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Medical Forum / Diseases and Disorders / Prostate Cancer / April 2008At what point is chemotherapy usually begun?
I have a slowly rising psa the past several months. I also have lung nodules which have not grown larger since I added Casodex to my Eligard injections. I will be going to the oncologist in a couple of weeks. My psa had gone up from 1.0 to 1.3 when I visited with him the last time. (All of my scans and even an MRI of thorasic and lumbar spines showed no metastatic growths. As far as can be ascertained, the metastases are all in the lungs. Do you think lung scans will be the determiner, or will the psa readings? One other question....I have not been able to find any discussion of prostate cancer nodules in the lungs. Do they tend to metastasize to the brain,or elsewhere? Finally, is taxotere an effective chemotherapeutic agent? My wife's husband has had prostate cancer for a long time and now he is hormone refractory. He is 90 and says he will not take chemo. (How much time would the chemo buy him? Would it relieve the pain if he did take it?) Excuse the rambling. Ralph "slight" correction in my initial post------I said, "My wife's husband!!..I meant to say---My wife's friend's husband , etc....... uhhhh! /....snip >Finally, is taxotere an effective chemotherapeutic agent? My wife's >husband has had prostate cancer for a long time and now he is hormone [quoted text clipped - 4 lines] > >Ralph Don't know the answers to your first paras. But your headline question was the title of the DVD discussion among specialists for which Steve Jordan recenly gave the URL http://tinyurl.com/266q9u They were quite reassuring about taxotere! (It's a 'natural product'- the bark of a tree ...just another drug in hormone theapy... tra la la la) but the presentation was with humour and very clear. MMikeHi On Mar 29, 11:03 am, Mik...@anon.co.uk wrote: > >... He is 90 and says he will not take chemo. (How much time > >would the chemo buy him? Would it relieve the pain if he did [quoted text clipped - 4 lines] > for which Steve Jordan recenly gave the URL > http://tinyurl.com/266q9u ... That's a great video. What I concluded from it (perhaps incorrectly?) is: 1. Earlier chemotherapy appears to contribute more to long term survival than late chemotherapy. 2. The response to chemo is highly variable. Some men benefit a great deal and some not at all. 3. Tolerance to chemo is variable. Some men have no trouble with many treatments, some can't stand the side effects after a fairly small number. 4. There can be palliation of pain, but see point 2. Some men benefit and some don't. 5. Medical thinking about chemo is divided and confused. Not enough trials have been done and not enough different combinations of early and late treatment have been tried. 6. Chemotherapy requires good supportive care. The patient needs a doctor who will help with the side effects and not just infuse the chemo and send the patient home. Alan One point I'll add to what I've said above is that all of the six conclusions I drew seem to hold for ADT as well. Early is better than late. Response varies by patient. Toleration of side effects varies by patient. There can be palliation of pain. Medical thinking is divided about early vs. late. Good supportive care helps. Alan Given > Medical thinking is divided about early vs. late., how do you justify > Early is better than late? I.P. > Given > [quoted text clipped - 5 lines] > > I.P. I.P., Alan and RL- I also have nodules on my lungs (metastasized PCa), but am asymptomatic, and was told by my doc at M.D. Anderson in Houston that there are no studies to show starting chemo sooner rather than later would increase my life expectancy. -Les On Mar 31, 3:09 am, alv...@gmail.com wrote: > > Given > [quoted text clipped - 14 lines] > > -Les I.P. and Les, When I said early is better than late referring to chemotherapy, I was attempting summarize what I thought I heard in the video at the PCRI website. What Les' doctor at M.D. Anderson said appears to be true. The objective studies that could confirm this are still underway. A couple of the doctors on the panel pointed that out. Nevertheless, it was my impression that the majority of the panel thought that chemotherapy could be more effective if applied earlier, that there was already some evidence for this even if a conclusive trial had not yet completed, and that very few urologists understood what the chemotherapy studies completed so far actually showed. As far as ADT is concerned, there have been other studies cited especially by Steve Jordan and Ralph on this newsgroup that appeared to show that earlier is better (in the sense of contributing to longer life) than later. My own radiation oncologist at NCI told me the same thing. I recommend that people interested in the chemotherapy debate watch the video at: http://tinyurl.com/266q9u and draw their own conclusions. It's an interesting video, worth watching. Alan >I also have nodules on my lungs (metastasized PCa), but am >asymptomatic, and was told by my doc at M.D. Anderson in Houston that >there are no studies to show starting chemo sooner rather than later >would increase my life expectancy. > >-Les I would be glad for help with the definition of 'symptomatic' and 'asymptomatic' in PCa. To some extent its linked with the use of the word metastasis. I thought I knew now I'm not sure. Especially with Lud's email: he has nodules in his lung but is 'asymptomatic'. One definition of 'symptomatic': .. 'a disease is symptomatic when it is at a stage when the patient is experiencing symptoms.' Wilkipedia Medlineplus http://www.nlm.nih.gov/medlineplus/ency/article/002293.htm introduces (for me) a note of confusion: ....'Symptomatic can mean showing symptoms, or it may concern a specific symptom.' Lud has got nodules on his lungs. Is there a 'specific symptom' required in Pca which means Lud is metastasised, yet is also 'asymptomatic'? I can't get my little head round that! I have two nodules in my lymph gland. I assume I have metastasised? Am I symptomatic? if not, when? Much thanks. Very best of luck Lud for whenever they start and keep in good nick Gourd Dancer (your chemo results so great, well done). Very best wishes to all. MikeHi On April 3, MikeHi wrote: A discussion of "symptomatic" and "asymptomatic." Here's the Medscape Medical Dictionary definition of "symptom:" "subjective evidence of disease or physical disturbance observed by the patient <headache is a symptom of many diseases> <visual disturbances may be a symptom of retinal arteriosclerosis>; broadly : something that indicates the presence of a physical disorder" Regards, Steve J > On April 3, MikeHi wrote: > [quoted text clipped - 6 lines] > may be a symptom of retinal arteriosclerosis>; broadly : something that > indicates the presence of a physical disorder" That's how I've always understood the term, with the emphasis on "subjective" and "observed by the patient". PSA, x-rays, etc., might indicate the presence of a physical disorder, but they aren't obvious to the patient. "Symptoms" of PCa would be things like pain, shortness of breath, weakness, difficulty urinating, etc. Alan > I have two nodules in my lymph gland. I assume I have metastasised? Am > I symptomatic? if not, when? Symptomatic: We can feel it. Asymptomatic: We can't feel it. I.P. >> I have two nodules in my lymph gland. I assume I have metastasised? Am >> I symptomatic? if not, when? [quoted text clipped - 3 lines] > >I.P. Thanks I.P., Steve, and Alan - simple, and perfectly clear now. Best regards and wishes to all. MikeHi Mike - Precondition for my going on Taxotere were that I was hormone refractory (using Zoladex and Trans Dermal estrogen) and I had a suspicion of bone metastisis. My oncologist felt I should not start Chemo until I was symptomatic, the cancer was causing actual physical problems (no mention of mental anguish) but I pushed for early Tx and she agreed. I had only 3 cycles (once every 3 weeks) because I had some bad side effects, I had to stop. Luckily it did drop my PSA from 8 down to 3. The I pushed for LDK and that worked even better. Just can't tell what will work from the studies - trial and error seems best. My view is to get whatever treatment a patient is willing to try and is prepared to live through/consequences without regrets. At this point in time there are not enough studies to give clear guidance as to what will best for any individual patient. It's a bummer Mike and we have to make the choice with inadequate information. As I was told -' it is the practice of medicine' not the science. Lud ~~~~~~~~~~~~~ On Apr 3, 4:24 pm, Mik...@anon.co.uk wrote: > >I also have nodules on my lungs (metastasized PCa), but am > >asymptomatic, and was told by my doc at M.D. Anderson in Houston that [quoted text clipped - 28 lines] > > MikeHi > ... I had only 3 cycles (once every 3 weeks) because I had > some bad side effects, I had to stop. ... What were the side effects Lud? Were they life threatening, or did they just make you wish you were dead? > ... Then I pushed for LDK and that worked even better. What's "LDK"? > ... Just can't tell what will work from the studies - trial and > error seems best. I think that's because of the huge variability in cancers. As I understand it, cancer is caused by damage to DNA inside cells (due either to exposure to damaging factors like radiation or carcinogens, or just to old age). Each person's damage can be different, altering or completely destroying a somewhat different set of genes. As a result, different people, and even different tumor cells within one person, will react differently to different treatments. For that reason, I think a patient is best served by a medical oncologist who is knowledgeable about as many treatments as possible, and who is willing to keep trying different ones if one doesn't work or stops working. > My view is to get whatever treatment a patient is willing to > try and is prepared to live through/consequences without > regrets. Yes. > At this point in time there are not enough studies to give > clear guidance as to what will best for any individual patient. > It's a bummer Mike and we have to make the choice with > inadequate information. As I was told -' it is the practice of > medicine' not the science. Alan On April 5, Alan Meyer inquired, in pertinent part: > What's "LDK"? Low Dose Ketoconazole. Brand name is Nizoral. Its "label" use is, believe it or not, as an antifungal med. It does, however, have an effect of lowering testosterone. It can be considered to be a form of ADT. It is prescribed in both low- and high-dose regimens. For an excellent essay on the subject, written by one of the best med oncs in the world, see http://www.prostate-cancer.org/education/andeprv/Lam_HDK.html Regards, Steve J > see http://www.prostate-cancer.org/education/andeprv/Lam_HDK.html Thanks Steve. Looks like a good article. Alan Did ya'll notice that I took 400 mg of ketoconazole three tmes a day for 1200 mg a day each week along with the one infusion of doxorubicin a week. This was for three weeks, then alternated with paciltaxel and estrusitime for three weeks as one course - repeated this process three times for a total of six months. Yes keto is an antifuncal is low doses, but has PCa killing properties in high doses. GD > On April 5, Alan Meyer inquired, in pertinent part: > [quoted text clipped - 15 lines] > > Steve J On Apr 5, 5:00 pm, "Gourd Dancer" <!!!msheets!!!@!!!sbcglobal!!!.net> wrote: > Did ya'll notice that I took 400 mg of ketoconazole three tmes a day for > 1200 mg a day each week along with the one infusion of doxorubicin a week. [quoted text clipped - 6 lines] > > GD In previous post you mentioned an 8 week cycle - that is 6 alternating weeks repeated 3 times for a total of 18 weeks. or is it 8 weeks repeat 3 x for 24 weeks? Then were weeks 7 and 8 off Tx for recovery. How did you survive this? - or is it to painful to recall? Lud Typo, eight week course is correct three times. I never thought about it as painful, just a pain in the a.s. But given the alternative, stayed the course. Keto doses aggravated nausea in my opinion, but took Zofran to counter. Yes, I was glad when it was over. But the point is that one has to decide for himself if side effect threat is more important than living..... GD > On Apr 5, 5:00 pm, "Gourd Dancer" <!!!msheets!!!@!!!sbcglobal!!!.net> > wrote: [quoted text clipped - 18 lines] > > Lud > > ... I had only 3 cycles (once every 3 weeks) because I had > > some bad side effects, I had to stop. ... [quoted text clipped - 5 lines] > > What's "LDK"? ...... > Alan By the 3rd cycle, I had learned to manage the side effects but had a debilitating back pain for a few days (unrelated). The meds I received really upset me and I could not continue. I found the initial standard dose of 75 mg/m2 skin area (average person has 2 m2 giving a dose of 150 mg) was too high and the onco reduced it to 60 but it seemed it could be lower. Standard med doses are often too high for me. Cycle 1 - neutrophils went to 0 in 7 days and developed a severe case of thrush (white fungal mouth) and ended in hospital for 6 days on ABX- IV (IV anti-biotics) until neutrophils started to come back up. Also hemoglobin was dropping. Cycle 2 - Aranesp shots kept my white blood cells from disappearing, good oral hygiene kept the thrush down but not the sore throat and my hemoglobin dropped further. Started getting mild neuropathy on the bottoms of my feet. Cycle 3 - Aranesp for white blood cells, Procrit for red blood cells and ice cubes in my mouth kept thrush and sore mouth away. I wasn't knowledgeable enough to bring my own ice cubes so I contracted a throat infection (viral) that was going around at that time (despite high white blood count). That delayed my next cycle and then the back problem so Taxotere stopped there. Most studies on Taxotere were based on once every 3 weeks (q21) but in consultation with Dr Sartor, he said that he looked at the data and found that Taxotere weekly for 3 weeks and 4th week off was as effective as q21. The 3 cycles of Taxotere dropped the PSA from 8.6 to 3 (rate of drop was 50% in about 3 months) On LDK (low dose ketoconazole) 200 mg BID, dropped the PSA from 16.4 to 1.4 from May to Dec last year (rate of drop for 50% was about 1 month - with a break). Without trying different drugs and combinations, there is no way of predicting what will work especially after it becomes hormone refractory (that was July-04 for me). I found that if I keep trying, there is some therapy that works and for most side effects there is a counter measure that alleviates that it. Caution - This is pure anecdotal information. Lud Lud, I experienced none of the side effects of which you write. I tolerated treatment well. I knew of others who had to cease the trial because of blood counts, etc. GD >> > ... I had only 3 cycles (once every 3 weeks) because I had >> > some bad side effects, I had to stop. ... [quoted text clipped - 55 lines] > > Lud > I have a slowly rising psa the past several months. I also have lung > nodules which have not grown larger since I added Casodex to my Eligard [quoted text clipped - 17 lines] > > Ralph There are many options at your stage, list is from less toxic to more and every patient responds differently. Basic principle is that small amount of cancer is easier to treat than a large one. 1- Trans Dermal Estradiol therapy using estradiol patches or gel (Okrim has done the pioneering studies) 2- Trying different anti-androgens or stopping them (some cancer cells may adapt and use Casodex as a nutrient) 3- Ketoconazole, starting low dose of 200 mg TID up to 400 mg TID with hydrocortisone support 4- DES 1 mg TID with coumadin and full aspirin as support 5- Taxotere, the standard is once every 3 weeks but weekly for 3 weeks and 1 week off is less toxic with many supporting medications. No one knows if early is better because the studies have not been done (men are 20 years behind the women). If you look at the approach used for breast cancer then earlier is better. As all treatments may not be helpful, trying is the only way to find out. Good luck Ludwick Lud, I started chemo ( Each course of chemotherapy lasts for 8 weeks. Patients were treated in weeks 1, 3, and 5 with doxorubicin 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with ketoconazole 400 mg orally 3 times a day daily for 7 days. In weeks 2, 4, and 6, treatment consisted of paclitaxel 100 mg/m2 intravenously on the first day of every week in combination with estramustine 280 mg orally 3 times a day for 7 days.) within two months of two mets to my spine. (I think that is pretty early.) Although both Taxoids, the main difference between paclitaxel and docetaxel (Taxotere) is that paclitaxel hits cells that are dividing. This was a Phase II trial. Coming up to four years in July, mets are still gone and PSA still undetectible. Keep kicking the bastard! Gourd Dancer >> I have a slowly rising psa the past several months. I also have lung >> nodules which have not grown larger since I added Casodex to my Eligard [quoted text clipped - 44 lines] > Good luck > Ludwick Well done GD - that is the best response I have heard - keep up the good fight!!! What has happened after the clinical trial? Breast cancer treatments have used combined therapies for years while PCa doctors are so timid to be aggressive. I have been pushing my doctors and they have worked their best within the Medicare regulations in Ontario. But to get such an aggressive approach I believe it would be impossible here and probably with most doctors in the USA. What are you doing off therapy? - how long did it take you to get over all the side effects? Thanks for the great news and Good Luck to you as well. LUd On Apr 3, 11:43 am, "Gourd Dancer" <!!!msheets!!!@!!!sbcglobal!!!.net> wrote: > Lud, I started chemo ( Each course of chemotherapy lasts for 8 weeks. > Patients were treated in weeks 1, 3, and 5 with doxorubicin 20 mg/m2 as a [quoted text clipped - 14 lines] > > Gourd Dancer "Lud" <Ludwi...@gmail.com> wrote in message > news:ab13c433-4026-4df8-89ba-2d86a2d000cf@i36g2000prf.googlegroups.com... > [quoted text clipped - 46 lines] > > Good luck > > Ludwick Thanks, Lud. I am just the guinea pig, lol. I intentionally stayed away from standard FDA approved treatment. After having an aneurysm with a blot clot adhered on my LAD next to the aorta, I just did not care. I was dead anyway until the double bypass ..... or at least very close to it. So too me after researching for primary treatment and then reading about those with mets, I figured that I was dead again in several years with standrad treatment. So I searched out the best Medical Oncologists that I could find who specializes in Prostate Cancer. My search led me to a guy in academia who has research the disease for 24 years. I cast my die with him and together we decided to get aggressive with one of his trials (that I barely qualified for). Never worried about side effects. I was lucky in that I tolerated very well the poison running through my body. I even gained 80 pounds when most lost weight. To me that was the biggest side effect. I bounce around 255 to 270 ever since chemo. I really don't worry about the cancer either. (Remember for all practical purposes, I was dead anyway) I just think about my new lease on life or whatever comes my way. Now, I do admit that I wonder sometimes when PSA rises and mets return, back of my mind only, as I am sure that it will return someday. I just don't worry nor fret about its return. And when it returns, we will try for another silver bullet. My only advantage is residing in a city that has wonderful research going on and I am not afraid to be a test subject. Then again, my only other alternative, is to join some of the others in the Infusion Center and get treatment while they visit for a short while. Lud, its a waiting game until that silver bullet is found. I believe that it is just around the corner. All the researcher have to find is the right combination of treatment that kills the cancer and yet does not kill the patient. Its a fine line, but most do not want to be killed by the treatment even though the cancer is killing them at the same time. Each day that we have is blessed. I wish you the best in kicking the bastard. My favorite saying that I have is that you are a statistic on one. GD > Well done GD - that is the best response I have heard - keep up the > good fight!!! [quoted text clipped - 97 lines] >> > Good luck >> > Ludwick Hi all, I choose early chemo (taxotere) when I failed (3 consecutive increases) casodex combined w/Zoladex. My Onc supported the decision and my PSA dropped from 1.7 to 0.2. I also had lung nodules and 2 very small bone mets. I am currently 2 years post chemo and my PSA has risen to 1.6. Also, after 3 scans of my lungs 6 months apart, there has been no change in the nodules. My personal choice is to continue to "keep my PSA as low as I can for as long as I can". My supporting thoughts are that as cancer cells double over a period of time, it is easier to control at the low levels and get more bang for the buck. There are, of course, personal choices involved here as a good friend of mine on a very similar path has chosen to stay off treatment for as long as he can. Rich > Hi all, > [quoted text clipped - 13 lines] > > Rich That's not a bad response Rich, not as great as Gourd Dancer's, but much better than the statistics cited for taxotere. It looks to me like yet another datapoint to show that taxotere is much more effective if given when the cancer is small than when it's already way out of control. As I understand it, the general theory about chemotherapy is that the cancers eventually adapt to it. Some tumor cells that are less sensitive to it than others will be a larger percentage of the chemo survivor cells than they were of the pre-chemo cell population. As they grow and replicate, a higher percentage or your cells have lower sensitivity to chemo attack. Nevertheless, you might still get significant benefit from several rounds of chemo before it completely stops working. Are you planning another round of taxotere treatment? If not, what other plan do you have? Alan Great attitude Rich, the only difference is that I started a chemo mix regime at the same time as Eligard, attacking ecery cell that divides. I wish you the best. Keep kicking the bastard. GD > Hi all, > [quoted text clipped - 12 lines] > > Rich GD, you remind me of a member in our support group - he has gone through heart surgery, high doses of radiation and every other intervention and after all that he has the largest smile of anyone. Keep on SMILING GD. Where did you find your wizards? - must be LA. Lud On Apr 4, 5:01 pm, "Gourd Dancer" <!!!msheets!!!@!!!sbcglobal!!!.net> wrote: > Thanks, Lud. I am just the guinea pig, lol. I intentionally stayed away from > standard FDA approved treatment. After having an aneurysm with a blot clot [quoted text clipped - 136 lines] > >> > Good luck > >> > Ludwick Thanks, you too! No, Houston. Started with Baylor College of Medicine, after its divorce from Methodist Hospital System, stayed with the docs at Methodist Research Institute. GD > GD, you remind me of a member in our support group - he has gone > through heart surgery, high doses of radiation and every other [quoted text clipped - 186 lines] >> >> > Good luck >> >> > Ludwick |
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