Advanced Hormone Sensitive Metastatic Prostate Cancer

[Harry_B]

I'm new here but have already learned much from the posts.

My name is Harry. I am 70 years old, fit and active.

My cancer was diagnosed accidentally May 18 when I was hospitalised with a bowel obstruction. Bowel scan showed enlarged lymph nodes and the subsequent investigation revealed Gleason 8/9 prostate cancer and three bone metastases (spine and hip), adjacent lymph node lesions and possibly thyroid lesion. My PSA was up round 60.

I have excellent medical advice (GP, Urologist, Radiologist and Medical Oncologist) who all work together well.

Immediately on diagnosis I started chemical ADT (bicalutamide and goserelin implant) and Docetaxel infusions every three weeks (course completed yesterday).

My PSA is now 0.08 and still falling.

My medical team intends that I proceed with radiotherapy to treat the bone and possibly lymph metastases.

My Oncologist does not foresee any other medical treatment beyond continuation of ADT until my PSA starts rising again (castrate resistance).

Some of my reading indicates that Abiraterone with Prednisone to compensate for loss of natural aldosterone extends survival by a significant time.

I gather that the Abiraterone blocks the testosterone produced by the adrenal gland leaving none of this cancer 'food' for the disease?

My questions (that I have asked my oncologist and he is thinking about) are:

1. Should I contemplate the use of Abiraterone while still hormone sensitive? and

2. If I choose this course of action how long will I have to take synthetic steroids or does the Adrenal Gland recommence the production of Aldosterone when the Abiraterone treatment is stopped?

I note that in Australia, medical benefits don't cover Abiraterone until there is evidence of castrate resistance, but the cost is not prohibitive.

Any advice on this would be very much appreciated.

Harry

[Tall_Allen]

Hi Harry-

1. Yes,definitely

pcnrv.blogspot.com/2017/06/...

2. You have to titrate off of the prednisone when you stop the abiraterone. Abrupt stoppage can cause a bad reaction. You will probably only need one 5mg tablet per day, so you can titrate back to 3/week for a couple of weeks, then 2/week, 1/week, 0/week.

[Harry_B in reply to Tall_Allen]

Thank you Allen. My concern is that I don't want the effects of long term steroid use so it seems that the adrenal gland can get back to normal once abiraterone is stopped? Do you know how long the abiraterone course normally lasts?

[Tall_Allen in reply to Harry_B]

The prednisone is only a REPLACEMENT dose to make up for the cortisol that is not being manufactured by the adrenals because of the abiraterone. It is NOT like supplementing steroids, and would not have the effects that worry you.

Abiraterone lasts a different amount of time in all men, and varies depending on how soon it's used. In the STAMPEDE trial the median failure-free survival was not reached in 4 years.

[Harry_B in reply to Tall_Allen]

Thank you Allen.

cheers,

Harry

[Harry_B in reply to Harry_B]

Hello Allen,

I’d appreciate your advice.

When diagnosed my PSA was 680 with no other symptoms. After 5 months of chemical ADT and 6 infusions of docetaxel my PSA is down to 0.8.

My metastases are bone (spine and hip and abdominal lymph nodes).

You have already advised pressing with Abiraterone and Prednisone which makes sense as a means of taking testosterone down to the lowest level possible.

What else would you suggest? I’m reading that the profession is getting more aggressive with early multi-mode treatment and I have read some material on 4-MU and Sosylibin I3 but it is quite difficult to sort the wheat from the chaff.

I would not take action without the support of my oncologist, radiologist and urologist, but I do need help to know the line of discussion and questioning to get to the best plan.

Thanks,

Harry

[Harry_B]

Thank you for this insight. I have explored your thinking further and what you write makes a lot of sense.

Cheers,

Harry

[Peterd110]

I am the same, only in reverse. Diagnosed in early August (accidentally), PCA 352, extensive bone mets, none in lymph nodes, Gleason 9. Have had a shot of Trelstar and almost 1 month of Zytiga. PCA on Monday was 0.67. But I read of many men receiving the docetaxel and I wonder should I be too??? I am being seen by a gu team at a teaching hospital ??? I just want to give this my best shot. I have a 6 year old son and want to be here for him and my wife for a while.