Hazard

Hi Paul, sorry to hear about painful TURP. I cant comment on this or any aspect of Q1 but in regards to Q2 I started Enzalutamide 6 weeks ago and my MO is definitely keeping me on Zolodex. I am pretty sure that this is standard approach at Peter Mac. I was previously being treated at Epworth Hospital and when I became castrate resistant in 2017 I asked MO there if I would stay on Zolodex He said that although most of my PCa was castrate resistant maybe 5% was still responsive to ADT so they wanted me to continue. This is first time I have heard of anyone discontinuing Zolodex (or equivalent medication). I suggest that you get another opinion on this.

Regatds, Hazard

paulofaus in reply to Hazard

Thanks Hazard. The MO kind of left it in my court, saying that it (the Zoladex) is not really effective anymore. I am looking at getting Lutetium177 in a few months, so I might discuss staying off the Zoladex for now, but going back onto Degaralix if the Lu177 doesn't deliver the hoped for results. Cheers Paul.

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Tall_Allen

1) It is highly likely you have prostatitis. It is NOT ruled out by taking antibiotics. Rarely does prostatitis respond to antibiotics. Some guys get some relief by taking a tricyclic antidepressant (like Elavil). If that doesn't work, perhaps neurontin. It may remit on its own eventually.

2) One always keeps taking Zoladex after castration resistance sets in. The cancer becomes super-sensitive to even the smallest amount of androgen, so it is very important to take BOTH the Zoladex and the Xtandi. So far, Firmagon is only available as MONTHLY shots (and the first one or two may hurt). Another option worth considering is orchiectomy.

Hirsch in reply to Tall_Allen

Tall Allen. Why would orchiectomy be an alternative to Zoladex if he is apparently not responsive to the Zoladex? Thanks

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Tall_Allen in reply to Hirsch

They use the term castration resistant to describe the condition of cancer progression in spite of castration levels of testosterone. That doesn't mean that the chemical or physical castration is not working at all - in fact, it is. The situation would be much worse without the castration. The number of androgen receptors (ARs) on the cancer cell surface increases as PC progresses, among other changes. This means that even the smallest amount of testosterone can activate it and cause the cancer cell to multiply. So it becomes doubly important to continue the testosterone deprivation. Zytiga is useful, in part, because it prevents the adrenals from producing even the smallest amount of additional androgens (it also prevents the cancer from synthesizing its own androgens). Xtandi blocks the androgen receptors, but keeping up with the numerical increase is difficult.

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Hirsch in reply to Tall_Allen

Your explanation debunks the whole theory of bat therapy. I agree with you wholeheartedly

Thanks.

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Tall_Allen in reply to Hirsch

Not exactly - it is more complicated than that. I think there is a time period after castration resistance but before the supersensitization to androgens occur when BAT may be useful in some men:

pcnrv.blogspot.com/2016/09/...

The window of opportunity seems to occur in about half the non-symptomatic mCRPC men. They need to identify in whom it works and in whom it doesn't.

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Hirsch in reply to Hirsch

What is the mechanism by which the Zytiga prevents the cancer from producing its own androgens??

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Tall_Allen in reply to Hirsch

It blocks the enzymes cytochrome P450 17 alpha-hydroxylase (CYP17) and 17,20 lyase that the adrenals and the cancer uses in the biosynthesis of androgens. Ketoconazole also inhibits CYP 17 in the adrenals (but not as strongly) but doesn't inhibit intratumoral synthesis. CYP 17 inhibition also prevents biosynthesis of cortisol, so it must be replaced.

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Hirsch in reply to Tall_Allen

I did not know it works directly on the cancer cells. Thanks

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j-o-h-n in reply to Tall_Allen

To TallunderscoreAllen

I've said this before but you really know your shit! Take a bow!

Good Luck and Good Health.

JdashOdashHdashN Friday 08/17/2018 8:30 PM EDT

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paulofaus in reply to Tall_Allen

Thanks Tall_Allen, I've been reading your blog lately - my goodness, you are incredibly well read and informed, I really appreciate your input. Thanks Paul.

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Searoemer

I hope you find the MD curious enough to figure out the cause of the pain. I have no clinical reason to say this but I wonder if it is referred pain from another part of your body? In any event it might be a good idea to get referral to a pain clinic.

I recall different opinions about the efficacy of using two drugs rather then one to control PCA. . I guess I would try to get the docs to sort it out with you.

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