Discussions that mention zometa

Cancer: Prostate board

[QUOTE=flyfisher37;3778775]Thanks Jim for your reply. You have given me a lot of useful information and hope as well! I do know that my Gleason score was an 8 after my initial biopsy before surgery, although my psa was only 4.1 at that time.

If my psa continues to rise ( I'm getting another test done in a month ), my urologists said I will probably be facing radiation therapy, which doesn't thrill me at all....

Hi flyfisher,

You're welcome - glad to help! We are all here for each other!

I'm sorry that you had that Gleason 8 cancer :(, but as you may have learned, your prospects, if the cancer is recurring, include a basis for hope and optimism, along with strong motivation to have some kind of follow-up therapy :cool:. That's the other main value of the Freedland tables as I see it: when they don't reassure, they motivate, giving us a clearer picture whether follow-up therapy is needed.

As daff said, there are good options, and I can add a few. I'll do that in a separate post later today I hope, as this post is mostly about the Freedland tables for your case and I don't want it to be too long.

Here's what the Freedland tables say for Gleason 8 prostate cancer that has recurred 3 years or more after surgery at Johns Hopkins, for different PSA doubling times (PSADT) when the recurrence develops:

PSADT..........% Surviving (Prostate Cancer Specific Survival (Average percent, then ....................95% confidence range)
...........................5 Years..........10 Years..........15 Years

>15 months*.......99% (98-99)..96% (93-98)...87 (79-92) :)

9 - 14.9 months...98% (75-100).90 (58-98).....72% (35-92) :)

3- 8.9 months......94% (74-99)...68 (37-89)....30% (10-63)

<3 months**.......83% (52-96)...30 (10-63)....02% (<1-38) :(

* ">" means "greater than"

** "<" means "less than"

You can see that PSADT is very important; in fact it's the most important of the three factors. You can also see that, with decent doubling time, survival was quite good even for Gleason 8-10 patients. :cool:

You will get a better handle on your PSADT after the next PSA test. Since it is such a key indicator, be sure it's done with the same brand of PSA test at the same lab. I hope you see no change, or even a lower figure. (It can happen!)

It's important to keep in mind that these survival figures were developed from a group of men who were treated a number of years in the past. That means those with the more challenging cases were not able to enjoy treatments and approaches that became available later, such as use of bisphosphonate drugs, particularly Zometa for well-advanced cases. The advances are making large, not small, differences in our prospects! :D Also, a peculiarity of surgical treatment of prostate cancer at Johns Hopkins is that hormonal therapy was typically reserved until the patient showed symptoms from recurrence :(. While not yet completely proven, there is accumulating evidence that early hormonal therapy is superior to later therapy. :)

The confidence range, following the average percent: the average projected is sometimes based on many cases, and sometimes on fewer. Obviously, the projection is more reliable if it is based on many cases and if the variation in results is smaller, in contrast to projections based on few cases, especially where the results vary a lot. The 95% confidence range is a statistical tool; it is a sound, highly reliable (95% confidence, 5% possibility that chance is behind the results) estimate that the true result (if all possible cases were studied) would fall in the range. For example, if the result is "99% (98-99)," as it is for Gleason of 8-10, recurrence at three years or more, and PSADT greater than 15 months, we have 95% confidence that the true result is 98% or 99%. This contrasts with the result for Gleason of 8 or higher, recurrence at 3 years or more, but PSADT of less than 3 months. While survival of 83% is projected, the true value is between 52% and 96%. It is clear that not that many cases fell in this category, and they probably had a wide variation in outcomes.

It is also clear that some men were able to do quite well even when they were in an unfavorable survival category, as is indicated by the upper limit of each confidence range in those categories. I am keenly aware of this kind of thinking, as two doctors well respected in prostate cancer circles (one at Johns Hopkins, the other at the City of Hope, Duarte, CA), gave me a prognosis of five years back in late 1999/January 2000. Obviously, I'm doing a lot better than they thought I would do! :cool: I'm thoroughly convinced we can do a lot to affect our prospects.

Do you know how much your PSA rose in the year before diagnosis when it was at 4.1? That's another important clue.

To be continued,

[QUOTE=flyfisher37;3785521]Hi Jim,

... Because you had radiation, that must mean that you will have a psa count. Do you have to be checked every 6 months and are you taking any kind of medication to keep things under control? You also mentioned triple hormone blockade. How effective is this for fighting prostate cancer and how severe are the side effects? My uro did mention to me when I first met him, that hormone treatment was one option open to me, but since I was determined to be rid of the cancer once and for all, I elected to have the surgery....Take care..........Lionel

Hi again Lionel,

Actually, I never got to radiation and have had only intermittent hormonal blockade therapy. After I was rejected for surgery, a ProstaScint scan in early 2000 had a surprisingly good result - no detectable prostate cancer with just one doubtful area in an unlikely place, opening the door to radiation. I was headed in that direction, with several planning consultations up to the verge of the final planning consultation. However, I was learning more and more about combined hormonal blockade, and my PSA was responding well :). With the encouragement of my urologist team, in May of 2000 I decided to rely on hormonal blockade. Part of the thinking by all of us was that there was a strong chance I had some micro metastases that were just too small to be picked up yet. That likelihood made cure by radiation for my particular case a long shot as the cancer probably was beyond the range of the radiation. If I had had a better shot at a cure, I believe I would have gone for it like you did, rather than shooting for long-term control instead.

As you may know, the idea and practice of combining hormonal blockade drugs was fathered by a Canadian, Dr. Fernand Labrie of Laval University in Quebec. :cool: The concept was that men would do much better if a drug like Lupron or Zoladex had an "antiandrogen" class of drug like Casodex or flutamide in support. Other Canadians, particularly Dr. Nicholas Bruchovsky in Vancouver have pioneered intermittent blockade along with some American doctors. :cool: Intermittent triple hormonal blockade emerged out of this with the addition of a "five alpha reductase inhibitor" drug, Proscar (now generically available as finasteride), or recently, Avodart. The role played by each drug in triple blockade, encouraging results, and information about side effects are presented in two books, "A Primer on Prostate Cancer - The Empowered Patient's Guide," Strum and Pogliano, and "Beating Prostate Cancer: Hormonal Therapy & Diet," Myers. :cool:

Accumulating evidence indicates intermittent triple blockade is highly effective in controlling cancer for the vast majority of us. :cool: However, there is only one :( key paper about it in a major prestigious journal, which details impressive experience at the Strum/Scholz - now Scholz/Lam practice, though several other practices have less formally documented their success with it. While I'm convinced that triple blockade is best for most of us, some approaches using single drug blockade (such as just an "LHRH agonist" (Leutenizing Hormone Releasing Hormone agonist) like Lupron, Zoladex, Viadur, Eligard or a different class of drug - an antiandrogen like Casodex) or two drug blockade (the LHRH agonist plus an antiandrogen, or an antiandrogen plus finasteride or Avodart) appear to work very well for some of us and are probably better known and accepted in the medical community treating prostate cancer.

Also, there are a couple of very widespread negative myths about hormonal blockade. :( One is that it does not work for very long. The myth is supported by studies from the 90s that correctly indicate hormonal blockade did not control prostate cancer for very long for men who were already at a late stage of the disease, such as widespread and painful metastases, when the therapy was started. Men at such late stages do somewhat better today based on advances since the 90s, but the really striking successes with intermittent triple blockade come with men who use it as primary therapy for early stage disease or for recurrences that have not yet turned detectably metastatic - that's most of us! :cool: Dr. Mark Scholz, one of the leading doctors with this approach, said that typically men achieve excellent for about ten or eleven years, or indefinitely, with the latter more likely if it has controlled prostate cancer for three to five years, as it often does.

Another myth is that hormonal blockade patients suffer from all kinds of terrible side effects. What is true is that there is a risk of a number of side effects: hot flashes, decrease in bone density, bone and joint pain, weight gain, loss of muscle mass - especially in the upper body, weakness, loss of libido, loss of potency, increase in cholesterol - etc., "hypercholesterolemia, mental/emotional changes, and anemia. :(

What is also true is that most of us will only experience some of these, and that those we do experience can be quite tolerable, especially if we use countermeasures if needed. Perhaps the most serious potential side effect is a decrease in bone density. Fortunately, my impression is that can be virtually eliminated by using a bisphosphonate drug. Such drugs range from the mild ones, like Fosamax, Boniva and Actonel, to the powerful Zometa. I've virtually reversed the loss in bone density I experienced, before starting the drugs, with Fosamax, and more recently Boniva. Dr. Scholz, his colleague Dr. Lam, and the Prostate Cancer Research Institute have written some excellent papers on using countermeasures. The Primer has a good table on the likelihood and severity of the main side effects. For reasons not yet fully understood, younger men seem to have a generally rougher time with side effects. I'm on my third cycle of triple blockade, and each cycle has been less of a burden than the previous cycle, though for me it was always tolerable. Also, a key point, when we intermittent patients go "off therapy" - meaning off the heavy duty drugs like Lupron and Casodex, the side effects disappear after a few months for most of us (as they do for me). :cool:

Advancing knowledge is indicating that about a year to a year and a half achieves most of the benefit from one round of hormonal blockade, with long-term continuous use adding little except side effects. (However, up to at least a couple of years ago, Dr. Labrie would debate that, arguing instead for up to around nine years of blockade before going off therapy.) These much shorter cycles of use have cut down substantially on the impact of side effects.

Also, the most annoying side effect for some - intense, frequent, prolonged hot flashes, can be virtually eliminated through use of one of several medications, such as Megace, from what I've read. My flashes have never been enough of a burden for me to choose additional medication.

While on full therapy, I'm monitored with PSA and other tests, as well as an exam by my oncologist, every two to four months, typically closer to two months except when my PSA is very low.

I hope this helps,