Hello and need advice for advanced PC... - Advanced Prostate...

Advanced Prostate Cancer
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Hello and need advice for advanced PCa, 83 year old, 23 years out, what next?

JackFoster
JackFoster
23 Replies

Hello, I am Linda writing for my 83-year-old husband Jack. He has had a recent rising PSA (up to 9.8 after a Lupron shot one month ago and are now faced with what treatments to pursue next. Jack was a former Dr. Myers patient from 2008 - 2016 and since, we have been to three new doctors in the last three years. Not sure where to turn for good advice, latest treatments, etc. He's presently seeing a cancer dr. in a large Buffalo cancer hospital. We like our doctor, but would like alternative info, or a second opinion and knowledge of the latest treatments! I hope someone can steer us in a good direction? If you would need more history of his cancer, I can add it. Thanks in advance for any and all advice!

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Tall_Allen

Roswell is one of top cancer centers in the US. If there is something on the leading edge, they will know about it. You didn't mention metastases. If he is still not detectably metastatic, Erleada and Xtandi were recently approved. If he is metastatic, there are several medicines he can take (docetaxel, Provenge, Zytiga, Xtandi, Xofigo (if bone mets)) and many more in clinical trials.

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JackFoster

There are a few lymph node enlargements, but no other detectable mets in bones or elsewhere. Would lynoh node enlargement be considered a met? Forgive me, we have been pretty stable for so many years that we have not been up to date on PCa info.

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Tall_Allen

Yes, it's metastatic, but regional. Has he ever had radiation to his pelvic lymph nodes?

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JackFoster

Yes he did have external beam radiation in pelvic/prostate bed. Not sure if the nodes were targeted.

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Tall_Allen

If he got whole pelvic radiation, then he can't have more.

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Magnus1964

There are other ADT drugs that could extend his quality of life. Consider casodex, zytiga or xtandi. At his age I would not consider anything major like chemotherapy.

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Nalakrats

Some of us like myself would want to see a history.

Nalakrats

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JackFoster

OK thank you. I will try to oblige. Here is a condensed summary. I also have PSA and treatment lists if you would like and they would help?

Previous Therapy:

1. Diagnosed in 1996 with Gleason's 3+4=7/10. He received neoadjuvant Lupron followed by radical prostatectomy on 04/22/1997. He was well until 02/2000 when PSA started to rise.

2. He received external beam radiation therapy 05/2005 to 06/2005.

3. PSA decreased slightly following radiation to 2.1, but then gradually began to increase. He had a metastatic workup between 09/2006 and 12/2006 and only found possible prostate bed recurrence by ProstaScint scan.

4. Started Lupron 09/2007, followed by Proscar and Casodex.

5. On 08/08/2008, Casodex and Lupron discontinued by Dr. Myers.

6. Patient of Dr. Myers from 2008 – 2016.

Treatment Summary:

Current Therapy: Avodart 0.5 mg daily, Celebrex 200 mg one tablet orally daily b.i.d., Fosamax 70 mg once a week, Casodex 50mg daily.

10/2017 Casodex 50mg was changed from 3 times a week to once a day for rising PSA with good results.

03/19/2019 Eligard 22.5mg and stopped Casodex

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Nalakrats

Well I can definitely tell that starting in 2008, the treatments were classic Meyers.

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Nalakrats
Nalakrats
in reply to Nalakrats

Sorry I hit the reply--to continue, this sudden rise in PSA, near 10, is probably indicative of Castrate Resistance setting in. And with apparent metastatic condition, locally, I would assume the first thing to do is to get at least an Axumin Scan, or a F-18 Pet Scan--and really determine where everything is--as with this high a PSA, most if not all places the Mets are, will light up.

Behind this may very well be 2nd line ADT---Zytiga/Prednisone/Lupron. But Chemo might be preferred to go first, and then follow with the 2nd line ADT. At 83 one must be healthy enough to do Chemo. I am just giving some patterns that occur regularly.

A Gene Mapping may be in order, along with a PD-1 and PDL-1 determination, for Targeted Immunology Drugs. You may need to consider Xofigo, as for what is found in the bones. Gene Mapping can be arranged by calling Foundation One--800 number on web site--paid by Medicare. Adviser will answer phone.

And if able to do a PSMA Pet scan, it can be determined if their is enough expression in the Pca cells, to warrant Lu-177-PSMA-617.

So there is a whole lot and more coming out this year, such as Darolutamide, a 3rd level ADT drug.

And instead of Zytiga, a combo of Xtandi, with Indomethacin, is doing well in Trial.

So there is a lot to talk with the Doctors. But the right scan can provide the best route to go.

Nalakrats

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JackFoster

OH this is so helpful! and yes, a month ago Jack had scans and MRI all at Roswell Park Cancer Inst. in Buffalo NY. We were supposed to go over these reports yesterday with Dr. Chatta, but he was not there, all we had was a PA. We have another appt. on May 8 to discuss all. This is why I am doing the research now. From what I could read online in the patient portal, there were no mets to his bones or anywhere else, except two lymph node enlargements. The PA recommended three ways to treat: Xtandi or Zytiga w/ADT, Provenge then Zytiga or a clinical trial of Xtandi and EZH2. Forgive me, but Im not sure what the expression in the Pca cells means or PSMA pet scan? He did go to Datolli and Sand Lake in FL in 2011 and had scans there that were all negative. Dr. Myers responded that his PCa was so sensitive to the HBT that the cancer was undetectable. We will take your reply with us to our next visit. We very much appreciate your input! these are the tests or scans he had done in March: CT Chest, Abdomen, and Pelvis with contrast, SPECT-CT CERVICAL SPINE; UPPER THORAX with contrast/IV.

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abmicro
abmicro
in reply to JackFoster

I did those same scans in Sand Lake Florida. Great scans and great scan doctors writing reports. I got a 32 page report. I had a a CT scans at Kaiser and the reports were one or 2 pages with 1 line statements with absolutely no comments about any problems I had. The set of scans ordered by Dr Myers saved my life.

It is because of those scans ordered by Myers to Sand Lake Imaging that I spotted a small cancer spot which I treated, and spotted another big problems which could have killed me. It was an anurism caused by a large ASD hole in my heart. Need to be plugged before it caused anurism to grow and rupture like it did for actor John Ritter. High pressures in one side of my heart where causing dangerous things to happen to my heart. Plugged it in 2008 and it was the best thing I ever did. Instant energy, perfect EKGs, no more dizziness when I stood up, no more arrhythmia, enlarged heart actually shrank a little. I have a lot to thank Dr Myers for.

Read this about John Ritter:

A thoracic aortic aneurysm involves the ascending aorta, arch, or descending aorta. Aortic aneurysms are the 13th leading cause of death in the United States. They cause an estimated 15,000 to 20,000 deaths a year. Ritter died at the age of 54 on September 11, 2003 from an undiagnosed aortic dissection.

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JackFoster
JackFoster
in reply to abmicro

very happy to hear your story! bless you with continued good health.

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j-o-h-n
j-o-h-n
in reply to abmicro

Good show amigo abmicro,

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/21/2019 4:50 PM DST

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Nalakrats

On this Easter Day, I Pray for a great Visit with your Docs. on May 8th.

Shalom,

Nalakrats

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charlesmeyers1964

he's 83 let it go and let him enjoy the reswt of time he has left. the meds are a poison to ones body and the longer one is on the worst it gets. so forget his treatments and enjoy his life.

charlie

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Scorpio99

Relax, the docs stop treating prostate cancer after their patients pass 70 because it progresses so slowly that they outlive it and die of old age.

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bobdc6
bobdc6
in reply to Scorpio99

I had proton and adt at age 75 (now 77, still under doc's care).

Bob, G 4+5

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JackFoster

understand what you are saying and we have heard that too, BUT, its in hisa lymph nodes and the PSA doubling time or velocity seems to be pretty fast, so that is what is concerning us. want to stop it in its tracks or at least make an effor to slow it down!

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GP24
GP24
in reply to JackFoster

You wrote: "03/19/2019 Eligard 22.5mg and stopped Casodex"

Eligard will stop the tumor progression. Just wait for the next PSA value. This is probably lower than the last one.

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j-o-h-n

83, Keep on keeping on.

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 04/21/2019 4:52 PM DST

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TomNew62

XTandi

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dadzone43

This is totally a PERSONAL response to some of my brothers' comments. It is hard for me to agree that lots of additional treatment does anything to "extend the quality of life." I would argue that in most cases, the quality of life FALLS with the side effects of additional treatment. Additional treatment may extend LIFE but we should think twice about extolling "QUALITY OF LIFE" when recommending ever-more-toxic treatment regimens to an octogenarian.

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