Advanced Prostate Cancer
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Advanced Cancer Treatment Options

I recently learned that I have four mets on my lungs, one on a rib and one on my pelvis. Had prostatectomy in March 2014 and follow-up radiation during June 2015. Over last year, PSA has climbed from 2.12 in September 2016 to 16.8 in October 2017. Currently, considering either hormone + chemo or hormone p + zytiga. Any thoughts?

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Hi wcochranbond

I am a PCa Advanced Stage 4 survivor since being diagnosed on 27.10.17. I am embarking my journey entirely in a different manner. This morning I feel great. Yesterday was able to have sex with very good ejectculation hence I will continue with my treatment but enhancing with 2x1500 mg omega 3 fish oil. I talk about cancer basics and we have to kill more cancer cells in our treatment plan and not turn them to dormant cancer cell masking as normal cells to reduce recurrence ( do not quote me I am not an expert). At the moment I feel great and have an amazing good quality living so I will continue and enjoy while it last

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A lot of trials were published last summer dealing with the use of Lupron with Zytiga. Here are some references.

nejm.org/doi/full/10.1056/N...

ascopost.com/News/55700

They have also used Zytiga with chemo, if you want to go that way.

One word of caution. Please make sure that your insurance company covers Zytiga. My company covers all but $22 of the $9500/month cost.

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Hi Dr_WHO

I hope you are not tired of me yet. I admire this site as I noticed most of you are fairly affluence. I think I have the resources to provide for most of the treatment as I am uninsured. But living and working in Australia I can access the public health system and still can perform all this oncologist treatment plan. The question now is they advise by often trial and error. I think I have for now developed s treatment plan that suits me personally. Like I said I am feeling great, looking to play 9 holes golf in 3 hours time. Be in touch.

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I am lucky that my insurance pays for Zytiga. Unfortunately right now now I am in tens of thousands of dollars in debt to the hospitals and clinics so I will not say I am well off. But we are all in this together. They say the best way to die is in dept. if I was single perhaps that is true. As it is now, when I approach the end I may divorce my wife so the she will not have to pay the bills...

But that is years (hopefully) in the future.

Have fun playing gulf.

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Hi Dr_WHO

Thanks for been frank. Like I say I do have the resources to sustain me for quite some time but in Australia I can use the Public Health system and pay minimal. I am always on the look out for those poor fellows that falls ill. If my treatment works the cost is dirt cheap. Who knows what my journey going to end up.

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Keep us posted. It may serve as a secondary treatment for those of us going the standard route at this time.

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Wochranbond - sorry to hear about your new mets. Have you been on hormone therapy before? If not, that decision is easy and needs to be started at once. Dr. Who sent some great links to read, too.

Talk to your doctor about what they recommend. Some patients believe having chemo early, if you are in generally good health, may be easier to tolerate now versus waiting until your health is morr challenges. I think you’ll find that the response rate is about the same between chemo and Zytiga in the studies.

I have been on Lupron and had early chemo. I’m starting Zytiga next week as my PSA is rising very slowly. If you are in generally good health, chemo is not nearly as bad as we all fear. So, if your doctor recommends it, don’t be afraid. And ask the men on this forum about what to expect and we can help you know how to expext and how to minimize the side effects.

Best wishes for a great response to your treatment. We are all pulling for you and praying for you!

James

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Looks like you will have to start with androgen deprivation therapy. At very least. Ir could knock it down for years. Mine lasted seven years. Ill proably be moving on to zitiga and possibly cheoi taxetotore. Ill find out in a few weeks.

The side effects from ADT vary from each individual so i wont spew my side effects

Find your new normal and run with it

Thomas

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Hi wcochranbond,

If you live in the US then your insurance will most likely not cover chemotherapy or Zytiga at your stage. The FDA has only approved these drugs in men who are hormone sensitive who are newly diagnosed, hormone therapy-naive and with very high Gleasons. Since you are not newly diagnosed and you do not qualify for these drugs. It might be possible that your Doctor can appeal, but it would be an uphill battle.

This approval situation is not unlike in the rest of the world. The standard of care would be for you to have hormone therapy (ADT) starting with at least 10 days of Casodex (bicalutamide) and then Lupron or a similar type of drug. The approved alternative, and probably superior, would be Firmagon.

Joel

CancerABCs.org

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Insurance might pay, mine did and I live in Atlanta.

I was in the same situation. RP in 2010 followed by salvage radiation, then last year 6 months of taxotere chemo with Lupron. It worked very well for me, psa disappeared very quickly, then my tumors, too. Chemo sucked but I'm better now. So far it was worth it. I am now taking a Lupron break, just had my last shot Thursday. I will be checking my psa every 3 mos. for the next few years.

Take care

Bill

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You have good advice above---I personally would have after the radiation, done the Lupron Casodex routine, with Avodart, to offset the 5-Alpha Reductase action on T, DHT, to E2. And if getting a Nadir PSA of undetectable, or near it---gone IADT, or taken a vacation, after, at least a year of having a low Nadir.

Nalakrats

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