Discussions that mention zometa

Cancer: Prostate board


I too lack a crystal ball and am a patient with no enrolled medical education, but I've been battling a challenging case since late 1999, and I have had to learn a lot about the disease. (I'm now doing great - as if I never had the disease - in my second off-therapy period of intermittent triple androgen deprivation therapy (hormonal blockade).

First the bad news, but you and your grandpa have no doubt already guessed it: at this point the prostate cancer is almost surely incurable. That high and rising PSA and the CT scan results show advanced metastatic cancer.

Now the better news: with the great advances that have been made in the past decade and that continue to be made, your grandpa may be able to get his cancer under good control and even achieve a long, perhaps permanent remission. I've heard doctors considered to be experts describe these kinds of strategies: a course of chemotherapy preceding hormonal blockade, or delivered as hormonal blockade therapy is started, or hormonal blockade without chemo to see how well the patient does. Personally, I like the last strategy as the patient may do very well without the chemo. (Note that this is using chemo as a tactic to get the cancer under control and not as an end-stage maneuver.)

For those patients where cancer control is clearly paramount, as in your grandpa's case, my studying the disease has convinced me that a triple pronged hormonal blockade program is best, supported by a bone density/metastasis control program as well as a diet/nutrition/supplements, exercise and stress reduction program. The hormonal blockade program involves three classes of drugs: an "LHRH agonist" (typically Lupron, Zoladex, Eligard, or Viadur, all pretty much equal in effectiveness) given by a shot or implant; an "anti-androgen" (usually Casodex, which is expensive but covered very well by good insurance, or otherwise flutamide, not quite as effective and with a less favorable side effect profile, but much less expensive) given as a small pill(s) (Casodex) or timed pills (flutamide); and finally a "5-alpha reductase inhibitor", either finasteride (cheaper) or Avodart (arguably more effective). For a patient with existing metastases, the cornerstone of the bone program is Zometa, given by infusion on a fairly frequent basis - and carefully the first time at a lower dose to avoid an "acute phase response", probably every three months or more often. There are side effects in the total program, but for most of us they are quite manageable and tolerable if effective, known countermeasures are used. A highly readable recent book on this is "Beating Prostate Cancer - Hormonal Therapy & Diet," Dr. Charles Myers, MD. Another excellent book is "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen Strum, MD, and Donna Pogliano.

Other tactics are also available, such as the drug known as Leukine.

Finding an excellent physician is key, and a "medical oncologist" is the kind of doctor who would probably be most helpful.

There have been amazing remissions, including rolling back and elimination of metastases, with modern approaches, though it is not a cake walk and not a sure thing. The Myers book has excellent examples of dire cases (PSAs in the thousands) with wonderful responses, and a number of expert doctors are reporting many successes with challenging cases.

Keep your spirits up, and good luck to you and your grandpa!

Jim
There is great hope even for well advanced and metastatic prostate cancer patients today, though it is far from a cake walk and such patients may not survive the disease. But not surviving does not rule out enjoying good years. Some such patients will not only survive but do well for their remaining years. :)

I would like to offer a different opinion on getting a prognosis from your dad's doctor. While we would all like to trust our doctors, many of them do not really have a clue when it comes to advanced and well advanced prostate cancer. Your grandpa's situation is not a death sentence as no one knows enough to impose such a sentence at this time, in my survivor's opinion - no enrolled medical education. I like Debbie's line that only God knows, though there are some clues from medical studies.

For example, using my own more favorable but still challenging case, I saw two respected doctors at highly respected institutions (City of Hope, Johns Hopkins) who, at my insistance, gave me a five year prognosis (three good years, two declining years) around New Year's day of 2000. That was based on what they knew at the time: first ever PSA of 113.6 and lousy biopsy to match (GS 4+3=7, all cores positive, most 100%, stage 3) but negative scans. I'm now doing fine and feeling great in my second off-therapy period under intermittent triple hormonal blockade with finasteride maintenance. I think the two reasons they were off were that I did not have detectable metastases based on a later test, and they did not understand the potential of hormonal blockade therapy. I've attended a number of conventions for prostate cancer patients, and many, many men tell the same story of overly pessimistic prognoses. :( We need to keep Mickey Mantle, the Yankee slugger in mind: "I I'd known I would live so long, I would have taken better care of myself.":)

There have been several significant advances just in the eight years since I was diagnosed that could be relevant to your grandfather's situation. One is in understanding the great impact of triple hormonal blockade therapy, and another in the use of bisphosphonate drugs to protect bone density and even control and help reverse bone metastases, particularly under the powerful drug Zometa. :) Zometa was not even available in 2000. Unfortunately, a great many doctors do not yet appreciate the value of or need for such drugs :(, though that is changing as the medical associations emphasize these topics in their key Education Books. Also unfortunately, the evidence supporting triple blockade is not of the high quality (gold standard type clinical trials) that would persuade more doctors to jump on board. :( Yet some evidence has been published in a prestigious peer-reviewed medical journal. :)

More advances may be coming within the next year or two, though the path will likely be strewn with disappointments along with the successes. In the last month the promising drug Satraplatin turned out to be a dud, and the combo of calcitriol and docetaxel also resulted in disappointment. :( But Leukine continues to look strong, thalidomide and its cousin Revlimid are looking good in combinations, and the immune activating drugs GVAX and Provenge should be up for FDA approval within a year or so. Provenge is looking especially good in combination with docetaxel. :)

The doctors I follow would probably want your dad on hormonal blockade, preferably triple blockade, and he would probably experience a huge drop in his PSA, reflecting cancer that is declining. The question is whether that would be enough. While it probably will help him greatly, additional treatment is typically needed. It may be enough to knock his metastases back into undetectability. The doctors would also probably want bone density assessed as well as vitamin D3, both of which are highly relevant to successful treatment for prostate cancer, especially under hormonal blockade, as well as bone density health.

You are doing a real service for your grandpa. :angel: Keep it up!

Good luck and take care,

Jim