My father was recently diagnosed with advanced stage prostate cancer (Gleason Score 8-9) and PSA of 340. He has bone mets in his shoulders, ribs, hips, and spine. He has a compressed vertebrae in his spine, and is in a lot of pain. The doctor recently prescribed him Firmagon, Zometa, and Percocet (for pain), and prednisone (for the inflammation about the compressed vertebrae).
My father has a few questions for you:
1) How long does it take once starting the treatment for there to be a relief in bone pain? (or in general, for symptoms to start improving?)
2) Which is better--Zometa vs. Xgeva, and why?
My questions for you:
My father, in desperation to feel better, has become intrigued by the Hippocrates Health Institute, a natural healing place off of Palm Beach, FL. I should make it clear that my father is committed to conventional treatments, but would like to pursue this place as a form of complementary medicine.
I am not a particular fan of this place, but was wondering if anyone else had any experience with it? It seems very expensive, and I have not found any research that supports the idea that a raw vegan diet is more beneficial than just all around eating healthy.
Anyway, any support you can give me I would greatly appreciate.
Thank you so much for allowing me to post on here--it means a lot.
Last edited by Administrator; 06-02-2012 at 02:57 AM.
I'm sorry to hear about the pain your father is going through. It sounds like his oncologist is giving him some of the best drugs currently available. Sometimes they give radiation to the known bone mets for instant relief. Firmagon is the fastest hormone therapy available. It should bring his testosterone down to castrate levels within a few days and his metastases will shrink soon thereafter.
Zometa and Xgeva are pretty similar in their effects and side effects. Xgeva demonstrated a longer time to the first skeletal event, but your father is past that, and many researchers think that it may not worth the extra cost. Osteonecrosis of the jaw is a rare side effect of both and should be watched for, especially if there was recent dental work. Here's an abstract that discusses the difference: http://www.ncbi.nlm.nih.gov/pubmed/21343556
There are also a few new drugs that may be of interest to your father in the future. Many new drugs receive approval first for those who have failed chemo and hormone therapy, and are tested later for earlier stage metastatic disease and non-metastatic disease. Alpharadin, which seems to work wonders on bone mets ; and Enzalutamide (formerly MDV 3100) which seems to outperform Zytiga (abiraterone) and may extend the time during which the cancer stays hormone responsive. Both of these new drugs are on fast track for full FDA approval for metastatic castrate-resistant prostate cancer (mCRPC), which is expected this year. Once a drug is FDA approved, it can be prescribed off-label even for earlier stages of cancer development, although insurance may not cover it then. Zytiga is already approved for mCRPC.
Have you talked to your father's oncologist about one of the two approved vaccines/immune boosters, Yervoy or Provenge? Provenge is so far only approved for mCRPC, and Yervoy has been approved for melanoma but not yet for prostate cancer (it's in clinical trials). There's another one ProstVac-VF that is doing very well so far in clinical trials.
Also worth noting is a Phase III trial of Cabozantanib. I saw some of the early results that were astounding -- bone mets completely cleared in some men in just 6-12 weeks:
It is possible that chemo like Taxotere or Jevtana may be beneficial at an earlier stage, especially as part of cocktail with an anti-angiogenesis drug (like Tasquinimod) and a tyrosine-kinase inhibitor (like Cabozantanib) when they get FDA approval.
I was gratified to see the positive results of so many clinical trials presented at this year's ASCO (American Society of Clinical Oncologists) meeting. I think we will have a whole new arsenal of drugs against metastatic PC in the next couple of years.
I agree with you that in general diets that are heart-healthy are also prostate-healthy. There have been many dietary interventions that have been looked at for possibly preventing PC, but few have proven benefit in curing or slowing down PC. With that caveat, there are two drugs that look good in trials among men with advanced disease - statins (low dose) and Celebrex. Also, pomegranate juice seems to slow down PSA doubling time, and I suspect that many highly-colored fruits (blackberries, cranberries, black grapes, etc.) would have a similar effect if tested. Raw broccoli may have some benefit - the active ingredient, sulforaphane requires an enzyme in raw but not cooked broccoli, to be absorbed. Other supplements that may be beneficial are curcumin, soy isoflavones, omega-3s. I'm sure he is already taking calcium and Vitamin D with his bone medicine. Vitamin supplements, especially those with Vitamin E and folates may be harmful. Caloric restriction seems to slow down many cancers, but I haven't seen anything on PC specifically. Dairy and animal meats are probably not the best sources of protein. I think that if your father regains a sense of control by undertaking a dietary intervention, the psychological boost alone may make it worthwhile.
Last edited by Administrator; 06-02-2012 at 02:57 AM.
Thank you so much for your kind response. Noone has mentioned radiation for the bone mets. Do you think that radiation (I assume you mean the external beam radiation) would be helpful? Do you think that it is something that we should ask for?
Thank you for your information regarding XGeva and Zometa. I think my father is going to use Zometa because his office has offered for him to join a clinical trial that would allow him to get it for $25dollars a month, which is very reasonable. Unless there is a determining health benefit to XGeva considering my father's late stage (i.e. has already had the first skeletal fracture), then I think he will just stick with Zometa.
In terms of newer treatments, I remember seeing Cabozantinib in the New York Times and you are right, the results are astounding. Where would we go to get some of these drugs if my father wanted to try them prior to chemo? (He is adamant about not having chemo.) Is that a bad thing to ask a doctor..., "will you prescribe this for off-label use?" Also, I would imagine that these drugs would be very expensive if insurance didn't pay for them, and although my parents are not financially strapped, my father is determined that he doesn't let this cancer bleed his savings dry. He doesn't want my mother, as a widow, wanting for anything.
My dad has cut out all meat with the exception of an egg once a week and maybe fish once or twice a week. I am working with my mother on getting him protein supplements (I am vegan, so I know about alternative protein sources such as tofu and seitan) but overall he has completely changed his diet (no sugar) and has lost 75 pounds as a result of eating healthy.
Just out of curiosity, what is your experience with men with my father's stage in terms of prognosis? My sister is not positive (she is a nurse and her husband is a doctor), and my mother, father, and I are more so. Don't worry abou thurting my feelings and upsetting me because regardless of what his chances are, I intend to help him as much as I can. (My sister thinks he will only last a year...she has been talking to a hospice care nurse.)
Anyway, thank you so very much.
Last edited by Administrator; 06-02-2012 at 02:55 AM.
I hope your father has an oncologist that you feel comfortable talking to and asking questions like these. I think that forging that relationship is critically important. Unfortunately, I've found that bedside manner bears no relationship to medical competence. Some of the best doctors I've met are "nerds" who can't communicate well; some of the worst have been "glad-handers" that have the personality of used car salesmen. Finding a urologic oncologist who stays on top of his field and is willing to work with you is half the battle.
You ought to talk to a radiation oncologist about the possible benefits of external radiation or internal radiation for your father. I know they use precision external delivery systems like CyberKnife or RapidArc to zap the bone mets. Radioisotopes (like Alpharadin in trials now) zap them from the inside. Some radioisotopes may only be available at certain cancer centers.
You can find out about Cabozantanib and other clinical trials from the clinicaltrials.gov website that acts as a clearinghouse for information. If you enter "prostate cancer" and "cabozantanib" for example, it will show you the details of clinical trials going on now. As I said, you will find that most clinical trials are for men with metastatic and castrate-resistant prostate cancer. They will not allow your father to enroll until he becomes unresponsive to hormone therapy, which may be many years away.
As far as "off-label" use, that depends on the doctor and your relationship with him. I think many oncologists are willing to try earlier interventions and may be willing to work with you on insurance issues. Others may be wary of legal liabilities or medicine for which there is no supporting evidence.
No one can give you a timeframe. As you know, there is no cure yet for metastatic disease. However, your father is still hormone responsive, and this phase can last many years.
Last edited by Administrator; 06-04-2012 at 10:16 AM.