1) over the past 8-12 months I've had lots of pain in the prostate area. It can be stabbing pain or a dull ache, which keeps me awake at night. It gets much worse when I walk, mow the lawn or stand up for extended periods of time. My Uro said it could be prostatitis, but several commonly used anti-biotics have done nothing for the pain. My MO, RO and Uro all said it's unusual to actually have pain in the prostate from prostate cancer and since we've pretty much ruled out prostatitis/bacterial infection, I still have no idea what's causing it. I had a TURP 3 weeks ago, as I was getting chronic retention. The retention problem has improved (a bit) but I still have the pain and it's worse than ever. I can't stand up or walk for more than a few minutes before the pain is too much too bear. Has anyone else experience anything similar, or does anyone else have any idea what may be the cause, or even better, what a solution might be. The TURP has been a trauma to the area, so I guess it's no surprise I have pain, I just hope it starts to improve. I'm ag 51, usually quite active and fit, healthy, other than MCRPCa (diagnosed 2.5 years ago, now on Enzalutamide).
2) My Medical Oncologist, who I switched to recently, said that I don't need to continue with Zoladex implants, now that I am on Enzalutamide as the Zoladex has lost its effectiveness. My previous MO said I had to stay on Zoladex as well as Enzalutamide. I'm not sure which one is right. Does anyone have any thoughts? I am inclined to switch to Degaralix, as it's been shown to have lower cardiovascular risk and I'm convinced Zoladex has caused me to have High blood pressure, which I've never had before in my life.
Thanks in advance.
Paul
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paulofaus
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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.
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.
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.
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.
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:
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.
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.
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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