Discussions that mention zometa

Cancer: Prostate board

[QUOTE=medved;3646538]My brother had radiation treatment a number of years ago. That failed. Then Lupron for some years, and then taxotere, and now LDK. Each worked for some time, and then not. Next try will likely be HDK (w/ prednisone). Anyone have experience with other "second line" treatments? Estadiol? DES? Other chemos?

In evaluating the "progress" of advanced metastatic p ca, what is most important -- psa levels? other blood tests? scans?

Hello medved,

Your brother is fortunate to have you in his corner. That's the kind of support we all like to have! :cool:

I can sympathize with your brother's plight as he gradually has to retreat to other lines of defense in his battle against prostate cancer. That's never a good feeling. :( Fortunately, there are some things that have worked in many patients, and something should help him.

About the Lupron: Your brother's treatment was almost surely not optimum, and possibly could be improved on and tried again. Lupron alone works very well for some patients, but it's my impression that it will not work well very long for a majority of us. While it is excellent at controlling or eliminating testosterone produced by the testes, it does nothing to prevent the production of testosterone indirectly by the adrenal glands. While for many of us their production is not enough to wreck a program of hormonal blockade early on, in some men the adrenals ramp up production, and I've heard they can sometimes account for 40% of normal testosterone production. Also, Lupron does nothing to block the conversion of testosterone to 5-alpha dihydrotestosterone (DHT) by the enzyme 5-alpha reductase, nor to block the docking of any testosterone or DHT with the androgen receptor on the cancer cell, which then fuels the cancer. :(

The drug Casodex or alternately flutamide will block most of the docking, especially with an LHRH-agonist class of drug reducing the amount of testosterone and related DHT to be blocked, and either of the drugs finasteride (generic for Proscar) or Avodart will block much (finasteride) or almost all (Avodart) of the conversion of testosterone to the much more potent prostate cancer fuel DHT. That's why a combination of Lupron (or Zoladex, or "LHRH-agonist" equivalent) plus Casodex (150 mg often recommended for men with metastases) or flutamide (in the US), plus Avodart or finasteride, should have worked better. While this combination apparently works best when used early in the disease, it might work at your brother's current stage in my layman's view. (I've never had any enrolled medical education.)

Did your brother have bone mineral density (BMD) tests to assess and monitor his bone density while on Lupron, or was he on a drug from the bisphosphonate class to protect his bone density and help guard against metastasis to the bones? That threat and highly effective countermeasures were recognized over a decade ago by leaders in hormonal blockade therapy, but many doctors have only recently caught on, so it would not be surprising if your brother had never had the chance to benefit from this often needed monitoring and therapy.

Both the choices in monitoring BMD (DEXA scan, quantitative CT scan) and alternate medications are described in the excellent book "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen B. Strum, MD, and Donna Pogliano. I've been on Fosamax (for over six years) then Boniva (until the present) for about eight years now as my bisphosphonate choices, and my latest BMD test showed both hip and spine returning to normal after taking a hit and decreasing to the osteopenia range before I started on Fosamax. Patients on these drugs take a calcium supplement plus vitamin D3.

The intravenous bisphosphonates appear to be more powerful, and the intravenous drug Zometa is very powerful, sometimes even reversing established bone metastasis in addition to rebuilding bone density. There is a rarely occuring but serious side effect affecting the jaw bone, but there are ways of reducing this already small risk. Zometa is usually the choice when a patient has mets, especially bone mets, as I understand it.

As for second line approaches (though the first line has not really been put to the test, as I mentioned above), the drug Leukine has worked extraordinarily well in many patients. This and other approaches are well described in Dr. Charles Myers' excellent recent book "Beating Prostate Cancer - Hormonal Therapy & Diet." Some of the responses have been spectacular. :cool: DES is not much favored because of the risk of serious cardiovascular side effects, but estradiol delivered through skin patches appears to avoid the problems while delivering a potent punch. It is growing in favor. :)

Dendreon Corporation should soon (this year) be reporting well-grounded interim results from a major trial of its vaccine Provenge, and if the results are favorable, approval by the FDA will be almost automatic according to a signed agreement. :) Results from earlier trials showed promise, but the data was not clear enough for approval. Further analysis indicated that patients who had had both Provenge and taxotere (docetaxel) did much better than patients who had just Provenge, and those patients did better than those receiving just taxotere.

Diet, nutrition, with wise use of supplements, exercise and stress reduction all appear to make a clear difference in outcomes for many of us, though it's hard to get conclusive evidence with those kinds of tactics. The evidence I've seen has been plenty persuasive enough for me, and those tactics are a major part of my program. :)

Regarding other scans, etc., the Primer advises that certain markers other than PSA are often valuable for advanced patients, especially if their prostate cells are so broken down (high Gleason) that they no longer can even produce much PSA. Some of those markers are PAP (prostatic acid phosphatase), CEA (carinoembryonic antigen), NEA (neuron specific enolase) and CGA (chromogranin alpha). For some patients, the PSA is still useful for monitoring the disease even when their case is well advanced. A fusion ProstaScint scan might also be useful for determining spread in soft tissues throughout the body. A bone scan, or 18F-deoxyglucose PET scan might be advisable for tracking metastases in the bones. Both (and fusion ProstaScint) are described in the Primer (with photos of scan result examples). The Primer is also great for giving us patients the specific words for these tests so that we can communicate with our medical team instead of drowning in medical jargon.

I hope this helps, and I hope you will get some other responses.

Take care,