A New Prescription Plus a Few Questions and Answers

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? .

Dr.: Yes

These questions and answers are virtually verbatim. I exercised editorial prerogative here and there to achieve clarity and continuity.

Stay tuned.

Hormone Lite

Much to my surprise, chagrin and profound disappointment my last two PSAs reversed course and returned to their upward momentum. Specifically September's result came in at 5.04 and October's at 6.27. Consequently my much anticipated discussion with Dr. Myers developed far differently than planned. Rather than a pleasant , mutually satisfying exchange of opinions as to the effectiveness of the treatment plan, we focused on the need for additional, more powerful medications and their accompanying side effects.
In addition to the medications, supplements and diet plan detailed in my  "A Miracle in the Making?" entry, Dr. Myers added the following two prescriptions:
1. Bicalutimide (Casodex). This drug is thought to suppress cancer by blocking the effect of male hormones particularly testosterone.
The Internet describes numerous side effects for this drug, but Dr. Myers thought my primary risks would be breast tenderness and an increased risk for developing diabetes.
2. Metformin. This drug is a first line treatment for Type II diabetes. It works by suppressing glucose production by the liver. Based on an Internet medical site this drug also "exhibits a strong and consistent antiproliferation action on several cancer cell lines including prostrate cancer cells."
It causes diarrhea in roughly fifty percent of its users.
Dr. Myers referred to the above plan as "Hormone Lite."
Repeat visitors to this journal may recall the first oncologist I consulted following my diagnosis of recurrent cancer prescribed Casodex. I rejected this recommendation based on a limited Internet research effort and on the advice of two trusted advisors whose counsel was subsequently confirmed by oncologist #2.
 Its a strange topsy-turvy world of prostate cancer in which I live. The experts rarely agree and treatment plans too often go awry. At this momentous juncture I am prepared to embrace a treatment plan which a few short  months ago seemed totally unacceptable if not irrational.
In retrospect I owe Dr. Cy Fer a cyberspace, Karma inspired apology for the unkind and presumably unwarranted pseudonym I attached to his persona. So be it!

Addendum: The prescriptions have arrived, and I will begin the revised treatment plan on 11/14/13.