Thanks for posting this.  This is an excellent and very understandable
article.

You've Been Diagnosed With Early-Stage DiseaseYour PSA Is Rising After
Initial TreatmentYour PSA Is Rising During Hormone Therapy

What to Consider When Your PSA Is Rising During Hormone Therapy

This section summarizes key points to consider when your PSA is rising
while undergoing hormone therapy. The list is by no means exhaustive,
and there might be other points that you want to think about as well.
The goal is to help you focus on what you need to know about each stage
of disease so you can hold meaningful, regular dialogues with all
members of your health care team as you find the treatment path that's
right for you.

1) A rising PSA during hormone therapy doesn't mean you're out of
options-it means you need to consider the use of other systemic
therapies such as chemotherapy or agents that target prostate cancer
bone metastases.

2) The primary goal of chemotherapy is to stop the cancer cells from
dividing and the cancer cells from growing. But when we look at whether
a drug is working, there are generally two levels of
effectiveness-whether a drug is palliative, meaning whether it can
alleviate symptoms, and whether it can affect the cancer cell growth
significantly enough to prolong life.

3) The benefits of chemotherapy in prostate cancer were only first
realized recently: mitoxantrone (Novantrone) was approved by the FDA in
1996 when it was shown to provide palliative benefit to men with
advanced prostate cancer; docetaxel (Taxotere) was approved in 2004 when
it was shown to prolong the lives of the men who took it and relieved
symptoms better than mitoxantrone.

4) Although all chemotherapy drugs are designed to slow or stop the
growth of cancer cells, each one tends to work in a slightly different
way, and using two or more together or one after another in a row can
often be more effective than just using one drug alone.

5) Pay close attention to your reactions to the different chemotherapy
drugs. You're the only one who really knows your own body, so you're the
only one who can know whether you are able to tolerate a particular
treatment regimen.

6) Don't be too tough or "macho." There are plenty of drugs available to
help ward off or treat the different side effects of chemotherapy.

7) Focus on yourself. It doesn't matter what you do, as long as it can
help you relieve stress and can help you with the most important part of
your cancer treatment-getting well.

8) Prostate cancer cells that have spread beyond the prostate seem to
prefer bone tissue and tend to migrate there after escaping the pelvic
region. Once the cells settle in, they're known as prostate cancer bone
metastases. Unlike bone cancer, which originates in the bone, prostate
cancer bone metastases are actually collections of prostate cancer cells
that happen to be sitting within the bones.

9) When prostate cancer cells settle in the bones, they interact with
the bone cells, causing new bone cells to grow and causing the bone
tissue to break down. The dye-like material that's injected during a
bone scan highlights areas of bone metabolism or activity-areas where
bone tissue is changing more rapidly than it normally would in a healthy
adult male.

10) Men who experience pain from a bone metastasis will often be treated
with radiation targeted directly to the metastasis or with
radiation-emitting drugs that settle in the metastasis after being
injected through a vein. The radiation will kill the prostate cancer
cells in the metastasis and thereby relieve the pain.

11) Bisphosphonates are drugs that are designed to help reset the
balance in the bone between bone growth and bone destruction which is
disrupted by the prostate cancer bone metastases. Zoledronic acid
(Zometa) is a bisphosphonate given intravenously that can delay the
onset of complications associated with prostate cancer bone metastases
and relieve pain. It is typically given once every three weeks as a
15-minute infusion.

12) As the bones in the spine weaken, they can collapse one of top of
the other, compressing the spinal cord and the nerves that run out from
it. Cord compression associated with metastatic prostate cancer can
cause serious problems if not managed immediately, so be sure to tell
your doctors about any new pain, weakness, or changes in bowel habits,
any of which can result from spinal cord compression.

13) Cancer can be painful, and there's no benefit in acting stoic and
pretending it doesn't affect you. There are plenty of very effective
pain medications available, and using them will allow you to feel better
and stay stronger.

14) Don't assume that you can't get pain relief unless you're completely
doped up. Some very simple and easy to take oral medications might be
enough to ease your pain.

15) Don't worry about becoming addicted to pain medication. Taking pain
medications so that you can spend your days feeling healthier and
stronger is the opposite of addictive behavior. However, both physical
dependence and tolerance are possible as your body starts to get used to
the drugs, so you and your doctors should take them into consideration
as you start and stop different pain medications.

16) Consider enrolling in a clinical trial of an experimental new
treatment or regimen. Clinical trials are the only way that new and
better treatments will be developed and tested appropriately.

knowledge is power - growing old is mandatory - growing wise is optional
"Many more men die with prostate cancer than of it. Growing old is
invariably fatal. Prostate cancer is only sometimes so."
http://community.webtv.net/PALMER_ENT/doc

Dear Curtis,

Thank you so much for this.  Some of this info is hard to swallow, but
in this case, ignorance is not bliss.  So you have done a public
service.

I don't know much about this, but I was looking into clinical trials
yesterday at clinicaltrials.gov.  There were very many studies
ongoing, and most involved metastatic cancer.

The reason i was looking into this is that I have a fantasy that if
you participate in a research study you will get more attention from
the medics?

Anyway, it's definitely worth a look.  I printed out two studies
involving vaccines that my husband would qualify for here in NY.  One
is at Rockefeller U., which is a collection of geniuses.  However, we
are not at that point yet.

I think Google is screwing up this msg. but I'll give it a try.

I also appreciate your mentioning that there are medications that can
alleviate the pain of advanced PC.  Some people make it sound
otherwise.  What about Fentanyl?  I think it's 100x more powerful than
morphin.

I think that's what they gave me to put me out when I had an
endoscopy, and i call tell you that it was absolutely blissful.

Best to you all.

Leah