Etoposide and Estramustine not working "as well as we'd like."

We don't see these two drugs being used much anymore..(Etoposide and Estramustine).. They had some interest 20-25 years ago but you don't see them being used much today..

A newer treatment, Provenge, might be worth considering, or chemo using Dosetaxel can be very effective..

Lisa,

I don't see Xtandi in the list of treatments. I went on that when the Zytiga tried to kill my liver along with the PSA stone drop that was hoped for. Xtandi worked well, dropping my PSA back to < 1.0, and my mets became (downgraded to) "suspicious" spots on the bone scan. For a little over a year. "Only" a year, but I take it one day at a time.

I think this post points out a serious problem with treatment options. Like many of you, I am years deep in the prostate cancer fight. BUT I do not keep aware of the many different treatment options that have been tested over the past several years for advanced prostate cancer .

I do not have the medical interest or aptitude that Tall Allen and others thrive on. I just want to know what is working and why it is working. So, my question is simple. I have never heard of etopiside or estramustine. What are they? Are they different names for drugs we already have discussed? What is the "currently" preferred drug to deal with advanced prostate cancer?

Is there some way we can stop with all the initials and medical terms and medical stuff and simplify the information that we get on this website? I know it is easier for regular posters, but I think it scares many new peolple away. They are the people who need our help.

Lisa,

I went on Zytiga & Prednisone when the Lupron & Casodex stopped keeping the PSA down.
My Onco wanted me to do Xtandi first, but insurance would not pay for it, as it was a few thousand $$ a month more. I had to start with Zytiga, took it until the liver failure started, came off of it, then had to wait for three months of consecutive PSA increases. At that point they allowed Xtandi.

There was no discussion of one not working after the other. I've heard that said, but it was not a consideration. The only factor was the $2000 a month higher cost of the Xtandi.

The Taxotere is faltering, and my PSA has gone up twice in the last two tests. A third increase and we'll have to punt. At that point I'll have to change oncologists, as the advanced stuff in this practice is reserved to the big hospital cancer center way downtown, where you are more likely to be robbed and killed in the parking lot than be cured. Needless to say I'm not looking forward to that. And getting someone to take me down there will be real problematic. Where I go now is in a nice peripheral town, convenient for everyone.

We'll see what happens.

Estramustine and Etoposide in combination are old drugs (1997) that have been found to be affective in treating prostate cancer. https://www.sciencedirect.com/science/article/pii/S0090429597003233 It was never explained to me why he was placed on this combination as I wasn't at the appointment. I have heard that they sometimes use this combination with a rare and quickly progressing form of PCa, one in which a person is not expected to live a year. My dad does not have that form. My assumption is that they are just buying time but that's just a guess on my part. Lifeguyd, I am not an expert on this stuff either. I only know these terms because that's what the doctor put him on. To be honest, I tried to research the medications that are available for PCa, thinking that those were the doctor's options for my dad and then come to find out Etoposide wasn't even on the list. So you see I don't know all the treatment options either. I am sorry to confuse you. I do not know the recommended drug to treat PCa but I'm assuming it's Xtandi or Taxotere. You probably have never heard of Etoposide with Estramustine because I've heard they really aren't used that much anymore.
I wish I knew the name of the drug he's supposed to take next but since it's the weekend, I haven't been able to call. It's been a rough weekend for him. He said he feels like he's dying and he goes up to his bed, then comes down, goes up, then comes down. He goes to town and then comes back and goes to bed, then comes down again telling us how he has cramps. He wants to know why it's taking so long for them to call about his results for his stomach problems. We told him it's because it's the weekend. His hair is all falling out on the side of his head and he looks bad. But the thing is last Thursday he was telling us how he felt good and the only thing that bothered him was the cramps. As soon as he heard the medication wasn't working as well as they wanted, all that went to hell and now he has given up. He told me that no medication works for him and that he was crying. I told him nobody said that and showed him a big list of a bunch of medicines they can try. He stopped taking his anti-depressants which I know is going to catch up with him. Both he and I suffer from major depression and I know how he feels but he just won't help himself. He said he is too sick to take them. I think he's lost all hope as he feels bad all the time, his hair is falling out, his mouth hurts, etc. But he's never even had it in his bones. His PSA only went up 2 points this last time when it would have likely went up by 32 points had he not taken this chemo. He can't see that as a positive. He just thinks it's not working. I told him it's working but they want a drug that works even better. He didn't seem to flinch. He has been saying he wishes he would just die and get it over with. My mom said she can't really stand it anymore. She says it's so depressing and she is under a lot of stress. She doesn't want to sit around hearing all that negativity because she will be the next one sick. I just wish my dad would put in a little more effort and try to help himself. He moans and groans around the house. Life is hard enough for everyone, it would be nice if he would help himself. That would help everyone around him. I understand he doesn't feel well, but I tend to think he is wanting sympathy a lot of the time. Glaf to hear your mom got better on the Welbutrin, TallAllen. It never helped me. Now I'm on Lamotrigene, Zoloft, Depakote and Lorazepam (as needed). I worry less and am able to see more rationally. It's amazing how different it makes a person feel.
142, my dad went on the Zytiga as you did, after the Casodex (and likely Lupron) stopped working. He did well on it for about 8 months and then it stopped working for him. At one of his most recent appointments, he mentioned to the doctor that he liked the Zytiga and he wished he could go back on it and the doctor told him maybe later he could try again, as sometimes medications work again after you stop them for a while. That sort of surprised me a bit. Let's hope that's true with that and also with Xtandi. How is your liver now? My husband had Hepatitis C so I know a little bit about the liver. Has your liver returned back to normal? It's supposed to be the only organ that can heal itself. Thank God they monitor for these things! How are your mets now?
Kathy, thank you for your love and thoughts. How is your dad??? I wonder about him all the time. Did he ever go to the ENT? What limitations does your dad have now? Can he walk anymore? Are they helping him with pain? I hope he is still able to laugh with you. I know it must be bad for him and you and your family as well. Just hang in there and appreciate the time you have with him. I have come to realize lately that there's nothing I can do for my dad. I hope he lives a lot longer but I need to face he may not. You always assume your parents will be around forever and then when you realize they won't be, it's kind of a slap in the face. But I am taking it one day at a time and tomorrow I'll be going over to his house yet again to try to talk to him and try to make some headway. Thanks everyone for your thoughts and prayers and I will do the same for you.

Dad Dx 2011, age 63, PSA 16, Gleason 7 intermediate risk
Radiation PSA<1
Clear 2 years, relapse
2013 started HT (Casodex, Telstar)
2013 scans clear
HT 2-3 years
2016 PSA>1,3,5
Started Zytiga/Prednisone, worked 6-8 months
PSA>5, stopped Zytiga
Start Estramustine, PSA>9
1/18 Bone scans clear
2018 Restart Casodex
2018 Add Adovart
3/18 PSA 21
4/18 PSA 32
4/18 stop Casodex, add Etoposide
5/18 psa 34
6/18 PSA 36, WBC high, stop Etoposide and Estramustine
6/18 starting new medication (unknown name)

Post Edited (LisaInIndiana) : 6/17/2018 11:22:06 PM (GMT-6)

Lisa,

Yes, my liver numbers came back in line (actually better than before) after several months off Zytiga.

I have also seen discussion that meds, after a break, may work for a while again. It is a long discussion, but has to do with how the PCa morphs to survive, which can make it susceptible to the meds again later. The Onco has talked about retrying Xtandi after chemo, if/when that fails.

Hello LisaInIndiana ~

I understand the feeling that you shared, in terms of "wanting to get started" on the next step treatment ...

I remember "counting down the days" until my chemotherapy treatments were finished up ... and then the next day, after I finished them, thinking to myself, "Now what?"

The same thing happened after I finished up radiation treatments. You count them down, day by day, and you're thankful to finish them up. But then that worrisome little thought in the back of your mind, "What treatment should I be starting next?"

We get used to the cycles and series of treatments ... and then sometimes the "quiet that follows the storm" after the treatments finish up leave us anxious and wondering what ELSE we should be doing to maintain our health goals.

Keep us updated on your dad --- we're all in this together!

CYCLONE ~ Iowa State Cyclone