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I feel guilty for making dad stoping Zoladex

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Posted 1/12/2015 10:52 PM (GMT 0)
Hi, i have posted here before about my dad who has been on zoladex for almost 2 years, which kept his psa undetectable , and than because of financial issue we had to look for alternative. He spoke to his doctor who suggested orchiemetry (removal of the tets)
Since having the operation and stopping zoladex his psa stayed undetectable for 8months and than jumped to 0.84 , the doctor checked his testosterone level witch came 0.95. A Ct scan showed bone mets.
the psa has raised to 1.21,
I feel bad that i didn 't keep him on zoladex witch was working, i feel really bad :-(
Thanks for taking time to read my post
Posted 1/12/2015 11:17 PM (GMT 0)
Laila,

Prostate cancer can only be controlled for so long by suppressing testosterone and after a while it will become "castrate resistant" and need other/different treatments. Between the zoladex and his orchiectomy your dad got several years. It is quite likely that the zoladex would have stopped working at about the same time as his surgical castration did and he would be in the same situation if he had kept getting the shots every three months.

The last time we heard from you Tall Allen suggested a few treatments your father can talk to his doctor about, some of which aren't crushingly expensive. Look for his comments on this thread (your previous one).

Don't feel bad. Your dad is no worse off than he would have been.
Posted 1/12/2015 11:20 PM (GMT 0)
Laila,

What was his testosterone level while on zoladex. I am far from being an expert, but from what I can see he was for below the testosterone saturation level. Possible he might have castration resistant PCA and has nothing to do with him going off zoladex.

Hopefully an expert can elaborate on this more.
Posted 1/12/2015 11:53 PM (GMT 0)
Don't let financial issues hold you back. There are numerous foundations that provide aid in that situation.

Call 855-824-7941 Patient Access Foundation on February 1st as they only adminsiter their aid on the first of the month. They paid $1,000 toward my travel expenses from FL to LAX for SBRT radiaiton, since I am on fixed retirement income.

There are others, but this is the one I had handy as I respond.

Here are some general financial tips

malecare.org/money-cancer/

LupronJim
Posted 1/13/2015 12:37 AM (GMT 0)
Like the others have said, guilt isn't something you should be feeling as it's likely he'd be in this place right now no matter the treatment. Keep working with the doctors to see if there is anything else they can do.

Andrew
Posted 1/13/2015 3:36 AM (GMT 0)
Laila,

Is your dad still in Morocco?
Posted 1/13/2015 5:06 AM (GMT 0)
Laila,
Please don't feel guilty about the PSA rise. This is an unpredictable disease and bone mets are scarey, but not the end-all for sure. Can you elaborate on the results of the bone scan? There are a lot of new radiation therapies for bone mets that might just kick it.
Hang in there and please, please stop blaming yourself. Check out the caregiver's corner when you get a chance. A lot of helpful information and support there too.
Beth
Posted 1/13/2015 1:47 PM (GMT 0)
Thank you so much for your quick replies,
Lapilot he wasn't checking his testosterone level when he was on Zoladex , the doctor was just monitoring his Psa.
Lupronjim , my dad is in Morocco and he has o pay for everything there because he has no medical insurance.
Andrew yes this what i am trying to do is to get more informations from you guys before calling his doctor.
Peter, yea my dad still in Morocco, i heard that treatment in UK will be more expensive because he is not a permanent resident.
Beth, the bone scan showed a spot in his lower spine with has been confirmed later to be bone mets, He is now on CAZODEX witch has helped in dropind the psa but the last test showed a jump from 0.59 to 1.21 , the doctor now is asking for another bone scan and MRI.
I don't know if the oncologist is delaying treatment i don't know
What do you think guys?
Posted 1/13/2015 1:58 PM (GMT 0)
Laila,

Last July Tall Allen listed a number of alternative treatments for your dad. Some of them are quite expensive and may not be available in Morocco but others are fairly inexpensive and are available most places.

The Tall One said...
All I can say is that castrate-resistance does set in eventually, sometimes sooner, sometimes later. There are a whole new set of hormonal drugs that may continue to work even after castrate resistance occurs. They include Zytiga, Xtandi, Ketoconazole and Estrogen.

Now may be a good time to begin chemo with docetaxel. There is an immunotherapy called Provenge - I don't know if it's available in Morocco.

Bone density erodes after castration, so it is necessary that he take Xgeva, Zometa, or other bisphosphonate. That may also prevent spinal compression and fractures.

It's harder to definitively diagnose bone mets after castrate resistance. Perhaps he can get a NaF18 PET/CT scan after his PSA gets a bit higher. If that indicates the spot on his spine is a met and there is only the one or very few, he can have it zapped with SBRT (3-5 treatments). If it discovers multiple mets (more than 5), he can have a single dose palliative treatment to them, or a new drug called Xofigo, if it's available there.

I seem to recall that Ketoconazole and Estrogen are relatively cheap. They might be things he could talk to his doctor about trying.
Posted 1/13/2015 5:56 PM (GMT 0)
Laila,
I think the orchiectomy was a good decision. The Zoladex, which just does chemically exactly what the orchiectomy does physically, would have stopped working at exactly the same time. It's called "castrate-resistance." It's the cancer - it outsmarts us at every turn.

Estrogen has had some good results in castrate-resistant men. It's cheap, and at low doses, or in a transdermal patch, it may be very effective. They have to monitor his blood clotting while he is taking it. There are different kinds of estrogen: DES, estradiol, or ethinyl estradiol. It may be a good idea to take tamoxifen (10 mg) with it to prevent breast enlargement and tenderness. Here's an article about it:

prostatecancerinfolink.net/2014/12/22/low-dose-diethystilbestrol-in-treatment-of-men-with-crpc/

- Allen
Posted 1/14/2015 6:53 AM (GMT 0)
From what Gary's radiologist told us, radiation trtmnt can be done in several treatments with longer lasting effects or a big hit one time. Perhaps that is something to ask the onc about too.
Posted 3/30/2015 12:11 PM (GMT 0)
Allen is DES the same as Casodex? Please guys i need your help dad is starting a new treatement and need to know if his oncologist is doing the right thing for him? Or does he need to seek a second opinion?
Please guys i need your opinions,
many thanks
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