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  • Is intermittent hormonal therapy possible for metastatic prostate cancer

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    Old 03-10-2009, 03:00 PM   #1
    IADT3since2000
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    Question Is intermittent hormonal therapy possible for metastatic prostate cancer

    I'm now in my third cycle of intermittent triple hormonal blockade, and I'm delighted that I've been able to go off the heavy duty drugs for long periods despite having a challenging case of prostate cancer (initial PSA 113.6, Gleason 4+3=7, all biopsy cores positive, most 100% cancer, etc., but fortunately no detectable metastasis). For most of us, going off those drugs means we get testosterone back with all its many benefits. I've really enjoyed those periods, and it's great to know that I should be able to again go off therapy in a year or so. Having that to look forward to is a great encouragement!

    However, some of us have metastatic prostate cancer that hormonal blockade therapy is able to control, and many patients in that group wonder whether they too can go off the heavy duty drugs after a period of time.

    Dr. Charles "Snuffy" Myers, MD, an expert doctor specializing in prostate cancer and a veteran of his own challenging case of ten years, addressed that question in the latest issue of his Prostate Forum newsletter, Volume 10 Number 10, published in February 2009. He was answering that question from a patient with three bone mets who had been able to reduce his PSA to .6, but no lower, with triple hormonal blockade for a year (9 years from diagnosis).

    Here's the key sentence in his reply: "For IHT [intermittent hormonal therapy] to be really effective, it is important to reduce the PSA to less than 0.01 ng/ml, otherwise your cancer will re-grow explosively as soon as your testosterone recovers...."

    I think its probably important to remember that he is talking about a patient with known bone mets; I suspect his answer would be more encouraging for a patient with no known mets, but I can't say for certain what his view is. I did notice that threshold he uses is "less than ("<") 0.01 ng/ml." That is lower than the <0.05 that Drs. Strum and Scholz used to talk about from their path-finding research, work which is partially described in "A Primer on Prostate Cancer - The Empowered Patient's Guide." My bet is that more recent observations and research, coupled with more widespread use of ultrasensitive PSA tests capable of reliably detecting PSAs as low as <0.01, have clarified the target we need to hit: not succeeding means that the therapy being used needs a boost and that going off the heavy duty drugs is not an option at that point.

    By the way, despite my challenging case, I was able to get my PSA to <0.01 by the end of both my first and second cycles of full triple blockade . As Dr. Myers indicated, as a patient who did get the PSA to <0.01 I did not have an explosive regrowth of cancer as my testosterone recovered, and I enjoyed a total of 55 months of vacation from the heavy duty drugs (Lupron and Casodex) (34 months for cycle months after 31 months on the drugs; 21 months for cycle 2 after 19 months on the drugs), though I did not enjoy the very extended off period of at least a number of years, such as five years to indefinitely long, that those patients with much lower risk cases typically experience.

    Dr. Myers did go on to advise the patient that he falls into that class of patients who have just a few metastases, fewer than five. Research from just the past few years has opened a tremendously encouraging door to such patients: spot treatment with precisely aimed radiation plus aggressive hormonal therapy often leads to long remissions! As Dr. Myers put it, that approach "... might put you into a durable complete remission where you could remain off hormonal therapy for years." He mentions his book where that approach is more fully explained ("Beating Prostate Cancer: Hormonal Therapy & Diet").

    We are so greatly fortunate to be surviving in an era where advances in imaging for metastastasis detection and location, in radiation, in hormonal therapy, plus support from other drugs are enabling many patients with metastatic disease to do very well. As of 2009, it seems to me that this wonderful situation is possible for quite a few of those patients with "fewer than five metastatic sites." Technically, using medical speak, those patients are known as those with oligometastatic disease," with the root "oligo" meaning "few." I mention that detail because I've seen it in a paper on treatment, which I cannot find. I'm hoping that someone will be able to locate it. I've had bad luck with [url]www.pubmed.gov[/url] searches - getting too many responses, most irrelevant . I have heard that radiation expert Dr. Michael Dattoli has treated a number of such cases, but apparently he has not yet published results.

    Jim

     
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    Old 03-11-2009, 03:22 AM   #2
    gregge
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    Re: Is intermittent hormonal therapy possible for metastatic prostate cancer

    Hi Jim,

    Thanks for the info! Any idea what this means for someone (like me) with lymph node involvement? Does this come under the "mets" heading that Dr. Myers was referring to? (I sent off for his book, but it got lost somewhere over the Pacific. I suspect it ended up in Thailand. )

    On a good note: I just got back from my three-month PSA test - the first one since I stopped hormone therapy in December - and found that my numbers dropped from .54 to .41. This is the first time I've seen my doctor get happy about my test results. (You should know that I went into my appointment armed with "Jim Notes.")

    Bless you,

    Gregg

     
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