Dr.. Myers makes himself available to his patients via an Internet "Patient Portal." Patients are able to raise questions about their treatment at anytime. Likewise he communicates with his patients at will. The following Patient Portal exchange (1) introduces a new medication to my treatment plan, and (2) provides a snapshot of Dr. Myers' approach to the treatment of prostate cancer.
Pt.: Why did Avodart appear to work so well for the first four months of treatment then cease to be effective? .
Dr.:Recent studies have shown that prostate cancer can overcome Avodart and even Casodex by picking up LDL cholesterol and converting it to dihydrotestosteron. By lowering your LDL with a statin we can block this. I added low dose Simvastatin (Zucor) to your program. This statin has powerful anti-inflammatory activity and very low risk of side effects,
Pt.: If Simvastatin effectively controls the progression of my cancer, the Casodex and Metformin may not be needed at this time. If the Simvastatin has little or no effect on the progression, it may not be needed, Do we dare experiment for a month or so?
Dr.: Cancer is complex and adapts rapidly. This is more difficult if the cancer is attacked from different angles at the same time. If you have 3 drugs each with a 1/100 odds of resistance, the odds of resistance to all three are 1/100x1/100x1/100 which equals one in a million. This is why cancer, tuberculosis and AIDS are all treated with combinations
Pt.: Is "Hormone Lite" likely to become hormone resistant? If so, when?
Dr.: Sometimes, usually after several years.
Pt.: Am I now or am I likely to become a candidate for chemo-therapy? Is this an alternative we should have discussed on the 29th?
Dr.: Highly unlikely.
Pt.: What percentage of us on Casodex will experience gynecomastia? Is breast tenderness a precursor to gynecomestia? I believe you indicated these symptoms, if they occur, do not show up for about two years. If I recall you advised me we could address these issues when and if they occur. Does this mean preventive action, e. g., radiation, is contraindicated?
Dr.: It develops very gradually with plenty of time to do something about it..
Pt.:Are these the only side effects that are likely to occur? .
These questions and answers are virtually verbatim. I exercised editorial prerogative here and there to achieve clarity and continuity.