4/15/10; other vacation drugs included bicalutamide and finasteride, with a bisphosphonate again in support of bone density). My PSA slowly rose from a nadir of 0.02 to 9.76 on 6/22/2011, and I started low-dose thalidomide on 7/7/2011. Though my PSA seemed steady at about 8.4 in October, by 11/14/2011 it was at 11.70 (confirmed at 11.57 on 11/22/2011). As recommended by an expert and planned with my oncologist, I started Celebrex on 11/22/2011. My PSA soon fell, and has essentially steady at around 9.6 since the initial decline.
In short, I'm convinced that Celebrex is helping me keep prostate cancer under control. While it has worked for me, I believe it does not work for everyone, and it will be too risky for some of us.