Updates from Singapore

Hello fellow brothers,

Just some updates from a review yesterday. My dad has completed his 6 cycles of taxotere/carboplatin regime. However, latest blood works showed mixed results. His PSA had rose to 130 but his ALP had drop to 1000 (originally was 3000). So for now, the medonc decided to give my dad a break from chemo (1 month) to get this stamina back. Despite the risen PSA, he remains well and active with occasionally aches and pains somewhere. Other than that, he's fine overall.

The medonc also gave us a few options for subsequent treatments, namely:

1. Xtandi
2. Jevtana
3. Etopiside/Cisplatin (very toxic)

I had read somewhere that the 3rd option is very toxic and the SEs associated to it is much felt compared to taxotere. Now we at the juncture of choosing the next treatment options. Therefore I sincerely would like to hear from the brothers here regarding this. Btw, my dads Chromogranin A level is high, which would suggest small cell cancer. His recent CT scan showed cleared for both the lungs and liver. Bone disease remain stable and similar to the previous scan.

Hello !

I've followed your posts over time, in regard to your father's case.

I realize he has a case with some complexities. I'm thankful he got through his series of chemotherapy treatments. At the end of those treatments, a person's body needs a chance to RESTORE itself ... so, I can see the reason for the doctor's recommendation to wait for a month.

Meanwhile ... I know you are considering "next steps" very carefully ...

I see that you have already tried ZYTIGA ... now that your father has completed his chemotherapy treatments, I believe that he may have the opportunity to give XTANDI a try, as suggested by the doctors. There have been instances where a series of chemotherapy treatments re-sensitizes the patient, and another medication can have some effectiveness.

I have a couple of friends who have complex cases and they are now going through a SECOND SERIES of chemotherapy treatments --- this was done ONLY after VERY careful and thoughtful consultations with their doctors. They are having success with their second round of treatments, I'm thankful to say, but each situation must be carefully considered and evaluated.

Each case is very unique and this is a time to really rely upon your father's doctors for EXPERT advice during medical consultations. Listen quite carefully to your father's doctors ... take a list of questions to every appointment ... and it would be wise for a family member to accompany your father to his next medical appointments, for moral support, and to be present during the consultations.

We are here to support you and your father. It's easy to see your devotion to his father and his health and well-being. That means everything right now. Please keep us informed, and let us know how you and your father are faring.

From across the miles, I am sending you my care and concern and compassion --- from here in the United States to you and your father in Singapore.

Sent with my very best,
"Cyclone Fan" ~ Iowa State University

Hello everybody (brothers and sister),

I feel so grateful to know all of you here and being able to get wonderful and important suggestions by all of you here! All of you here are really helpful towards me and my dad, providing inspiring comments in different ways.

Actually after the doctor's appointment, dad actually spoke about taking pills (which i suppose he's referring to Xtandi). Partly because he wanted to take a break from chemo and allow his body to restore as much as possible before going for another chemo regime - Jevtana or Etopside/Cisplatin (after Xtandi fails). For now, i will be doing some researches and get some questions for the doctor regarding each proposed regimes. Tall Allen's advice regarding the removal of the prostate glands and LNs to check on the clones is certainly one of the things that I didnt know about it. What was all in my mind was, mets from either the liver or lungs (which was really a good news that both were negative).

I guess for now, the most important thing is to have the entire family enjoying ourselves without having to think about this disease. Being happy, remain positive and maintaining laughter is the best to tackle and face such disease.

Once again, thanks you so much Allen, Beth+Gary and Cyclone! Really great to have you around.

Cheers and smile always!

I think the only reason why you would not try to debulk the original tumor is because you think it will not help anyway. However, Allen mentioned several studies which reported significant improvements after the primary tumor was removed.

In addition I want to mention the study by Andy C. M. Won et.al.
Primary treatment of the prostate improves local palliation in men who ultimately develop castrate-resistant prostate cancer

There are the following objectives for debulking the primary tumor:

Mr. Won reports that removing the prostate will avoid bladder outlet obstruction and ureteric obstruction which will happen when the primary tumor continues to grow.

Further, he also reports that patients who received local therapy to the prostate showed a longer mean time to develop castrate-resistant prostate cancer (8 years) compared to patients that did not (4 years). (Page E252)

George

Xofigo is great stuff. But if he only has only two bone mets, why not just zap those two with a couple of SBRT treatments? There are no SEs and very little myelosuppression from it.

Hi Allen and George,

I'm sorry about the non-updated information. His CT scan dated to Jan 2016 showed progression in the number of bony mets. The mets are now in his sternum, pelvic, right thigh bone and some parts of the spine. That's also the reason why they stopped the zytiga and proceed with taxotere in Jan 2016.
However the scans done 2 weeks ago showed stable bone diseases.

fuunit, I can't comment on the specifics of your situation, it's very different from mine. I will say that it sure sounds like your dad is getting state of the art care 'over there', which is great to hear. There are great docs all over the world.

Hi George,

Its very nice of you to help by offering a suggestion that I didnt thought of. My father is actually undergoing his treatment in Singapore General Hospital and he is visiting the nuclear medicine department for Radium223. I will definitely bring the idea of PRRT to the doc and see what would be his option on that treatment.

Perhaps the big question now is how to prevent bone fractures and spinal compression. You want him to be able to walk and get about as much as possible. I assume he's taking the Zometa+Celebrex, and switching to Xgeva + Celebrex may be slightly (20%) better for preventing bone problems.

Xofigo will help destroy some of the mets in the bone, and so will Jevtana. The problem with small cell is it is both radio-resistant and chemo-resistant. Either will shrink the mets as far as they are composed of normal cancer cells, but not as much on small cell component. They can try a combo of Jevtana and carboplatin (and maybe something like irinotecan) in order to attack both kinds of cancer cells, but this can get very toxic.

I see the dilemma, and I doubt that there's a really good solution. Does the oncologist have a recommendation based on his experience?

Hello Fuunit,

Mindful of your situation --- hoping that you can continue to consult closely with your doctors. I know you are troubled by the rising P.S.A. level --- always a source of worry and anxiety for all of us here, as you know.

Please keep in touch with us here --- let us know how you are faring --- hopefully your doctors will have ideas and treatment recommendations. It's hard when you are standing there at the crossroads, trying to find your path ... so many thoughts ... so many decisions ... so many considerations.

Support right here for you ... care and concern from our members ...

Just a line from the United States, to you in Singapore --- and to let you know I am thinking about you.

Sent with my best, from across the miles,
"Cyclone Team Fan" ~ Iowa State University