A Welcome Annual Appointment Report

As my regular readers may have discerned the doctor-patient  relationship between Dr. Myers and yours truly has become a tad strained. The uneasiness in our relationship is most apparent from our Patient Portal e-mail exchanges as recorded in a few of my recent journal entries. At this juncture therefore, it gives me considerable pleasure to report that my annual appointment with Dr. Myers on October 28 could not have gone much smoother. Our discussion can best be described as cordially professional with nary a hint of discord.

Dr. Myers expressed complete satisfaction with the monthly blood analyses he uses to monitor my general  health and the effectiveness of his Hormone Lite protocol. Parameters measured, among several others, include PSA, testosterone, dihydrotestosterone, cholesterol, hemoglobin, blood glucose, and vitamin D.

We devoted some of our time to the following topics:

Question:

What is your perspective on the recent steep rise in my PSAs?

Response:

I am unsure the elevation represents a progression of your prostate cancer. In relation to the complete record of PSA graphs we have on file, the elevation appears insignificant. In any event your PSA has responded quite favorably to the increase of Casodex I recently prescribed for you.

Question:

Am I now or have I ever been a candidate for complete and durable remission?

Response

Yes. As a matter of fact based on your highly favorable response to the increased Casodex , it's conceivable  you will achieve a complete and durable remission with our current protocol.

The above statement of Dr. Myer's caught me by surprise. It struck me as being so radically different from our previous  discussions on this topic it "boggled my mind."  To avoid jeopardizing  the patient/doctor rapport we managed to reestablish, I chose not to pursue the matter further. .

In conclusion: (1) I am skeptical about my chances of achieving a compete and durable remission on my present protocol, and (2) I will be satisfied to continue my current quality of life for another two, three (preferably four or five) years.

Stay tuned.

Continued Effectiveness of Hormone Lite Called Into Question: Round II

In response to a rapidly rising PSA, Dr. Myers tweaked my protocol on August 14, 2015 --see prior entry. I am pleased to report my PSA has dropped dramatically to .13, i. e., within .01 of the level that it began its alarming upward trend. Alleluia! The making of a modern day medical miracle appears to be back on track!

Continued Effectiveness of Hormone Lite Called Into Question??!!

The following exchange of emails lays the groundwork for future personal "adventures" and new journal entries:

A. Recent Patient Portal Email to Dr. Myers

Over the past several months I have kept my Patient Portal inquiries to an absolute minimum. I intend to continue to do so. Currently, however, I feel compelled to call the following trends in my PSAs to your attention.

Over the past nine months my PSAs more than doubled, I. e., from .077 in December 2014  to  my current (August) reading of .18. This rise in PSAs is preceded by a drop from .365 in March of 2014 to .096 in November of 2014. Is this reversal of trends cause for concern in your professional judgment?

B. Dr. Myers Responds

WE DISCUSSED EXTENSIVELY THE OPTIONS VIA THIS PORTAL AND YOU WERE UNCOMFORTABLE WITH PROCEEDING. WE AGREED WE WOULD REVIEW THEM AT YOUR CLINIC VISIT AND MAKE A FINAL DECISION.

C. My Response to Dr. Myers

I am a major fan of the Patient Portal. It offers patients an opportunity to consult with you directly as issues arise. I have used this option often and much appreciate the prompt professional assistance provided by you and various members  of your staff.. I am equally appreciative of how effective Hormone Lite has been for me over the past two years solely due to your medical care and expertise. It is doubtful that I could have fared any better under the care of any other clinician anywhere.

If we have reached a point that my current protocol needs to be modified or replaced, I am prepared to discuss my options in any forum you deem appropriate. Our next regularly scheduled appointment is set for 11:30 A.M. on October 28,2015.

Addendum
 Positivity Produces Reciprocity
Dr. Myers responded to the above heartfelt statement with a more welcome, more compassionate message as shown below:
" I think we should move to daily bicalutimide. If the PSA does not respond, then in October we can adjust. I sent the script to your pharmacy."
This protocol modification represents an increase from three to seven 50 MG tablets weekly.

Chances of a Complete and Durable Remission On My Current Protocol: Dr Myers Weighs In

As stated in my prior journal entry, I thought I might be well positioned to achieve a complete and durable remission. This assumption, based to some degree on wishful thinking no doubt, led to a series of e-mails between me and Dr. Myers. His response is concise and crystal clear; see below:

YOU FIRST WOULD HAVE TO GET AN UNDETECTABLE PSA. YOU ARE NOT ON A PROGRAM THAT WILL LEAD TO A COMPLETE REMISSION. THAT WOULD REQUIRE  AGGRESSIVE HORMONAL THERAPY AND OTHER AGENTS

COMPLETE REMISSION WOULD REQUIRE 6 MONTHS OF HORMONAL THERAPY AND IMMUNE STIMULATION

 

I intend to explore the feasibility of pursuing a complete and durable remission, although I suspect my age (79),  represents a substantial hurdle. This may take awhile. My next few journal entries will be devoted to this endeavor. Stay tuned.

Addendum  April 24, 2015
In an attempt to determine whether I am a candidate for complete and durable remission, I posed a series of questions via the Patient Portal. Dr. Myers answered a number of my questions, but evidently, there is a limit to his magnanimity. His response to my most recent series of questions appears below:
"These matters can best be addressed at our next scheduled appointment."
Consequently my next entry on this topic will remain on hold until next November, i. e., at the very soonest.

Hormone Lite: Protocol Update and Progress Report

Since initiating treatment with Dr. Myers on November 11, 2013 my protocol has been modified slightly two or three times. My current protocol appears below (the purpose of each component is summarized more fully in earlier entries):
I. Prescription Drugs
 A. Metformin 500 MG 4 daily. Anti-cancer
 B. Avodart .5 MG 3 a week. Anti-cancer
 C. Casodex 50 MG 2 a week. Anti-cancer
 D. Zocor 10 MG 1 daily. Anti-cancer
 E. Losartan 50 MG 1 daily. Blood pressure.
 F. Penoxifylline 400 MG 2 daily.
     Mitigate bladder damage caused by PBRT
II. Supplements
 A. Pomegranate 1 daily 10 MG. Anti-cancer
 B. Vitamin D3 5000 IU 2 daily. Restore deficiency
 C. Super Bio-Curcumin 400 MG 1 daily. Anti-inflammatory
 D, Optmized Resveratol 250 MG 1 daily. Anti-inflammatory
 E, Taco-Sorb 1 daily. Mitigate bladder damage caused by PBRT
III. Mediterranean Diet
In a recent Internet audio-visual presentation Dr. Myers discusses his objective of achieving a complete and durable remission in the treatment of his Pca patients. Dr. Myers defines a complete and durable remission as follows:
--complete recovery of general health
--the cancer is not growing or growing more slowly
--undetectable PSA
--normal testosterone level
Dr. Myers is a survivor of metastatic prostate cancer whose complete and durable remission is in its sixteenth year.
It may be premature but I have begun to think in terms of a complete and durable remission in my case. This possibility is bolstered  in part by (1) a recent meeting with Dr. Myers in which he calculated that my 1.1 cm tumor had shrunk by 60 to 70 per cent and (2) the following sampling of my PSAs:
11/26/13  1.69
12/28/13  .490
3/15/14   . 365
4/15/14    .256
11/14/14  .096
12/6/14    .077
1/2/15      .091
2/5/15      .098
Although I have begun to think more positively about my prognosis, I am painfully aware there are no guarantees in this marathon battle. Stay tuned.

A Layman's Perspective on the Role of Metformin in the Treatment of Prostate Cancer

I am neither a doctor nor scientist nor do I have ready access to medical journals. Nor have I ever been accused of being overly academic. When a bona fide research document comes my way I often have difficulty in determining its full scientific value. Accordingly the following information is shared, sketchy though it may be, in the hope that a few others in my situation will be made aware of the potential of Metformin in the treatment of prostate cancer. Another positive outcome would be to trigger responses from individuals who can fill in the blanks.

My initial protocol prescribed by Dr. Myers in 2013 did not include Metformin. In 2014 in conjunction with a few other changes Dr. Myers prescribed a daily dose of Metformin. At the time I described the purpose of this addition as follows: "This drug is a first line treatment for Type II diabetes. It works by suppressing glucose production of 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." This October Dr. Myers quadrupled my prescription Currently my protocol calls for four 500 mg tablets a day, i. e., two each morning and two each evening.

In retrospect I cannot recall an explanation for this rather substantial increase. About the only comment I can recall went something like follows: "Metformin" (pause) "now there is an interesting medical story if ever there was one." As I reflected more on our discussion and mentally chastised myself for not raising a few logical and timely questions, I recalled an Internet audio-visual presentation by Dr. Myers on this topic; a summary of this presentation appears below:

Patients on Metformin:

1.In the treatment of diabetes:

--experienced fewer mortalities from a variety of adult illnesses including heart attacks, strokes and cancers.

--experienced a reduction in diagnoses of all cancers.

2. In the treatment of prostate cancer:

--"Put a lid" on the progression of metastatic prostate cancer in a sizable proportion of patients in a Swiss study.

--(may) reduce the likelihood of developing hormone resistance.

--reduces the development of adverse side effects of hormone therapy.

--prevents the weight gain associated with hormone therapy.

Dr. Myers concluded his presentation with the following prediction (paraphrased):   " I expect Metformin to become a part of any Pca treatment program designed to induce a compete and durable remission."

Addendum January 1, 2015

One of my trusted advisors "Iron Mike" offered the following comments:

"In contrast to Dr. Myers views, however, there was a report just a few months ago based on a meta-analysis of data from nearly 1,000 patients, all of whom had a history of treatment with metformin and all of whom were all newly diagnosed with non-metastatic prostate cancer between April 1, 1998 and December 31, 2009, suggesting no benefit whatsoever from their use of metformin before or after diagnosis with prostate cancer.

Indeed,in that study (see here) a cumulative duration of treatment (before and after diagnosis with prostate cancer) with metformin of ≥ 938 days was actually associated with a roughly threefold increase in risk for prostate cancer-specific mortality.

In all honesty, until we have some data from a large, well-conducted, randomized trial, I think the jury is out on whether metformin has any meaningful clinical benefit in the management of prostate cancer."

When and if I can reconcile the vastly different points of view expressed herein, I will do so.

Addendum January 12, 20i5
Dr. Myers weighed in on the meta-analysis report as follows:

"THAT STUDY IS A POPULATION-BASED STUDY AND AS SUCH PROBABLY NOT WORTH THE PAPER IT IS WRITTEN ON. WE HAVE A PHASE 2 TRIAL SHOWNG A RESPONSE RATE CLOSE TO THAT OF TAXOTERE":
Addendum January 14, 2015
"Iron Mike" responded to Dr. Myers as shown:
"Alas that Swiss Phase II trial was a non-randomized, single arm trial in just 44 patients. As I indicated above, it is "interesting" but hardly "compelling" (in my judgment). Dr. Myers is, of course, entirely entitled to his opinions, but we appear not to be on the same page yet about the potential value of metformin.
My suspicion at this time is that metformin may have value in a particular subset of men with  advanced prostate cancer. The difficulty will be working out how to define and identify that subset."

Addendum January 29, 2015
In a recently released audio-visual Dr. Myers discusses the use of metformin to slow or prevent the return of prostate cancer after complete remission has been achieved by more aggressive forms of treatment. Avodart is  now routinely used for this purpose. Dr.Myers indicates several studies demonstrate metformin shows great promise

 

 

A Heretofore Unaddressed Radiation Side Effect

As  long time readers of this journal will surely agree, I have been preoccupied with one emergency after another  week after week, month after month for far too long. With the most urgent health issues moreorless under control, the time seems right to address the issue outlined below in an email to my UFPTI case manager:

Bladder Control

Two or three times each evening my sleep is interrupted by the need  to empty my bladder  Frequency is not the primary problem however. Each time involves a stop and go fairly lengthy process which takes two or three minutes to complete. I suspect this problem is proton radiation related. It evolved a year or so following treatment, and I have a friend also a UFPTI graduate who is experiencing similar symptoms .How common is this problem? Why does it occur? Our concern is that it will progress rather than resolve.  Is this a problem that should be addressed? If so, how and when? Please feel free to consult with anyone at UFPTI (or elsewhere) that you think may help answer these questions.

After a week or two during which she consulted with Dr. Gud E. Nuff  and one or more of her counterparts, my case manager contacted me by phone at which time the following discussion ensued (broadly interpreted and liberally paraphrased):

Potty Training

CM: During our early years all of us are indoctrinated with the idea that we need to HOLD OUR WATER throughout the night. Woe be unto those who fail to do so.

Pt: This explanation does not account for the onset of the problem at the age of 72 roughly a year following proton radiation. 

Avodart

CM: Dr. Myers may need to increase your dosage of Avodart.

Pt: I do not  intend to ask Dr. Myers to modify my protocol in an effort to resolve my bladder problem.

Anatomical Anomaly

CM: Your problem may be due to an enlarged prostate.

Pt: I have never been so diagnosed. My medical record on file at UFPTI will directly contradict the possibility of an enlarged prostate.

Diet

CM: Your diet may be overly acidic.

Pt: On rare occasions I treat myself to blackened chicken or blackened Ahi tuna. On even rarer occasions my wife over seasons our spaghetti sauce. I assured my case manager this was the extent of our culinary adventurousness.

Liquid Consumption

At the end of the above described give and take, my case manager expressed an interest in my daily intake of alcohol and water. I confessed to a longtime nightly routine of one or two beers just prior to bedtime. I also admitted to the possibility of consuming too little water during the day, especially  here in Texas, because I play two hours of tennis six days a week (sometimes seven). On hotter days it can be difficult to stay hydrated.

At her behest I agreed to modify this pattern on a trial basis. For the suggested three day period, I discontinued my beer drinking routine.and significantly increased my water consumption.The net result? No change. Oddly enough neither of us seemed overly surprised.

 

In the absence of a definitive, plausible answer, we agreed that I should raise this issue during my upcoming appointment with Dr. Myers. I did so with the following result. His response is summarized below in an email to my case manager:

"With considerable confidence and no hesitation Dr. Myers diagnosed my late evening voiding complications as scarification due to radiation. He seemed irritated that radiation treatment centers like UFPTI do not recognize such damage and leave it to unaffiliated clinics like his for follow-up care. This condition is easily controlled. He then prescribed Trental 400 mg twice a day and Jarrow tocosorb once a day. At the end of this discussion he provided me with a copy of a clinical study titled "Randomized, Placebo-Controlled Trial of Combined Pentoxifylline and Tocopheral for Regression of Superficial Radiation-Induced Fibrosis."

 

A week or two later my case manager contacted me by phone with the following responses: (1) In rare instances some of our patients experience symptoms similar to yours that may be due to scarification of the bladder, (2) We here at UFPTI have used Trental from time to time and (3) We apologize for irritating Dr, Myers.