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PSA down w/HT now going up 4mo. Dr. Prescribed Casodex?

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Posted 12/8/2013 10:43 AM (GMT 0)
Looking for suggestions. Started at high of 49PSA, lowest was 7 after 3 treatments. Then 11 at 4mo. Now 17??? Dec 4th. Dr. Suggested beginning Casodex, said Tumors can "start producing testosterone themselves"? My husband is wanting to be "conservative" in his treatment, I'm a little concerned and think we may need to get "on top" of this before it gets more out of control. See signature below for diagnoses.
Thank you all and God Bless.
Posted 12/8/2013 12:22 PM (GMT 0)
Dear Barb, I wanted to write to confirm to you that your approach (being agressive) is the most appropriate attitude for keeping your husband alive for a long time. Your husbands cancer is aggressive - it has acquired the ability to move outside of prostate, and for that to happen, it takes many mutations. Therefore his treatment has to be agressive. Even if your husband had NO treatment, he would live for many years, however, since his bone scan is clean I think you have a very narrow window of opportunity to "chase" down this cancer. C11 acetate scan or Feraheme MRI are scans that may reveal which lymph nodes are affected, and that would give you then a target to treat with radiation. These scans are not widely available, so this is the road less travelled, but some HW members have travelled it - I do hope they chime in.
I have seen many profiles of PC patients, and one thing that is common among those that have survived longer than the seriousness of their disease would indicate, is that they are always one step ahead of the disease. The power of knowledge goes a long way. There are a handful of PC experts in the US, and I mean top-notch. These are doctors that treat an individual and not only follow the protocol. Following a protocol is all right, this is how our Western medicine functions, however, PC is a disease that shows so many different faces, that you need a doctor to discover exactly what kind of enemy your husband is facing (genetic testing, etc). Dr.Myers, Dr. Scholz, Dr.Logothetis are some of the names that come to mind.

Best to you and your husband.
Posted 12/8/2013 1:59 PM (GMT 0)
Barb what you are being told comports with what Dr. Charles "Snuffy" Myers said in one of his weekly when Zytiga and Xtandi were new on the scene in 2012.

askdrmyers.wordpress.com/page/11/

I just had occasion to re-read it during an on-line exchange with the Wampuscats. Here is an excerpt from Dr. Myers' article

"While it is approved for use after chemotherapy, Xtandi is a form of hormonal therapy. It works by disrupting the function of the androgen receptor through which testosterone and dihydrotestosterone exert their effects on prostate cancer. This drug works after chemotherapy fails because even at that stage between 80-90% of cancers are still dependent on the androgen receptor. The discovery of this fact is revolutionizing prostate cancer treatment. When drugs like Lupron and Casodex have failed, the cancer is not in fact hormone resistant. In fact, the cancer has adapted by becoming even more sensitive to testosterone. This cancer can change to grow at testosterone levels 1/100 to 1/1,000 of that found in a normal adult male. Lupron and Casodex fail because they are not powerful enough. Prostate cancer accomplishes this by several different mechanisms. Prostate cancer cells can make their own testosterone, making them independent of outside sources. The cells can increase the amount of androgen receptor so that it traps enough testosterone to continue to grow, like using a larger sail in a light wind. The cancer cells can also change the androgen receptor so that it treats Casodex or Eulexin as if it were testosterone, so that drugs that are used to block testosterone now act as if they were testosterone! This is why some patients respond when Casodex is stopped. Finally, the androgen receptor can be altered so that it is activated with little or no testosterone. The end result of all of this research is that we now know that it is quite uncommon for prostate cancer to become androgen independent. This led to a blossoming in research to find drugs able to restore hormone-responsiveness in men with advanced prostate cancer."

LupronJim
Posted 12/8/2013 6:07 PM (GMT 0)
I'm not a big believer in the "sequential" approach; i.e., try A until it fails, then try B. PC will always evolve to meet each challenge. I prefer a "cocktail" approach -- challenge the cancer from several directions at the same time.

In your previous thread, I suggested some clinical trials he may be eligible for that would do this. There's also some evidence that chemo with Taxotere started earlier may work better. You can hit it with additional hormone therapies (e.g., Zytiga, Xtandi), chemotherapy (e.g., Taxotere), growth factor inhibitors (e.g.,cabozantanib), angiogenesis inhibitors (e.g., Tasquinimod), and Xgeva for bone mets, should they occur. MD Anderson is famous for their involvement in clinical trials, particularly Dr. Logothetis - you can ask for a consult.

Have you discussed pelvic radiation as a first step?

Have you let your doctor know that you want to get more aggressive?
Posted 12/8/2013 6:59 PM (GMT 0)
Thank you all for your input. One dr. We consulted had initially recommended IMRT. But after reviewing his scans said the cancer was too extensive and would cause more damage than good. Then just recommended just HRT for now. But, since PSA not coming down to ideal level and now going back up so soon. Onc. At MD Anderson suggesting starting chemo drug. Another we are consulting has recommended trying Casodex first to see if this helps with the receptors and getting Testosterone and PSA to respond. MRI done a couple weeks ago does show lymph Tumors have gotten somewhat smaller. Good news, but with PSA active Dr. Feels there is still some "lil buggers" trying to pull a fast one. Anyone seeing Dr. Myers and having success at Gleason 9?
Posted 12/8/2013 7:14 PM (GMT 0)
Tall Allen, yes Taxetore is what Onc. Suggested. Since Tumors are responding in size, husband wants to hold off. But, concerned about PSA rising. Feels great other wise. I think he's fearful of side effects of chemo since he is feeling so good. Doing some other "alternative" treatment to strengthen and build immune system.
Special Lady, I will check out the scans. Have heard there can be micro matastisis that can cause the PSA to elevate.
Thank you for all advice as we are still early in this journey.
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