This is the kind of post that brings me back here every day. Can you please share a brief history of your treatment over the years so we can compare to our own?
DX'd with PCa, Gleason 7 (4+3), PSA at 6.8 in March 2003. In April had 117 Palladium seeds implanted and 25 courses of IRMT. PSA never really came down. By Feb 2004, PSA 12; Mar, PSA 24; and 1st week of May, PSA 32.3. Scans revealed two mets. Took a 3 mo Lupron injection. Five weeks later I enrolled in s chemo trial for early aggressive treatment for metastatic Prostate Cancer.
Each course of chemotherapy lasts for 8 weeks. Patients were treated in weeks 1, 3, and 5 with doxorubicin 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with ketoconazole 400 mg orally 3 times a day daily for 7 days. In weeks 2, 4, and 6, treatment consisted of paclitaxel 100 mg/m2 intravenously on the first day of every week in combination with estramustine 280 mg orally 3 times a day for 7 days. 30 mg of Prednisone everyday through the three courses of chemotherapy.
After years of undetectables, my doctor suggested that I stop Lupron and in Feb 2010, I did so. Two years later T did not come back, so my doctor suggested that I try testosterone replacement therapy. I did.
I continue to use 4 mg of Androgen twice a week. T ranges between 360 to 720. PSA remains undetectable. In making the changes in 2010 and 2012, I knew that if it did not work, that I could always re-start Lupron injections.
Congrats. You and I have had the same treatment regiment with almost similar starting point but mine evidently is a different cancer mutation and have not responded as well. Am now on Zytiga and we’ll see how the beast responded (only been a month).
"Forty-six patients were enrolled, and forty-five patients were evaluable. Median progression-free survival (PFS) was 23.4 months. Median overall survival (OS) was 53.7 months.
Out of 45 patients with measurable disease, 22 patients had an objective response: 9 patients achieved a complete response; 2 patients achieved a partial response; 10 patients achieved stable disease.
Frequent grade 3 adverse events included elevated ALT (17 %), hypokalemia (13 %), and hypophosphatemia (13 %). Grade 4 adverse events were rare and included low bicarbonate (2 %), hypokalemia (2 %), leukocytopenia (2 %), and neutropenia (2 %)."
I am one of the nine. I enrolled within 45 days of confirmed metastatic disease. My thought process was simply, hit the cancer hard when first diagnosed while my body was strong and the cancer was not yet totally involved.
I think that in play is the Amato Hypothesis:
"Chemotherapy is a setting of hormone refractory prostate cancer has shown palliative benefit especially with substantial PSA decline strongly suggesting that disease modifying potential exists. Recently, chemotherapy is beginning to show a survival advantage. The stage is set for chemotherapy given earlier in a disease course. As a working hypothesis, we suspect that the transformation from an androgen-dependent to an androgen-independent phenotype is mediated by the expansion of an androgen-independent clone already present at the time of androgen deprivation. If this model is correct, then it would be desirable to bring treatment to bear on the androgen-independent component when the corresponding tumor burden is minimal. Thus, we view the androgen-independent component as analogous to “microscopic residual” or “micro-metastatic” disease for which adjuvant chemotherapy has shown to be effective in other contexts."
This boils down to early intervention of chemotherapy using two different infusion agents each paired up with two different orals plus 30 mg of Prednisone (has Cancer killing properties) over a six month period.
George, currently it is my understanding that he is not taking new patients for Clinic; instead concentrating on Research and Teaching responsibilities.
A most rare post. One of nine. You can see how thrilled all of us are for you, gourd_dancer. We are hopeful for Nalakrats, too. Let’s see. Your and our early ADT and chemo plus God. You’ve got to admit it’s a strange combo. Go well all. Mrs. S
Congratulations gourd! Happy to hear of how well you are doing after such a long time.
It’s success stories like yours that give the rest of us hope, and inspire us to be more aggressive early in the course of the disease.
I was Stage 4 oligometastatic at Dx in May, 2015. I wanted to be more aggressive right from the start, but there was nothing at that time that was FDA approved. Thanks to Stampede, the standard of care finally evolved and expanded to cover low volume guys like me, even though the stats didn’t show a significant benefit in terms of OS or PFS. Last November, After 2+ years of Lupron and bicalutamide my MO at the Mayo in Jax and I decided to add a course of docetaxel, 6 infusions at 3 week intervals, which I just completed 2 weeks ago. The logic behind it was, as you and others in our little club have alluded to, that the androgen drugs may halt the production of, or the reception of cancer cells, but don’t kill them. Chemo kills cancer cells. It seemed to me that logically, that the more of the little monsters you kill, the easier it is to control the rest of them. Time will tell. You are my new role model. I plan to be a 14+ year survivor like you.
Thanks for the post Mike. You motivate a lot of us with that kind of news. I am only a year out and did the chemo early on and my PSA is still very low. I am vacationing in Fatima, Portugal now and prayed that our dear Lord will continue to protect us and give us many many years to live.
Hello Lulu. Thanks but that was 7 months ago when I was in Fatima. I did say a big prayer for all of us that God will protect us and give us many many more years.
Nalarats, look at my response to ewhite999. Heck, I don't even know really what Zytiga is as it was, to my knowledge, not around in 2004. Same goes for Platinium based chemo. Best wishes to you as we kick this bastard.
Bruce, hit it hard, hit it early before the cancer cells have time to multiple and grow further. As far as I know, and I could be wrong, but it is a premise which I believe in, metastatic cancer cells (micro-metastasis) exists in your vascular and lymphatic systems riding the highway through your body just looking for a place to land and multiply. The only way that I am aware of killing these cells is through an aggressive chemotherapy program. The chemotherapy trial is different from what is currently available with standard treatment. Why? I can only surmise that it was based on my particular trial. I think that those who delayed, even with the same protocol, just had too much metastatic cells to overcome without dying from the treatment. To me, it is either that or the Good Lord is not ready for me.
Most Medical Oncologists are going to follow standard protocol until there is solid long-term proof otherwise. I was extremely lucky to find a paradigm shifting PCa Researcher in academia. With all this said, I will never forget the hospital staff Medical Oncologist who told me in 2009 while under going a total knee replacement, that one if the infusion drugs was counter inductcated and would never work. Not withstanding that fact that the drug was heavily used to treat cancer in the 80's and 90's before the development of Taxane-based drugs.
Read my other posts in this thread and you will find, the published hypothesis, treatment and results. I wish you the best in kicking this bastard.
Thanks for the encouraging update! So glad you made a great decision and won. I'm new here, just diagnosed and in the similar position you were back then, just much higher PSA from the get go. I'm going to start based on CHAARTED protocol in a week. Still looking for what could be even more aggressive. I'm fairly young (47) and think can withstand a loads of chemicals. Not sure if anyone does now similar combination cocktails like was in your case. Btw, I'm Texas as well. Howdy!
Thank you. Good luck. The only person that I know with this protocol is Robert Amato in the Texas Medical Center- Ut Health Sciences and Memorial Hermann Cancer Center.
Such great news, and so much hope. My husband had his first diagnosis almost 10 years ago, agressive prostrate cancer.. He had thre months of radaition using a clypso and 80 points planted to radiate. Then two years of lupron for two years. He was doing great up until this jan started feeling like something was wrong, blood in urine, hips hurting and he had his psa checked and it showed 3.5 at our primary, my husband went straight to his MO at CTCA in Zion Ill. The bone scan first then a cat scan, found a mass on adrenal gland, then we went back for the speclized Pet Scan of the prostrate. Found the prostrate "lit up" and the tip of the pancreas looked like the prostrate was swollen there. So then he wanted us to come back and do a MRI of his prostrate and abdoman. They did that and found out the adrenal gland is a benigned cyst and it looks like the cancer is still just in the prostrate area. Our last visit they did a MRI Bisopy fusion to get the lay of the land to prepare for his next visit which will be a biospy. I assume even though we are lucky for it to be hopefuly contained I assume the scores are still going to be as agressive as they were last time. My father in law passed from this same cancer. I am curious to what kind of treatment plan they will suggest. With everything you know what would be your thoughts?
Thank you,
Kim Lewallen
Kim, I imagine a Lupron injection first then plan a strategy with your Medical Oncologist.
That said I am biased towards chemotherapy with a Taxol derivative; what ever is current. Almost all use Taxotere. I had two different alternating chemo infusions; plus some orals in a trial. I have posted my treatment protocols.
Don't lose hope; stay positive and kick this bastard down.
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