Discussions that mention zometa

Cancer: Prostate board


[QUOTE=gpradeepraj;3397202]Hi everyone
... I have Prostate cancer. I am 47. By the time it was detected it was in my every bone. I was treated with Harmone blockers. PSA went down to 0.6. in July 2007. When this was detected in Oct2006 psa was 63.

In Nov, i got my pain back and PSA got upto 20. Doctors decided to put me on docetaxel (Taxotare). the first dose was given on 17 dec 07, the second on 5 Jan 08. next is on 28 Jan 08. Besides, 10 mg 3 tabs per day of prednisolone for 3 days after the chemo.

Anybody has anything that would help me
How long will i live?

Pradeep

Hello Pradeep,

My wife and I traveled to Europe last year and our seat mate was a woman from your city who was working at a hospital near me in Virginia. She was going back to visit her family. As I remember it, it was cold in Virginia, requiring heavy coats, but it was going to be very hot when she reached her destination. She was a wonderful seat mate. :)

I'm sorry you got such a virulent case of prostate cancer at a young age. :( I was somewhat older when I was diagnosed, age 56, in late 1999. I had a challenging diagnosis but not as challenging as yours (PSA 113.6, all biopsy cores positive with Gleason 7, but no detectable metastasis). My story and a followup are posted starting 11/20/2007 and 12/7/2007.

You may already know this, but your treatment matches the standard of care in the US for men in your situation: docetaxel plus prednisone. That was proven just in the past few years to have a survival advantage of several months over the older standard of care, mitoxantrone plus prednisone. Some survivors misunderstand that they will only live several months longer if they take the drugs and have to endure all the side effects. :( That's not so. What it means is that even the previous standard of care resulted in a survival advantage, but that the now current combination is several months better than the previous standard. :) I went to the US Government website [url]www.fda.gov[/url], for our Food and Drug Administration, and got a lot of hits by searching for " "prostate cancer" docetaxel prednisone ". The FDA has abundant information available that I plan to review more fully if I someday need this therapy.

However, the "length of survival" data leave out a vitally important part of the story. That's because what you see in most tables are reports of "median" survival, which as you probably know is the break point where half the patients do better and half do worse. That median information would be fine, except that typically in trials many patients simply do not respond to a therapy, or they have a minimal response, yet they are included in the statistics and graphs, and this waters down the survival advantage so that it does not look as large. :( (As I understand it as a layman with no enrolled medical education, doctors can spot non-responders fairly quickly and should then try something different.) For those that do respond, it would be most helpful to us to know the median survival of just those patients who had a substantial response. It would also be most helpful to see survival graphs charted only for patients who had a substantial response.

I was privileged to be a survivor representative at a medical conference that included many leading prostate cancer researchers, and I was able to raise this issue with some leading researchers. They reacted with great interest, not previously realizing the importance of this information to survivors considering therapies, so I'm hopeful for the future. :) Unfortunately, I don't think you will see that kind of information in most past trial reports or in FDA hearing records, and it will probably still take some time before the idea takes hold.

Let me ask you a question or two about your hormonal blockade that no longer seemed to work. In the US there is a problem in that most doctors administering blockade therapy to patients are urologists rather than oncologists, and they generally are not well informed on managing blockade therapy. :( For instance, they will often not test for testosterone levels at all to see if the blockade is working, and if they do, they tend to use a level of below 50 ng/dl as an indicator of success instead of below 20 ng/dl. If the therapy is not working sufficiently, many are unaware that they can decrease the interval between shots for Lupron or Zoladex, or correct administration errors such as injecting into fat instead of muscle, expulsion of the Zoladex plug, or improper mixing or preservation of the drug before administration. Oncologists are usually much more knowledgeable in administering this therapy. I'm thinking you are seeing an oncologist now, so these things may not be issues. Was your testosterone level tested before your doctor determined that hormone therapy was no longer adequate?

Another issue is incomplete hormonal blockade. While the LHRH-agonist (Lupron, Zoladex, Trelstar, Viadur, Eligard) takes care of testicular testosterone if properly administered with interval adustment if needed, the adrenal glands also produce a typically small amount that is not addressed by the LHRH-agonist. In many men that small amount may not do much harm, but in some men, an abnormally large amount is produced when the body senses that testicular testosterone has been shut down. The adrenals can account for up to 40% of normal testosterone, and if that happens, it will wreck a hormonal blockade therapy program. :(

The solution is an antiandrogen drug, preferably in the US Casodex (bicalutamide), with flutamide if that is not feasible, at a dose of 150 mg/day for metastatic or risky cases, from what I've heard (remember I'm a layman not a doctor). Even then, a small amount of testosterone still often gets by, and some of it is converted to dihydrotestosterone, DHT, which is far more harmful than testosterone, up to ten times more efficient at fueling prostate cancer in some men. That conversion can be virtually shut down by 5-alpha reductase inhibitor (5-ARI) drugs, either finasteride (the older drug), or Avodart, which appears to be superior to finasteride. That triple therapy (LHRH-agonist, antiandrogen, and 5-ARI) has been my therapy on an intermittent basis. Some men with fairly widespread metastases have had impressive responses, though typically that therapy is more effective when the cancer is at an earlier stage.

This is already long, but if you are interested, I could pass on some thoughts about drugs like Zometa that help preserve bone density while sometimes stabilizing or even reversing bone metastases, and other drugs that have sometimes produced dramatic responses in late stage patients, drugs like leukine. Nutrition, exercise and stress reduction also appear to play a strong supportive role.

I get a lot of my information from leading doctors who take the time to communicate to groups of patients, but I confirm much of what I hear and read from evidence from the same research reports that doctors study, available on [url]www.pubmed.gov[/url], the US Government's National Library of Medicine site that covers published research from all over the world, making free abstracts of studies available. To me this is one of my country's great gifts to the world, and in a way it is a partial repayment for all the benefits my country has enjoyed from the talents of people coming here from all over the world, especially including your country.

With all the resources now becoming available to late stage prostate cancer patients, I think it is very difficult to say how many years you will have. It is quite possible that the time you gain because of your current therapy will enable you to live to take advantage of another therapy that does not yet exist. :)

I hope this helps, and I hope your therapy is successful. :)

Jim