lupron & chemo anyone???

You've had more than your share of problems. What can one do? Just deal with them as they come.

I assume your doctors have ruled out (by bone biopsy) that the Valley Fever has infected your bones and is showing as lesions on the bone scan.

Fluconazole, aside from being a potent anti-fungal, is a member of a class of drugs (azoles) that includes ketoconazole, which has been used for many years against prostate cancer because it blocks the enzymatic conversion of cholesterol into testosterone. Recently, another member of this class, itraconazole, has shown potency against some cancers because it additionally inhibits something called the "hedgehog pathway" that cancer cells may use to grow and replicate. They also block liver enzymes responsible for metabolizing quite a number of different drugs, so be sure your oncologist is well aware that you are taking it for another purpose. Switching to Itraconazole or Ketoconazole may do double-duty for you, if they can cure your Valley Fever as well.

Most men who take Taxotere, the primary kind of "chemo" used with prostate cancer, also continue to take Lupron (or a similar drug) as well. An open question is whether there's a benefit to also adding in other medications into the cocktail at this time. There are clinical trials to investigate that.

If you're having pain from bone mets, I hope your doctor is talking to you about radiation. One large dose may be enough to do the trick. Another option is Xofigo, which irradiates them from the inside. You are probably also taking Zometa or Xgeva to prevent fractures and spinal compression.

Another option to discuss with your oncologist is whether to de-bulk the primary tumor by removing the prostate. This might relieve the need to have a catheter in and seems to sometimes slow the spread. This is controversial and involves a thorough discussion of pros and cons with your oncologist.

I hope you are seeing a good oncologist, preferably one who specializes in urologic oncology. He also may be able to plug you into some very promising clinical trials.

- Allen