Clive,

I fear that your father-in-law is at a point where
hormone therapy has started to fail and additional
hormone treatments are only likely to help for a
short time.

He might want to consider entering a clinical trial
of some new experimental therapies.  It is often
the case that a patient must be relatively healthy
in order to qualify for a trial, and your FIL may still
be in that state.

Here's what I think will likely happen if he enters
a clinical trial:

1. He likely will not be cured.  He'll probably die
of PCa, just as he would have without the experimental
treatment.  But trials are only conducted on therapies
that have shown some promise in animal tests, and it's
possible that he'll get some extra months of life and
there is always hope for a breakthrough and a remission.

2. He will be seen and treated by true prostate cancer
specialists.  The people doing research are likely to be
as smart, knowledgeable, experienced, up-to-date,
and committed to good medicine as anyone he
could see anywhere.

3. He'll get more attention than is usually the case at
most HMOs and private doctors.  The research doctors
typically see much smaller numbers of patients, perform
many more medical tests, and do very thorough followup
as compared with many HMO and private doctors.  I'm
not knocking HMO or private doctors.  They often do
an outstanding job.  But if they're not, a clinical trial might
be a place where he'll get a higher standard of care.

4. He may not have to pay for treatment.  Many clinical
trials are paid for by research funds.

5. He may get some satisfaction in knowing that other
patients will benefit from the research he participates in.

For more information, go to:
  http://www.cancer.gov/clinicaltrials

Best wishes to your father-in-law and the family.

   Alan

That's Casodex.  As I have heard it, Casodex does not reduce the amount of
testosterone produced but rather blocks the cancer cells ability to use what is
produced.  I am on Lupron and Casodex.  When my PSA one month after surgery was
12.5, I was put on Casodex to reduce prostate volume for raciation.  Casodex
brought the PSA down to 0.5 in two months.  Two years later my PSA went to 34
and they put me on Lupron.  Lupron is supposed to bring the PSA down less than
1, in fact less than 0.1, and keep it there for a median time of about three or
four years.   Your father and I became HR in well under that median time,
apparently.  There are chemotherapy treatments that can help, but they are all
in clinical trials.  Mine kept the PSA fairly level for almost a year.  Casodex
may keep your father's PSA down for several more months, then they try
something else.  Thalidomide might work, Leukine might work, adriamycin and
taxotere might work... Thalidomide prevents the growth of new blood vessels,
which starves the cancer, leukine stimulates the white blood cells to more
aggressive behavior,  adriamycin and taxotere makes you grow bald and lose your
fingernails and toenails, and kills cancer cells...

Casodex is a logical next step.  I believe it will be a trial and error
step.  His original PSA was not terrible, but that Gleason 10 is a real
worry.  It is not surprising that HT is starting to fail already.  But,
there are more alternatives and more coming out all the time.  He can expect
to be on different medications and therapies for the preponderance of the
rest of his life, but I imagine he still has some life to live.