Have you ever heard of this treatment plan?????

Hi everyone.as u see fromm the signature my dad has been goinh through many treatment. And now is on docetaxel.chemo.
His psa has rised to 62 . he had a meeting with an oncologist today and she said that he has to start taking Casodex(once a day) and Zoladex (every 3 months) and zometa and she booked him for a chemo session next friday.

Does it make sense? He was on hormone therapy before casodex+zoladex and he had orchiemetry so he stoped using zoladex.

Please guys do you have an explication for this treatment plan . i don't understand why she want to put him on casodex and zoladex.

Thanks for your help

Having had the orchiectomy, that should eliminate the need for any ADT drugs.

Ask your oncologist if he meets the definition of "Hormone Refractory" or not..If he IS hormone refractory, then he should be able to get Zytiga or Xtandi which work similar to Casodex but are 10 or 20 times more effective...If you need help with co-pays, there are Foundations (set up by the drug companies) that can and will help you....If it turns out it's your insurance company that's putting up roadblocks, YOU call them directly and ask them why they are interfering with your fathers treatment..

Casodex is an "anti-androgen" and zolodex is a "LHRH agonist" which is are often prescribed as a part of a "hormone therapy" regimen.

So I believe what you are questioning about is whether continuing the casodex and or zolodex after an orchiectomy makes sense. The answer is that it might, if the orchiectomy or LHRH agonist is unable to keep testosterone levels at sufficiently low levels...which sometimes happens. Orchiectomy will stop testosterone from being produced in the testicles, but this does not eliminate the testosterone produced by the adrenals. about 90% of testosterone is produced by the testicles. So orchiectomy (alone) is an effective solution to blocking testosterone release in many (not all) cases.

Double check this, of course, with the oncologist.

Here's some pretty technical reading: http://www.europeanurology.com/article/S1569-9056(06)00358-7/fulltext/advanced-prostate-cancer-hormones-and-beyond

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added later as an edit

The link I provided earlier was pretty complicated; here's a more readable one:
www.ijbs.com/v10p0596.htm

Post Edited (JackH) : 6/13/2016 12:49:33 PM (GMT-6)

Is this a new doctor? Perhaps the doctor forgot about the orchiectomy? His T is already at castrate level. They often give metastatic men Casodex at the start of Zoladex to prevent a testosterone flare, but that would not apply to men who've had an orchiectomy. It might be a good idea to call and remind her of that fact. I think she didn't read his chart properly.

What I'm saying is - make sure she understands that he has had an orchiectomy. Doctors are human and a reminder could not hurt. This should be explained to your satisfaction.

laila,

Good thing he said something!

I forgot what country he's in - which of the following medicines are available to him there?
- Xtandi (enzalutamide)
- Zytiga (abiraterone acetate)
- Provenge (sipuleucel)
- Zometa (zoledronic acid) or Xgeva (denosumab)
- Celebrex (celecoxib)
- Jevtana (cabazitaxel)

In the US, docetaxel is given intermittently in 18-week cycles. It sounds like he has become docetaxel resistant. Jevtana (cabazitaxel) was specific developed for this situation. Perhaps it is available in Morocco?

If he can get Zometa plus Celebrex, that has shown to be an effective combination.

If he can get Zytiga and prednisone, that may work for him too.

If the bone mets are painful, radiation can help. Xofigo is useful too, but it probably isn't available there.

- Allen