Wouldn't It Be Nice; A Whimsical Diversion

 An extremely frustrating aspect of a PCa diagnosis has been the lack of consensus among the recognized experts. Most all practitioners including urologists, radiologists (a diverse group unto themselves), medical oncologists and a variety of surgeons appear to regard us as an ideal candidate for their area of expertise. Too often we PCa warriors rely on the first specialist we encounter or equally worrisome we research our options to the best of our ability and base our decision on woefully incomplete data. Either way it's a crap shoot. For the life of me (said with tongue only partly in cheek), I can think of no other affliction where the treatment choice is so problematic. 

 A couple of months ago the TV program "Sixty Minutes" covered a potential solution to our dilemma. The show featured a cancer center located at the University of North Carolina where a team of experts develop treatment plans for cancer patients who have failed standard therapy using the computerized Watson System of Artificial Intelligence. AI capability enables the team to formulate more effective plans based on all the medical literature published world wide including up-to-date clinical trial data.

Wouldn't it be nice if one institute or another with Watson AI capability focused on prostate cancer? Us PCa warriors can only hope.

To view a transcript of the Sixty Minutes segment; see:   

http://www.cbsnews.com/news/artificial-intelligence-positioned-to-be-a-game-changer/

Back on Track with Hormone Lite/Xtandi

Over the past year my PSA has risen slowly but surely from .11 to .76. As any reader of this journal knows, I searched long and hard for a solution with a high likelihood of success with minimal side effects. Rightly or wrongly throughout my ordeal I have placed a premium on preserving quality of life. To my way of thinking a cure would be most welcome, but the risk involved has inevitably tended to over shadow the desired outcome. Its been a crapshoot from the outset and that has never changed.

At this juncture I am pleased to report that after being on xtandi for only three weeks my PSA has dropped back to .11.The predominant side effect of fatigue has materialized as expected. In my case this means after two hours of tennis doubles three days a week I tend to fall asleep in the evenings while attempting to catch up on my reading or watching a sporting event on TV. Short story abbreviated to the max, I am satisfied with my results thus far. A brief but pertinent Patient Portal exchange with Dr. Myers appears below:

Pt.

 Assuming xtandi proves effective as indicated by my monthly blood draws, how long do you expect this medication to control the progression of my PCa?

Dr. Myers

 IT MIGHT WORK FOR YEARS OR AS SHORT AS 6 MONTHS

 

Stay tuned

Serendipitous Contacts Transform the Treatment Plan

The following exchange of emails is self explanatory:

To Dr.Myers:

"As per your request, I consulted with a specialist at Univ. of Mich. who performs all of the hospital's prostate cryosugeries. He advised me that his outcomes parallel the national norms as outlined below:

--A cure rate of 50% as indicated by a PSA less than 1.0

--100% erectile dysfunction (the procedure destroys the enabling nerve system)

--5% stress related incontinence

--1% fistula

In a subsequent exchange of emails, a patient of yours and a friend of mine, informed me that he has been on xtandi for nine months. He expressed complete satisfaction with his results to date. His only side effect  is fatigue which he counteracts with a daily nap.

At one point you were prepared to put me on xtandi, but decided otherwise based on the fatigue factor. Although xtandi may not offer the prospect of a cure as does cryosurgery my personal preference would be to initiate what you at one time labeled Hormone Lite (Xtandi). Can we reconsider this option?"

From Dr. Myers:

"Yes, I will send a script".

 

I implemented the new protocol on March 11.

Stay tuned.

Approaching the Slippery Slope

 

 I have devoted considerable time and effort attempting to identify a safe and effective means to control or eliminate my recurrent PCa. I outlined the history of this endeavor in my previous journal entry. I have tentatively decided on the following ADT protocol recommended by a medical oncologist I consulted at the University of Michigan : Intermittent three-month-duration Lupron injections to be administered each time my PSA rises to 7.0. My current PSA is .60. His educated guess is it will take two years before the first injection will be needed. In the meantime, as per his recommendation, I will continue on Casodex as prescribed by Dr. Myers.

Up to this point I have avoided Lupron like the veritable plague. I first learned of  ADT researching options  following  my diagnosis in 2008. The known side effects are "off-putting" to say the least. It's a bit difficult to fathom at this point, but Lupron appears to be my best choice. For more perspective in this regard I have included a rough draft of a journal entry that I chose not to use until now: see below:

"ADT with Lupron is a form of medical castration. It is designed to do many of the same things as surgical castration (orchiectomy). It is associated with a range of side effects that many men find to be highly delibitating and emotionally devastating, including loss of libido, loss of sexual function, genital shrinkage, hot flashes, weight gain, loss of bone mass, "Lupron Brain"(difficulty in concentrating, clarity of thought, memory loss, etc.) enlargement of the breasts and other symptoms of gynecomastia, and a long list of less common problems. This is not a form of therapy I would wish on anyone if it could be avoided. ADT on its own is not curative and has never been established to extend the survival of men with advanced prostate cancer. It is a palliative form of care whose primary function is to minimize the risk of bone pain associated with advanced prostate cancer. Many clinicians believe that all too many men with progressive prostate cancer are treated much too early with ADT because it can be used to manage the patient's PSA level. However overly early use of ADT is also associated with risk for early onset of castration-resistant prostate cancer. ADT  has shown to have a survival benefit only when used in combination with external beam radiation therapy for men with locally advanced prostate cancer (and to have a curative impact in some of these patients)."

Stay tuned.

Disease Progression and Treatment Synopsis

2005 to 2008  PSA  rose from 1.39 ( Apr. 8) to 3.97 ( Sept. 4 )

2008 Diagnosed with PCa. Two cores positive, Gleason 4+3

2009 Completed PBRT at UFPTI on March 11  PSA  dropped to .8. UFPTI reviewed my biopsy slide and agreed with Gleason 4+3 determination

2012  PSA  rose from .8 to 2.59 from May to Oct.; Dr. Kwon of Mayo Clinic  identified a small cancerous lesion in  prostate by Choline Scan. Mayo Clinic reviewed  my biopsy slide and determined my Gleason to be 4+4 

2013  Began Hormone Lite as prescribed by Dr. Charles Myers; see below:

  I. Prescription Drugs

    A. Metformin 500 MG 2 daily. Anti-cancer

    B. Avodart .5 MG 3 a week. Anti-cancer

    C. Casodex 50 MG 3 weekly. Anti-cancer

    D. Zocor 10 MG 1 daily. Anti-cancer

    E. Losartan 50 MG 1 daily. Blood pressure.

 II. Supplements

    A. Pomegranate 1 daily 10 MG. Anti-cancer

    B. Vitamin  B12 1000mcg

    C. Vitamin D3 5000 IU 2 daily. Restore deficiency

    D. Super Bio-Curcumin 400 MG 1 daily. Anti-inflammatory

    E. Optmized Resveratol 250 MG 1 daily. Anti-inflammatory

  III.  Mediterranean Diet

2015

  I.PSAs rose from .077 in Jan. to .18 in Aug. Dr. Myers increased my Casodex  from three times weekly to a daily dosage. PSAs returned to their former lower levels.

  II. Endorectal MRI at VCU; 3x5 mm tumor identified

2016  PSAs ascend from .11 in Apr to .49 in Dec. Follow-up endorectal MRI at VCU; tumor more than doubled in size to 10x7 mm .

I have considered several options the past few weeks including Pencil beam PBRT, cyberknife, prostatectomy, brachytherapy, focal beam ablation, cryotherapy , Hi Fu, modified hormone lite, full blown hormone therapy and chemotherapy. The first seven options have been pretty much eliminated each for a different reason. More recently an advisor recommended estrogen therapy which looks promising at least for a temporary period (a year or so?)

Major changes under consideration; too early and too fluid to document.

Stay tuned.