Crossroads : 66, had DaVinci in 201... - Advanced Prostate...

Advanced Prostate Cancer
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Crossroads

Beach18
Beach18

66, had DaVinci in 2015 and + margins and 1 node with a G score of 7.

PSA after went from .1 to over 20 quickly with extensive bone mets and pain but also had chest pain with cardiac cath showing 5 vessel disease and bypass recommended

Decided on medical therapy only for heart and doing ok so far

For cancer started firmagon which has resolved pain and PSA has stayed under 1 for 6 months so far

Chemo and the like all have cardiac side effects so until the cancer becomes hormone resistant, I feel like my best chance and best quality of life is to stay as healthy as possible and see if both the cancer and heart problems stay manageable

Of course it’s just a matter of time, but all the studies mentioned here focus on one condition - the cancer and other risk factors aren’t really noted except as a cause of death

I understand my Urologist’s argument for chemo ASAP and I think he understands my reasons to delay it for now

Trying different supplements and diets and this forum has been of great help

My point is, I believe we have to understand the treatments and their good and bad effects, and be involved in the plan. No one seems to have the right answers to a lot of the questions we have.

Happy New Year to all and let’s continue to fight in 2019 -

20 Replies
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Beach,

Getting healthy certainly helps...I say cancer is like a bear in the forest.....don't feed him, and I am starving mine...getting excess body weight off---it decreases your heart's workload....exercise (walking for 30 minutes or more--if OK'd by your MD) releases endorphins which helps...have a bone densitometry study--how strong are your bones??....strong bones slow down bony mets......still have to get some food-- your protein, vegetables, some fruits, low low carbohydrates is advised by many.....read Nalakrats and pjoshea13 on supplements and diet, they have been on this road for some time....with your cardiac issues, I guess they ruled out Zytiga for you...Extensive bone mets.....found by bone scan or auxumin scan ?? There is a difference...Good luck

All the best for the new year for all of us,

Fish

Thank you

Bone scan then MRI with contrast

NPfisherman
NPfisherman
in reply to Beach18

Beach,

The auxumin pet scan is considered the better test and the PSMA scan is even better--depends on your PSA---(insurances don't want to pay)--Get the bone densitometry if you haven't had it...My MO ordered it for me this month....strong bones help....I have bone mets--I am doing some weight lifting for building bone strength...Have you had the shingles vaccine--varicella--no use in leaving any doors open for problems later---if your MO says chemo is "ASAP" and the Cardiologist says "No", then you might want to look at the MM310 trial--phase 1/2 or if the MO thinks you can wait----you are castrate sensitive--watch it---docetaxol with liposomal attachment which they say is more tumor specific and less random...result is less chemo side effects...if it works as planned...(the big question)

Good luck and best wishes,

Fish

Beach18
Beach18
in reply to NPfisherman

Thanks Fish

You seem to be under the care of a urologist - why are you not seeing a medical oncologist? He can consult with your cardiologist.

Beach18
Beach18
in reply to Tall_Allen

Uro oncologist trained at MSK and is current on all protocols and latest research

Previous medical oncologist was not particularly interested and not a PC specialist

Cardio defers to them as I refused bypass which he thought was best therapy

Had a consult at Cancer Center in Atlanta (CTCA) which was protocol driven

Your blog and comments are excellent

Thanks

Tall_Allen
Tall_Allen
in reply to Beach18

Is the risk of cardiotoxicity of docetaxel worse than the risk of cardiotoxicity of ADT?

Beach18
Beach18
in reply to Tall_Allen

The firmagon seems to be less cardiotoxic than Lupron but of course they both destroy the cardiac benefits of testosterone

Adding docetaxel would increase the chance of an adverse cardiac event

My thinking is if I reach castrate resistance and stop firmagon, then the docetaxel would be used

I am missing the Latitude proven cumulative effect but decreasing the cardiac risk in my opinion

There’s not a lot of info regarding this issue of cardiac risk with the various treatment regimens

Tall_Allen
Tall_Allen
in reply to Beach18

Castration (chemical or physical) is always continued after castration resistance (the cancer becomes super-sensitive to ANY testosterone).

Beach18
Beach18
in reply to Tall_Allen

Sorry TA

I meant when the Firmagon is not helping and the cancer is castration resistant, then along with the Firmagon, docetaxel or ZYTIGA and prednisone would be added, either adding a cumulative cardio toxicity

I understand the ADT is not stopped but another therapy is added on

I’m hoping something new might be approved that would be less toxic in the near future

Since you have multiple bones mets and pain, you should not just have ADT. If you do not want to have Chemo, the guidelinies recommend Zytiga/Abiraterone. This works just as well as a chemo in your situation but you have to take it for a longer time. Talk with your MO about this.

Beach18
Beach18
in reply to GP24

No pain on Firmagon so delaying potential cardio risks of chemo

Thanks

GP24
GP24
in reply to Beach18

Abiraterone is no Chemo. This are hormone-blocking tablets.

cancer.gov/news-events/canc...

From this link: "Both trials showed that adding the hormone-blocking drug abiraterone (Zytiga®) to standard androgen-deprivation therapy (ADT) allowed men with metastatic hormone-sensitive prostate cancer to live longer than if they were treated with ADT alone."

Beach18
Beach18
in reply to GP24

I know but as you read more and more there were cardiac events that may have been triggered by both chemo and various hormone blocking agents in patients with cardiac risk factors and active cardiac disease

I’m trying to stay alive and ride the fence between the heart and cancer issues until something changes

GP24
GP24
in reply to Beach18

With Firmagon you should not experience cardiac events as you probably know. Abiraterone increases the risk. However, as this study reports:

ncbi.nlm.nih.gov/pubmed/293...

"Abiraterone was found to significantly increase the risk of both cardiac toxicity and hypertension, whereas enzalutamide [Xtandi] significantly increases only the risk of hypertension."

So you could wait for FDA approval of Xtandi in your situation

Interesting Thanks

I'm almost 7 years out 2.5 years on Lupron and 3 + on Xtandi. I also did a derth of supplements. Now I just take Zyflamend. Did they help , who knows? I certainly am getting a nice ride on Lupron and Xtandi.

I have a heart related issue too and one that might impact prostate cancer treatments. I take meds for atrial fibrillation. I had another episode last night. I had nine episodes last year. So, should I pursue ablation surgery to finally fix this problem? Tired of dealing with it all these years. I am 68.

Beach18
Beach18
in reply to WSOPeddie

In my opinion, for chronic or recurrent AFib, ablation is the way to go

But you need to get the ok from your cardiologist and cancer doc together

Happy New Year and all the best in 2019👍🏻

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