Low dose chemo + HT?

[arete1105]

PSA is .2 and T is 15. My Urologist (Kaiser) wants to alter on/off HT (Casodex + Lupron) al long as these numbers are low. But I am thinking that while the numbers are low to also add in low dose Chemo (10-15%) Any thoughts on this?

[Tall_Allen]

If you want to be aggressive, you might discuss adding Zytiga (and getting rid of the Casodex) if you can get insurance to cover it. Chemo has no proven benefit when there are few metastases. The other direction you can go in is Casodex ONLY (with raloxifene) with intermittent vacations.

[JimVanHorn]

Hello arete1105. My PSA went down to 0.00 on Lupron and stayed there for 6 and 1/2 years. I was on Casodex for just 3 weeks because Lupron causes a Testosterone spike at first. I also had 72 radiations over the last 11 years. I am no longer on any therapy for 4 months now and my PSA is still 0.00. I had bone metastases so I am on active surveillance now. So find a therapy that works for you and then stay with it. Good luck and keep truckin'.

[arete1105 in reply to JimVanHorn]

It always sounds good to hear about low PSA, but my question is what is the status of the cancer? Do you think that the radiation "fixed" the cancer? So you took Lupron for 6.5 yrs and Casodex for 3 weeks only? Lupron by itself works and is recommended?

Have you had your mets scanned to see the current status of them?

HT as you know is not a cancer killer, but merely a "slow boat" towards the final outcome.

[JimVanHorn in reply to arete1105]

Lets take these questions one at a time. The PSA is a test that tells you if your Prostate cells (healthy and cancerous) are multiplying (tumors). Now every cancer is different and in different parts of the prostate. Theoretically when your PSA is 0.00 no prostate cells are subdividing. Prostate cells require Testosterone to stimulate division (There is a spot on each Prostate cell call the AR). The AR (Androgen Receptor) must contact an androgen (like testosterone) to form the DNA molecules that divide. So Lupron does not kill cancer cells it keeps them from sub-dividing, both in the prostate and when metastasizing. Radiation actually kills cells. When there is an area in the prostate with large amounts of cancer, radiation goes to that spot and kills all the cells, both healthy and cancerous. But other areas may have small amounts of cancer so some doctors believe in removing the prostate. I did not have that done. Radiation can also zap metastases if they are concentrated in one area as seen on a bone scan. So radiation helps but is not 100%.

Casodex does the same thing as Lupron. It works faster but not as well. So when you start Lupron you get a spike in Testosterone. This is bad for your body. Casodex keeps the spike from going so high, but eventually the Lupron lowers the T better than Casodex. If your doctor is stopping and starting Lupron this may be why he is keeping you on Casodex. Lupron works by itself and in fact I no longer have cancer.

Metastases for me are in my long bones and hip bone. You see single cancerous cells and go into the blood steam at any time. They go through the body and have affinity mostly for bones and lymph nodes. As long as here is no testosterone they can not subdivide. Most cells in your body only live for about 7 years and die off. Then the basil cells replenish the new cells. The cancer cells are not in their normal place so when they die and nothing happens. They can attach to a bone and sit there. Then over time they sink into the bone and leave a pock mark on the bone. This weakens the bone but the cell eventually dies. When there are a lot of these you get osteoporosis (weak bones) and I had 3 shots of Xgeva during the 6 1/2 years. They did a bone marrow test and found no cancer cells. When cells go to lymph nodes, the nodes swell and become sore and white blood cell counts change. Then further tests must be done.

HT with Lupron is for patients that are receptive to stopping your T. You see Lupron is "fooling" your pituitary and telling it to "Not Make Androgens". For women it tells them to "RELEASE LEUTENIZING HORMONES" so they can have many babies. But many men are not responsive to Lupron and must use other medications. So this why there are so many protocols to follow. Eligard is a generic for Lupron and is less expensive.

Now Lupron has 14 side effects you need to understand. Look up the package insert on the computer under side effects of Lupron for MEN and just keep truckin'.

[arete1105 in reply to JimVanHorn]

I need some clarification: you said you no longer have cancer, but the next paragraph talks about your Mets. So you do or do not have cancer?

[JimVanHorn in reply to arete1105]

At the end of June, 2018 I was taken off of Lupron. Three months later my PSA was still 0.00 which means no prostate cells are multiplying. My bone metastases have sunken into the bone and are no longer viable. So I am on active surveillance and get tested every 3 months. If my PSA goes above 1.5 we will consider further treatment.

[arete1105 in reply to JimVanHorn]

I guess I don't understand what mets sunken into the bone means. Mets are CA cells that have spread. So are those cells dead, active or dormant?

[JimVanHorn in reply to arete1105]

The cancer cells sink into the bone and leave a pock mark (like when you have acne on your face). They then can not go anywhere and if there is no Testosterone they can not multiply. They die inside the bone. There was a study done to see the pock marks and count how many per square centimeter, but it is much easier to just do a bone density test. Now remember each of us have different kinds of cancers in different places in the prostate, so we can only do what is best for us. Sometimes all we can do is listen to the doctor and pray for the best.

[arete1105 in reply to JimVanHorn]

So will a scan tell you the condition of the mets?

[JimVanHorn in reply to arete1105]

No. The bone mets are kind of in a tomb so to speak. Hopefully they are dead. Active surveillance (watching and waiting) is all I can do and hope for the best, or start Lupron again or some other medication. I am 73 yrs old now and have a positive outlook.

[arete1105 in reply to JimVanHorn]

I guess what I am asking is how does a scan show active v dead cells

[JimVanHorn in reply to arete1105]

Well the dead cells are not active and a bone scan tells you how strong the bone is. If the bone is weak you have a lot of bone mets, and Xgeva helps that. I see that you have inflammation of the urethra? I had that when I received my last 30 radiations. The inside of my urethra had wavy folds half way up and I had to wait 5 to 10 minutes to urinate for about a year. I had to use a catheter. Then for some reason it just went away. I am urinary incontinent now, but that comes and goes at 6 month intervals. I have poor kidneys, but since I stopped Lupron my kidneys are getting better.

[dbrooks_h in reply to JimVanHorn]

What is HT

[dbrooks_h in reply to arete1105]

What is HT, what happen to ADT2.

[arete1105 in reply to dbrooks_h]

HT= Hormone Therapy, in my case Lupron + Casodex

[dbrooks_h in reply to arete1105]

Si, thanks