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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2006Contradictory Opinions
My dad was diagnosed with Prostate cancer in Apr 2003. It had spread to his spinal cord at that time. But recently we found out that it has spread to other bones as well including skull and ribs. The team of doctors he is consulting with in India are divided over whether he should be administered Docetaxel Chemotherapy or not. The urologist feels that since Chemo has little impact on prostate cancer it is not the best approach for him at this time while others have suggested Docetaxel Chemo. They are also discussing pain medication using Sr 89 after he starts experiencing bone pains. Does anyone have experience with Docetaxel Chemotherapy and or Sr 89. Also will Zometa prove helpful in containing the spread further. Thanks in advance for any assistance. > My dad was diagnosed with Prostate cancer in Apr 2003. It had spread to > his spinal cord at that time. But recently we found out that it has > spread to other bones as well including skull and ribs. I'm sorry to hear this. > The team of doctors he is consulting with in India are divided over > whether he should be administered Docetaxel Chemotherapy or not. The > urologist feels that since Chemo has little impact on prostate cancer > it is not the best approach for him at this time while others have > suggested Docetaxel Chemo. Well, our urologist said that ADT for systemic prostate cancer is "controversial." It is not. I think that urologists are trained first and foremost as surgeons, and whatever he says beyond his specialty should not be given too much weight. My husband is taking Taxotere (docetaxel) for chemo. Docetaxel has been to be most powerful when given in 21-day doses (not 7). There are other items that go along with that, prednisone daily and more meds in the days before and after the chemo. We are also doing androget deprivation at the same time (although that will go on longer.) > They are also discussing pain medication using Sr 89 after he starts > experiencing bone pains. What has he had up to now? An androgen blockade should be effective for a fairly long time. You might want to join the P2P mailing list. It stands for Physician to Patient, and prostate cancer specialists answer people's letters. It is best to be as specific and detailed as possible with his history from diagnosis onward. > Does anyone have experience with Docetaxel Chemotherapy and or Sr 89. We have only had one Docetaxel treatment so far, so can't be much help. > Also will Zometa prove helpful in containing the spread further. There are whole arts and sciences involved in preventing further spread. Have you any books on prostate cancer? You might try the website www.prostate-cancer.org for much more information on these things. > Thanks in advance for any assistance. Please let us know what happens and write back either to the list or to me. Best regards, laurel > My dad was diagnosed with Prostate cancer in Apr 2003. It had spread to > his spinal cord at that time. But recently we found out that it has [quoted text clipped - 12 lines] > > Also will Zometa prove helpful in containing the spread further. I agree with urologist. If he has a tumour, chemo can sometimes shrink it. if he has no tumour causing problem, Chemotherapy won't go to the spine. Is it spine (bone mets?) or in the spinal column? or tumour on the spinal cord? Tell him to take his bone scan and see a radiation oncologist to evaluate which bones can be treated with that. Have to be careful with ribs not to hit lung or heart or esophagus. It's called "judicious radiation therapy". Palliation and can sometimes mend certain bone mets. NCI article here about bone mets http://cancerweb.ncl.ac.uk/cancernet/103857.html I don't know the answer about Zometa but you have to be careful your father is not killed by over-treatment the way this man's father was <http://groups.google.com/group/alt.support.cancer.prostate/msg/e8be2be4d030bd77?hl=en&> If you see an oncologist, they often only talk about chemo. Please get opinion from radiation oncologist. he'll probably also tell you that radiation therapy is better than SR-89 If your father's cancer is in his spine and/or brain, come to alt.support.cancer, please. J I meant to give you this link: http://www.prostate-cancer.org/mailists/mailists.html The P2P list is a service of prostate cancer specialist doctors. If you post your questions, please also at the top put a summary of all your data. Dates, test results, treatments, results, etc. Then put your questions below. It can be very helpful. > My dad was diagnosed with Prostate cancer in Apr 2003. It had spread to > his spinal cord at that time. But recently we found out that it has [quoted text clipped - 14 lines] > > Thanks in advance for any assistance. You never mentioned your fathers age and how he's been treated so far and what is quality of life has been up tp this point. Chemotherapy has not proven effective in most cancer patients with a success rate of about 2% to 4%. Often a patients quality of life will be much better without the chemo treatments. You might read this article from this link about one persons view of the effectiveness of chemo; http://www.jonbarron.org/newsletters/news050606.htm I understand that he has a bias by selling a product but his views are consistant with what my wife and I have seen and heard from patients and families that have taken the chemo route. All so far have said they wouldn't do it again if they had to do it over. On April 26, ronju99 wrote, in pertinent part: > Chemotherapy has not > proven effective in most cancer patients with a success rate of about 2% [quoted text clipped - 3 lines] > http://www.jonbarron.org/newsletters/news050606.htm > Rather than relying upon the views of someone whose qualifications are unknown and who is trying to sell a book, I’d like to see some hard science that supports the allegation of a 2 - 4% success rate for chemotherapy. One important question is, how exactly is “success” measured? Regards, Steve J "A man's most valuable trait is a judicious sense of what not to believe." -- Euripides > On April 26, ronju99 wrote, in pertinent part: > > Chemotherapy has not [quoted text clipped - 7 lines] > > One important question is, how exactly is success measured? Depends on the type (and stage) of cancer. Sorry you don't like books. "Principles and Practise of Oncology" by De Vita Perez, Principle of Radiation Oncology Probably both have basic and advanced principles of various cancers. There are also very good sections in the standard oncology texts like DeVita and Fletcher. There's courses http://infohost.nmt.edu/~biology/cancer.htm <http://www.ovc.uoguelph.ca/BioMed/Courses/Public/Pharmacology/pharmsite/98-409/C ancer/Cancer_notes.html> really what you need is some basics about cancer A 1 cm cancer is 1,000,000,000 cancer cells. (not visible on any scan). These cells have gotten past the immune system; they've mutated and are more robust than our regular cells. As it grows or as a cancer is hit by RT and/or chemo, the outer circumference of cells slough off; some of these cells have died and exit the body or are digested; the others have mutated more; they spread locally or through the lymph or blood system and even if 10 of them implant themselves somewhere and acquire a blood source, that's 10 more tumours that 1) start the growth process 2) are resistant to the first line of chemo. So it's important to remove the primary, where spread hasn't occurred (surgery). Or hit it hard in some cases, with RT (like head and neck cancers). And so for epithelial cell type cancers, by the middle to end of the 2nd line treatment, the cancer has become resistant. The choice is go to something stronger; which may or may not kill more cancer cells, but certainly harms normal cells or change the goal to palliation. Some patients feel better on some chemos, some feel worse. (usually the latter). We did have one pancreatic patient, who spent his year working and on chemo. The chemo stopped his diarrhea, he was getting thinner and thinner and losing muscle mass, and needed a few days (every 10 days to just sleep from fatigue) but he felt well on Gemzar. Advanced lung cancer patients - most just diappear on us, either soon after diagnosis or around the 2nd or 3rd line of treatment. (at last word - very fatigued, unable to lift their heads and continuing fighting with chemo). No quality of life. That last webpage shows some cancers that do tend to respond well to chemos, blood cancers (leukemias, lymphomas), germ cell cancers and some childhood cancers. You really ought to get a good book that explains it all from basics to the complex about cancers. Cancers haven't changed in their behaviour(s). That's why we continue to tell people (and it may always be) that for every 100 cancers cured, radiation cures about 45 and surgery about 52. J Cancer Biology Third Edition might be another one ...(check your library) Raymond W. Ruddon, Director, Eppley Institute, and Professor of Oncology, University of Nebraska Price: £35.00 (Paperback) 0-19-509691-6 Publication date: 30 November 1995 OUP USA 534 pages, halftones, numerous line drawings, tables, 253mm x 176mm Thorough yet concise account of cancer biology Description Cancer Biology is a thorough yet concise account of the basic cellular and molecular mechanisms involved in cancer cell behaviour, covering the transformation of normal into malignant cells; the invasiveness of cancer cells into host tissues; and the metastatic spread of cancer cells in the host organism. The third edition includes completely new chapters on genetic alterations in cancer cells, tumour suppressor genes, transcriptional regulation, growth factors, and signal transductions mechanisms, cell cycle regulation and apoptosis, gene-targeted therapy for cancer, and cancer prevention. Quoting me: >> On April 26, ronju99 wrote, in pertinent part: >> [quoted text clipped - 10 lines] >> One important question is, how exactly is “success” measured? >> “J” then posted a lengthy and rather patronizing reply that failed to respond to the issues I raised above. When one posts an assertion that “A” is a fact, it is the poster’s duty, not the reader’s, to supply documentation. “J” has not done so and I must therefore conclude that (s)he cannot. I am finished with this thread. Regards, Steve J "What are the facts? Again and again and again -- what are the facts? Shun wishful thinking, ignore divine revelation, forget 'what the stars foretell,' avoid opinion, care not what the neighbors think, never mind the unguessable 'verdict of history' -- what are the facts, and to how many decimal places? You pilot always into an unknown future; facts are your single clue. Get the facts!" --Lazarus Long > Quoting me: > >> On April 26, ronju99 wrote, in pertinent part: [quoted text clipped - 16 lines] > When one posts an assertion that A is a fact, it is the posters duty, > not the readers, to supply documentation. That is false; I provided you a list of some books to read. > J has not done so and I must therefore conclude that (s)he cannot. > > I am finished with this thread. Many have preconceived ideas about chemo and won't let go of them. You've heard from Peter Moran and Steph; both experienced doctors about and with cancers. And the doctors in the "The contribution of cytotoxic chemotherapy to 5-year survival in adult malignancies" analysis. And results of clinical trials. As expected, you just plain don't want to learn nor accept. Sorry if I seem patronizing to you, but I seem to know more about cancers than you do. Contact Dr Ling in BC http://www.cancer.ca/ccs/internet/mediareleaselist/0,3208,3278_437890_419967126_ langId-en,00.html or ask your own oncologist about a book about how cancers grow which also covers chemo resistance. J J referenced: > Perez, Principle of Radiation Oncology Great. Googled it, as I may need RT someday. WHOA! $300, plus this rather discouraging book review: "Perez has a similar place in radiation oncology as Devita does in medical oncology. It is a comprehensive coverage of the whole field and provides a radiotherapists eye-view of the world of cancer. Its strengths are the comprehensive nature of the work, the reasonably complete treatment details as well as expectations for outcome and toxicity. Its weaknesses are the sometimes limited coverage given to other treatment modalities, the disappointing lack of discussion on late toxicity, and the dreadfully boring prose. For the oncologist interested in a more readable but still solid coverage of the field I would recommend Cox (the broad brush strokes) or Liebel (the nitty gritty too) over this book" But that got me pursuing similar textbooks. Sadly, reviews of them are not too encouraging for us laymen/patients. I'm very tired of wading through even books like Walsh; a thousand pages of medical prose sounds like a real QOL issue all by itself. ;-) Most of these reviews emphasize that these books are for physicians and oncology residents/students. > really what you need is some basics about cancer > You really ought to get a good book that explains it all > from basics to the complex about cancers. NOW you're talking. What source would you recommend that falls between the usual laymen's PC books and these professional tomes? We need practical decision-making information, not physics equations. I.P. > But that got me pursuing similar textbooks. Sadly, reviews of them are > not too encouraging for us laymen/patients. I'm very tired of wading [quoted text clipped - 10 lines] > the usual laymen's PC books and these professional tomes? We need > practical decision-making information, not physics equations. all good points. There's a book being written (not by me) as we speak that will probably fit the bill. It will have some equations and graphs. It will explain differences between many of the commonest cancers. Treatment modalities. Side effects Support Alternative therapies Clinical trials Prognosis Individual vs populations 5 year survival and cure Odds of recurrence Recurrence Persistence New primary Quality of life decisions. negligence honesty and full disclosure and so much more. I do not know if it will cover longterm risks of current treatments, but in order to get to that point, first one must survive the original cancer, so it's often an issue more for kids' treatments; ie depends on the age of the patient at diagnosis, while it is recognized that once a person is diagnosed with one cancer, they're often at risk for another cancer later. That might be mentioned - has to do with DNA damaged cells (whether inherent in the individual and/or from treatments).. I do not know if it'll cover issues such as impotence (indepth) - short and long term. Some of our (alt.support.cancer's) more frequently asked questions are: how long will I live if I choose no (surgery, or RT or chemo)? how will I know I'm dying (near the end)..ie what's the prognosis? how will I die? I don't think these issues will be in the book. How will i know when to stop treatments? (I think that will be covered extensively) What can I expect chemo to do (and not be able to do) - ditto Which cancers respond best to chemo - ditto curative treatments vs palliative treatments - ditto. which cancers respond best to RT - ditto which cancers do not respond to either (ie surgical cure is the only way) - ditto There will probably be a section on newer chemos (not sure) Unfortunately I'm not at liberty to say more. Unfortunately I do not know when it will be completed. I do not know if a publisher will pick up on it. I have to think that the public will want it. I have to think that it will be much less expensive, but part of that depends on contracts and how many will be printed up. And unfortunately, it's not ready now for the newly diagnosed, but I can tell you one thing for sure. I will be one of the first to buy it. I (or if I'm not around, someone else) will let this newsgroup know. J > There's a book being written (not by me) as we speak that > will probably fit the bill. SNIP > I will be one of the first to buy it. That sounds like a book most of us would highly recommend. Encourage your colleague to keep at it so you and I can jostle for first place in line. I.P. I am sorry about not giving enough details. He is 62 years old and was first diagnosed with Prostate cancer on April 2 2003, that showed bilateral hydronephrosis with significant retroperitoneal adenopathy. His PSA was above 100ng/ml at that time and he went through orchiectomy and was initiated on Casodex. That brought his PSA down to 2.86 ng/ml. Since the spread of cancer was on his kidneys too, he underwent placement of ureteral stenton in April 2003 (and it is changed every six months since then). He required palliative radiation to L4-L5 in Dec 2003 and his casodex was discontinued on Feb 2004. He had been doing reasonably well, despite the increase in his PSA to 42.52 ng/ml in Sep 2005. He was re-started on Casodex in Jun 2005. The bone scan performed on July 22 2005 showed increased tracer uptake in L5 vertrebra and Rt Pelvic bone. He required radiation therapy to Rt. Pelvic bone in Aug 2005 due to acute pain in that region. Last bone scan done on April 3 2006 brought the worst news, that the cancer has spread to skull, shoulders, ribs in addition to spine and hips. Also some x-rays showed traces in his lungs. He is currently not feeling much pain so we are confused if we should wait until the bone pains start to give pain medication or start taking chemo now to slow down the spread. Once again thanks for all you opinions. It's a very controversial topic particularly between "approved" treatment and clinical trial treatment. Regardless of what others say, I will tell you my experience. With PSA at 32.4 and two metastatic spots on my spine and failed radiation, I entered a trial with an alternating course every 8 weeks of: doxorubicin (IV) & ketoconazole (oral) paclitaxel (IV) and estramustine (oral) hydrocortisone daily for 6 months after completion of the chemo started Casodex for 9 months Eligard (Lupron) for 2 years Chemo lasted six months, hormones for two years. I am in the 21st month of treatment. PSA is 0.1 and the two mets on my spine are gone and replaced with new bone growth. The mets disappeared after the chemo. The study group has been published. Enrollment is ongoing. Further information on PSA response, radiographic response, and toxicity will be forthcoming. To date the median PSA reduction has been 95.6%. The group is made up of 50% Gleason 7, 12% - 8, 24% - 9, and 5% - 10. 35% with bone metastasis and 50% with nodal involvement. I am 59 years of age. I wish your Father the best. My suggestion would be to seek out a Medical Oncologist who specializes in Prostate Cancer. Mike > My dad was diagnosed with Prostate cancer in Apr 2003. It had spread to > his spinal cord at that time. But recently we found out that it has [quoted text clipped - 14 lines] > > Thanks in advance for any assistance. Hi Mike, Just wondered where you got your treatment from and how was your quality of life affected while you were going through the chemo and how is it now that you are on hormones? Ron S.
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