Last month I asked for advice for my 95 year old father who has advanced prostate cancer. He is being passed to another group in the doctor practice that handles the next phase. I set up the appointment and even before seeing him the medical practice was pushing Provenge as the preferred treatment. It was like it is a done deal. I also got a slick marketing package in the mail. I naturally get suspicious. I half expect that my father will get a toaster or tv for signing up. Maybe as care taker I will get a night in Atlantic City?
I will play devil's advocate in the upcoming appointment. But I do not stand a chance. Is Provenge a money maker for the doctors? Does the drug company place representatives in the Doctor's practice? I felt like I was talking to a sales person over the phone.
Every treatment and every appointment is a money maker for the doctors. Otherwise it wouldn't be practicing medicine at all. I don't know if provenge is a big moneymaker for them butt I would imagine the stress on a 95 year old man would be very difficult with any treatment. But the very best of luck to both of you.
They can have a number of factors affecting their decision making for anything. Money is just one of many factors that can affect a Docs decision making. Frequently a Doc will just have a favorite tool. That is why you always want to get a second opinion.
Go to Dr. Charles Myers in Virginia to get a second opinion. He uses everything. He doesn't take insurance but is worth a visit for a second opinion. I forget what he charges for a first visit and he charges more for advanced cases because they take more time. Maybe $1500, but you have probably paid bigger bills to a plumber.
Hi, Snuffy Myers cost now has risen. I don't know what the initial visit is, but for ongoing patients, it's 5,000. Patients got notice of a rise in cost. He's cut his days seeing patients to do more research.
Also, to tack on to the PROVENGE. The doc may get a kick back from the company.
I got Provenge in 2012 and it worked for a while but then stopped working! And it cost 107,000 dollars which I think was a ridiculous price! I did not have to pay for it! The insurance payed this price. It does not cure you anyway it lets you live longer!
It is extremely expensive, $100K, the psa still rises and they don't know why, but they will tell you it extends life by about 4 months. So we decided not to line their pockets. The data didn't make sense to us and at your fathers age, I would not do it. Some who have also have had very unpleasant side effects. Of course that is some pretty nice money for the makers so they have to push it. Personally, with most doing many other treatments at the same time and the fact that the psa keeps going up, I have to wonder if it really does work. Just my two cents!
My understanding is that Provenge is slower working (for some reason) and in a related sense works better on lower tumor burdens (low PSA). This is probably similar to the Cuban CIMAVax, which is for lung cancer but with hopes for other applications. The trial that showed 4 month overall survival benefit may well have allowed cross-over after progression. This means that the better comparison is to compare those who receive Provenge, in either arm, to those who declined Provenge after progression. This comparison is not the way that trials do comparisons, but is the way that patients should do comparisons, since what it means is the second set of patients received Provenge after a four or six month delay <snark>, the kind of delay you may experience while your medical provider ponders the options with the medical committee</snark>. This type of comparison showed a year survival. The hope is with a selected checkpoint blocker, Provenge will do better.
Thanks for the comments and advice. I feel like I am rolling the dice with the odds against my father. At the same time I should be grateful that there are drugs and treatments to at least have a fighting chance. The fear lurking in my conciousness is that the highest threat to my father is falling and hitting his head and not neccessairely prostate cancer.
At the end of the day it will be my father's decision on whether to do nothing or go with provenge or any of the other treatments.
It would be helpful to know your Dad's diagnostics to have a better idea of his current status before making recommendations. At your Dad's 95 years of age, it at least sounds somewhat ludicrous to recommend a procedure that costs just short of $100,000 (though Medicare allowance is much less - but even then if Medicare is your Dad's health insurance and he does not have a supplemental insurance, the copay could be big bucks out-of-pocket) that is unlikely to provide much information to the physicians in considering subsequent treatment. Again, what is your Dad's status? Only recently diagnosed? PSA levels leading to - a biopsy? Results from the biopsy as to number of tissue extractions showing evidence of prostate cancer, Gleason Score assigned each of those tissue samples, percentage of cancer on each of those tissue samples, and from which locations of the prostate were each of those samples with cancer identified? With the foregoing info we might have a better idea of what to recommend.
As regards the charges for appointments with Medical Oncologist Charles E. "Snuffy" Myers: The latest I am aware that went into effect recently New Patient Visit - $2,000 to $3,000. This is determined at “check out”. Follow Up Visit - $1,100 to $2,000. This is determined at “check out”. If you are scheduled for an appointment and miss it, you will be charged anyway. If Dr. Myers is not available for whatever reason and you end up being seen by his nurse, his regular fee applies despite not being seen specifically by him. Keep all this in mind before scheduling an appointment.
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Yes yes yes. Falls are the more urgent and immediate danger by far. Can he move to a safer house?
I did the treatments, October & November of last year. Three treatments @ ~145,000 EACH, thank God insurance paid 100%. AFLAC, however, didn't allow it for their supplemental coverage.
Absolutely no effect, went straight to chemo afterwards.
Provege requies you have blood taken out of one arm and returned through another arm after going through a machine that extracts the required components. This takes about 3 hours of sitting in a chair while this process takes place. 3 days later they will reinfuse the components with whatever Provenge does to it. This takes about one hour and you CAN'T miss that appointment and do it later as the reinfusion material goes bad. This is done 3 times over a couple months. As Chuck Mack said in another post, we would need more background and health info on your dad to offer our OPINION. I had it done but given your dad's age and possible cost to you I would give serious thought about putting him through the process given the possible benefit.
My father who is 95 has asymptomatic metastatic castrate – resistant (hormone – refractory) prostate cancer. Apparently, Lupron Depot is no longer controlling his prostate cancer. His PSA has increased from 1.8 to 15.8 and the CT scan shows a spot on his right hip. The spot has been there since 2012 and was the initial reason for taking Lupron Depot. The scans did not show any new metastatic spots. However, there has been an interval change to the old spot.
Unfortunately, I do not have any other medical indices.
In 2007 he was originally treated with radiation for prostate cancer. The adverse side-effects were proctitis and urinary incontinence. His rectal bleeding is mild and we can control the urinary incontinence (oxybutynin). He has only been treated with leuprolide (Lupron Depot) and he also takes Prosteon daily.
His urologist is sending him to his group’s practice that treats advanced prostate cancer.
My father is legally blind because of macular degeneration. His biggest threat is trip and fall which he has done in the past and he had to have burr holes to relieve the pressure from a subdural hematoma. His mind is still good – no dementia. He doesn't have any heart problems. He did have a bout of adult diabetes when his dermatologist put him on massive doses of steroids for eczema. His mother lived to 99. He still has the will to live.
When Lupron stopped controlling my PSA, I was given (in addition) bicalutamide (generic for Casodex) which worked for a long time. Then I moved on to abiraterone (generic for Zytiga) (taken with prednisone) which is giving me another good ride. Both of these treatments are pills, so non-intrusive although side effects are possible. (BTW, I've been told I'll be continuing to take Lupron for the rest of my life.) So based on my treatment in a health plan setting & what I've learned, it would be very much too early in the normal sequence of treatments for Provenge, & not just unjustified in terms of intrusiveness & expense. Good for you for being suspicious. This makes the expertise &/or ethics of your dad's provider seem extremely doubtful.
Get another opinion and maybe even a third. My local doctor (and maybe part owner) only pushed Provenge. He never offered any other treatment. I went to John Hopkins and UVA medical center in Charlottesville VA, Both the doctors from these institutions said that Provenge would not be effective for me. I'm sure there is a greater profit margin with provenge versus a prescription. With provenge my local doctors Infusion center would be involved. Another thing everyone needs to be aware of is that if you get any drug administered at the infusion center (chemo, Lupron) check with your insurance company. If the facility provides the drug, then it is processed under your medical benefits, and if you bring your own drugs it is processed under your prescription benefits as you have to get it was a prescription from a pharmacy. Check with your insurance company as this information can save you lots of $$$. I know from experience.
I don't know your father's situation but last year my PC spread to my lungs. I went on Provenge. I qualified for a grant and paid very little of the cost. (Your father's doctor should be able to check if your father qualifies for the grant.) The spots on my lungs disappeared. I know for some people this is a very expensive treatment. So my advise is look at it from all sides. If you don't trust your father's doctor, then get a second opinion.
Let me try and clear up some of the issues surrounding Provenge. Also, I want to make it clear that I have no financial interest in the drug or the treatment. I have been a very early advocate for the use of Provenge, but for the proper person. To understand who this proper man is requires a little understanding of how it works.
Provenge is an immunotherapy, not a chemotherapy and not a hormone therapy. Its mechanism of action is entirely different and the appearance of results is different than these two other types of therapies. You must suspend your expectations of immediate, measurable results like you PSA and changes on scans. Chemotherapy and hormone therapy have a quick and relatively immediate effect (if they are going to work), immunotherapies (Provenge) does not. Chemotherapy and ADT drugs act immediately on the cancer and we see the immediate results in these two measures, Provenge does not act with this type of mechanism.
Provenge introduces your own killer "T" cells back into your body, but these cells have been sensitized to see the cancer as an invader. Remember, prostate cancer cells are your own cells, not a bacteria or a virus. Prostate cancer hides from the immune system, the natural system your body has to destroy invading things. When the souped up, sensitized cells are re-introduced into the body they train the other cells to attack the cancer, but this takes time to happen.
The survival advantage of Provenge is a statistic, some men receive no survival benefit, some less than and others more benefit. When the survival was compared to the control group three years after treatment 38% more men were alive who had Provenge and at 4 years over 28% more men were still alive then the control group.
Provenge does not work quickly, it takes time for it to work, so the earlier you have it the more likely you are to have a benefit. So a man with very advanced disease, or one with many other commodities will probably not get benefit, but for others it is an excellent option that should be added to the treatments taken.
I strongly urge that anyone with questions go to the Malecare Advanced Prostate Cancer Blog (advancedprostatecancer.net) and search Provenge as I have written extensively about it. It is a legitimate treatment option for the right man.
Joel
There is a marvelous interview with Drs Szmulewitz and Catalona on the site Patient Power. They talk about the options and the latest thinking. It is a quick cram course by the experts. They talk about Provenge and note that it is not quick acting, hard to measure and that it should be used on a person with a small prostate cancer burden. They then say that the thinking is that it should be combined with Radium 223 (Xofigo). I have pasted the link below:
I wonder how you have been doing now since it's been a while of your provenge treatment ? My dad is getting it currently and you make me feel like it was a waste and hopeless.
I know that there is no immediate results so what are you expecting? What do you need to see or feel? After reading your post I feel hopeless for you and my dad.
It takes a while so other than expecting and praying for a miracle which I am I don't know why the negativity about provenge since you need to give it time to work. Please help me understand.
I thought about that too I read they get $7000 per patient back in 2010. But I think most pharmacueticals pay the doctor some sort of kick back sad they can send a man on the moon but till this day there is no cure for so many diseases as of yet. Just treatments to help one handle the illness. No cure for cancer no cure for Aids just pills, doctors and medicines to treat it no CURES. I think if they found cures people doctors and hospitals would be out of bussiness
It is over $100k today and it is a roll of the dice. I have leukemia. Before they started treatment with the standard of care chemo drugs, the doctor had a genetic profile done on me. Based upon my genetics they knew that this treatment would be a failure. So they matched treatment with my genetic profile and it was successful. The standard of care would have killed me. I feel that the advanced prostate treatments are flying through the mountains at night with no radio or radar.
It is called pharmacy companies soaking Medicare with a cut for the good doctors. Can we negotiate prices Medicare pays before the whole system comes crashing down? Sorry for the cynicism.
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