Overall Survival Over Time: I was doing... - Advanced Prostate...

Advanced Prostate Cancer
8,356 members9,171 posts

Overall Survival Over Time

I was doing some research for a possible blog post and came across this survival graph for "early Zytiga" use in metastatic patients from the STAMPEDE trial. If I recall correctly, the 5-year survival for such patients used to be about 28%. This graph stops just short of 5-years, but close enough to make some guesses.

It looks to me like the "don't use early Zytiga" curve is heading towards 40% at 5 years. This would reflect the benefit gained from newer drugs becoming available.

The "early Zytiga" curve is heading towards the high 50s possibly as high as 60%. This would reflect the benefit of using the available drugs sooner and in combination.

This is fantastic! To me it looks like five year survival has now doubled, and there's better than a coin flip chance of living more than 5 years.

114 Replies
oldestnewest

One problem that I'm finding is that there is not enough data that indicates what "low volume" compared to "high volume" disease is. Is this a chart that combined both?

4 likes
Reply

I expect so. It's difficult to start sub-dividing because you could do that based on volume, gleason score, PSA at diagnoses, etc., etc. and the combinations would explode.

2 likes
Reply

It's just something I ask myself whenever I see "high volume" vs "low volume". The cutoff many times isn't even gleason, just mets. So sometimes "high volume" is > or equal to 3 mets, sometimes its 5 mets. I've seen a recent study that is putting oligo-metastatic up to 8 mets.

My father started this with around 5 mets. Are one to two small mets really going to push him that much over the edge from low volume to high volume? I know right now he is still sitting at a 0.02 PSA 8 months in. Most of the mets have resolved except for 2 that have persisted since the beginning.

I would just like to see that studies with a greater breakdown and firm definition of what "high volume" vs "low volume" is. So we could possibly see greater precision in care.

2 likes
Reply

I think extent of “Mets” is relative and subjective.

My husband has 4-5 lymph nodes metastatic and at UCLA all drs described him as having “very low disease burden”

And all drs also said that when my father in law was diagnosed with PC in 1990 the prognosis was very poor for 5 year. Survival with distant Mets and that has changed considerably since then. New numbers don’t reflect the extended life expectancies.

And despite our best efforts— life is terminal.☺️

5 likes
Reply

I understand that "life is terminal". But it's "how did you die, how did you suffer, and how have you lived".

Knowing that "life is terminal for everyone" really doesn't do anything to ease suffering or to really even motivate me. I remember 7 years ago - i'm 32 now - I had to get open heart surgery to repair a leaky aortic valve. After the surgery, there were 3 wires coming out of my skin because as my sternum was healing, it was pushing the wires out. Combined with the terrible pain of the sternum, my depression because I had to drop out of grad-school at the time and forgo a co-op research effort with Yale, and the fact that i was misdiagnosed for 8 years and it hit my heart strength - I was told by a doctor that "Hey. Let me take you to the cancer ward and show you all the children that are suffering".

I wanted to body slam him through his 300k BMW that was sitting outside. Afterwards, I wanted to say "hey, now let me take you to the cancer ward and show you all the children that are suffering."

7 likes
Reply

I agree with you. And, we can make all of our best efforts at everything, living, avoiding suffering, being our best selves, and this physical life still ends.

My husband is the kindest, calmest, and healthiest stage 4 guy ever. Never a drinker, never a smoker, never a bad thing to say and he has a crummy cancer.

Life is unfair except in death, we are equal in that we all die.

2 likes
Reply

Why ruin a nice $300k BMW?

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/29/2019 12:24 PM DST

2 likes
Reply

What bmw?

Reply

Quote from BarronS (above) :

I was told by a doctor that "Hey. Let me take you to the cancer ward and show you all the children that are suffering".

I wanted to body slam him through his 300k BMW that was sitting outside. Afterwards, I wanted to say "hey, now let me take you to the cancer ward and show you all the children that are suffering."}

THAT BMW....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 07/23/2019 4:21 PM DST

1 like
Reply

I missed that. Good points. My MO said that same stupid line to me about everyone being terminal. Pisses me off too.

Reply

STAMPEDE conformed with the standard staging definition of metastatic, so they are talking about patients staged as M1 when they say metastatic. They also looked at a small group of men with N1 (pelvic lymph node).

Reply

But none whose primary treatment was RP.

Reply

They did have a small sample of recurrent men - it will take many more years to read an overall survival response compared to men who are already metastatic.

Reply

My understanding is that locally invaded lymph nodes are not considered to be "metastatic." I had 6 spots in my pelvic area 3 of which have been removed in 3 remain having been identified with a gallium scan. ADT plus radiation treatment is supposed to give me.a.real shot at remission according to UTSW docs. Scholz's group in LA say hit it also with Zytiga/prednisolone. I'm zonked today from radiation every day this week plus a monthly Firmagon shot yesterday. Headed to office to do some work

Reply

Hey Tom. How is it going? Did you decide on Zytiga? Your 3rd week if rads?

Reply

No Zytiga, I have much of it in hand. Dos here in Dallas convinced me that cancer cells can/will change their DNA to defeat a Firmagon Zytiga/prednisolone cocktail AND the side effects are no free lunch. Completed 4th week of radiation. Some days it (along with Firmagon) kicks my butt

1 like
Reply

An unplanned secondary analysis presented at ESMO 2018 looked at high volume vs low volume, and found it worked equally well in both situations:

The hazard ratios for men with high volume mets only were:

STAMPEDE: 0.60

The hazard ratio for men with low volume mets only were:

STAMPEDE: 0.64

urotoday.com/conference-hig...

4 likes
Reply

Allen, what does this mean in layman's terms?

Also, how risky do you think is zytiga, pred combo on someone with stable CAD with 30% plaque in a couple small heart arteries? I have to be so specific but when someone is not specific then people say they can't answer a general question . I read the charter study results which said that people who had very low PSA after 7 months on ADT alone faired best (even better than ADT+chemo) So, I'm guessing that an oncologist might want somebody that's doing well on just ADT to not add anything else..."If it aint broke, don't fix it". I also think my medical oncologist is concerned that adding Zytiga/pred might lower QOL and in turn, cause me to not exercise as much, eat more poorly, be more depressed, which could ultimately result in the same lifespan but with a lower QoL. Your thoughts on that? I realize you are not a practicing doctor. I'm not sure if Heart Artery plaque is a concern with zytiga and pred. That's partly what I'm trying to discern. I didn't notice a major increase in heart events with those adding Zytiga/pred. Did I miss something in the study results? I noticed my MO's name on an xtandi presentation slide at one of the national conferences. Maybe he is biased towards xtandi. I'm not sure why he'd want me to use xtandi first before zytiga, because of my CAD. It seemed like xtandi is harder on the heart than zytiga/pred, based on my readings???

Thanks,

George

Reply

It means that early Zytiga worked equally well regardless of the number of metastases. Sorry, I think your autocorrect made your comments unintelligible. Why is plaque a concern with abiraterone?

Reply

Sorry Allen, that was voice dictation earlier. I guess that technology needs to improve or I need to annunciate better lol.

I just edited it so it's legible now, if you are willing to take a crack at it again.

thanks,

George

Reply

I think you misunderstand the CHAARTED study. They only meant that a good response to ADT predicted a good response to docetaxel. I don't know of any relationship between plaque buildup and advanced hormonal therapies. I'm sure you are taking a statin. Exercise is certainly important to maintaining physical and mental health and QOL while on hormonal therapy.

Reply

I didn't mean to say that zytiga causes plaque buildup what I was saying is that I have plaque build up already and I'm concerned about the fact that zytiga and prednisone causes higher blood pressure and lot of people in cardiac events as quoted here, which is why I haven't started zytiga and prednisone yet:

" Safety of the abiraterone plus prednisone combination was similar to what has been previously reported, with an excess in grade 4 hypertension with androgen-deprivation therapy alone (20% vs 10%), hypokalemia (10.8% vs 1.2%), and elevated alanine transferase (5.3% vs 1%). Treatment discontinuation due to adverse events was reported in 12% of the abiraterone group and 10% of the control group. Due to an excess in cardiovascular events with abiraterone, Dr. Fizazi urged caution when considering this agent in men with cardiac risk factors."

Reply

Hypertension is caused by not taking enough prednisone when one is taking Zytiga. It's just a matter of adjusting the prednisone enough to prevent it. Not a reason to avoid it. This article may help explain the relationship:

pcnrv.blogspot.com/2019/06/...

Reply

That's good info Allen. That's why i come to this site. That's important information that i can use at the doctors office. Thanks

George

Reply

I'd consider sbrt to his persistent Mets

Reply

I also was wondering how those terms were defined. Also, I was told that

studies only count bone mets, whereas one of my mets was a lymph node. And- some scans are able to detect more mets now than other scans- so comparing the number of mets different patients have may be like comparing apples to oranges, if they didn’t have the exact same type of scans.

Reply

Barron they are using the Zytiga with adt for every stage of of the disease. Many cases are not cut and dried metastatic but they use the same plan. Not sure the trial was done the same for everyone but mine was right out of the New England journal of medicine. I found it after it was over.

I was put on Zytiga for 8 months to shrink the tumor before 39 rounds of radiation. I’ll be on it for two years total before going off unless I have a psa rise before my 2 years are up. My tumor was T4 out of the capsule against the rectum. With an mri only it was determined there was no lymph node involvement but a nerve bundle was invaded. The rectum has yet to be determined if it is invaded so it could or could not be. Long story short they don’t know for sure how long we are going to live. I know getting every test possible is the only way to determine the extent of the disease so they can guess a little better. I missed my chance to get a pet scan before they drove my psa down too low to work. Still pissed about that one.

2 likes
Reply

There is another chart from stampede showing a significant benefits in TTDP and OS for low burden metastatic patients who receive RT (like IMRT) to the primary timer along with ADT versus ADT alone. Here’s the article from Lancet:

thelancet.com/journals/lanc...

1 like
Reply

Woah, for high metastatic burden the control group did slightly better. Better count those mets before proceeding. :-)

Reply

Was there a distinction between the primary tumor being in the prostate versus outside of the prostate?

Reply

George, I don’t believe that distinction was made. The conclusion was, ”Therefore, prostate radiotherapy should be a standard treatment option for men with a low metastatic burden.” I’m not sure I understand what you mean by primary tumor being out side the prostate for PCa for low metastatically burdened patients. Can you give an example...

Reply

If the prostate was radiated with high dose brachy then the primary tumor is probably dead so anything outside of the prostate, in lymph node/metastatic would then become the primary tumor potentially, depending on how they defined the study.

Reply

Does this result apply to NEWLY diagnosed prostate cancer and/or RECURRENT prostate cancer?

I have been on Lupron & Cassodex for 3 treatments (9 months each treatment) and now looking at a 4th ADT treatment t very shortly.

Much appreciate your opinion.

Good health to all.

Mike

Reply

Looks like a combination of newly diagnosed high risk patients and recurrence after treating low risk cancer. All the details are here: nejm.org/doi/full/10.1056/N...

Reply

Median (50%) survival has not been reached with the limited follow-up of the STAMPEDE trial, but we can look at 60% survival and note that the curves are diverging, so the survival improvement is at least this large. In STAMPEDE, early Zytiga increased survival by at least 18 months; In LATITUDE, early Zytiga increased survival by 16.8 months.

2 likes
Reply

Thanks! I was looking for those numbers and couldn't find them.

Reply

Let me make sure I have this straight: the 16.8 and 18 month improvements are versus late Zytiga, which means in addition to the 4 month improvement when used after castrate resistance. Correct?

Reply

Sorry -no. They are compared to ADT w/o Zytiga. Zytiga adds 4 months to median survival among men who are castration-resistant and have had chemo.

nejm.org/doi/pdf/10.1056/NE...

1 like
Reply

Does this assume that the adt alone folks are zytiga when the psa started rising in adt alone group? If not, then how do they know whether or not adding it subsequently would work almost as good?

Reply
HiddenThis reply has been deleted

What you say is correct, we are individuals and not a statistic. We won't be 40% dead in 5 years. There's always that guy that refuses treatment, starts eating broccoli, and goes into remission. Yada yada yada.

My takeaway from these studies and statistics are:

1) This is a very serious disease, do everything you can to fight it

2) Using combinations of treatments earlier in the disease process is usually better, but not always. Studies are the best info we have to decide what works and what doesn't.

3) Five year survival has doubled, and that is probably out of date already. Dead men may not post (sometimes their wife does), but in the coming years we should be seeing more and more members living 5, 10, 20, or more years.

2 likes
Reply
HiddenThis reply has been deleted

Did you just tell me to run a lap? LOL! Ya know, I've been Googling all the research into cancer and exercise and... well I better go run two laps now, it's good for me!

4 likes
Reply

I think my toilet stats have shot WAY up!!

5 likes
Reply

Yea, let’s let it all hang out !

Reply

One of the benefits of ADT is ball shrinkage which keeps them out of the bowl while sitting!😜

Reply

Ha Ha, everything down there is shrinking, and my pants fit better!

Reply

Titan Coloplast IMplant 2013. My johnson is staying the same size!

Reply

Now that's an idea!!

Reply

"2.6 months of our lives sitting on a toilet."

But none of that time is spent out in the field...

In days of old when knights were bold and bowls where not invented, they laid their load in the middle of the road and walked away contented...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/29/2019 12:32 PM DST

Reply

Does using an outhouse and leaving the door open count as "time spent out in the field"?

2 likes
Reply

Funny, but I gotta check with my oncologist for the answer....Will get back to you...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/29/2019 12:49 PM DST

Reply

I do remember leaving the door open. And it didn't gag a maggot. A million flies. Oh my god, where is that Sears catalogue?

1 like
Reply

Monkey Wards... softer and more pages...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/29/2019 8:44 PM DST

Reply

John. How did you concoct that one?

Reply

At a "stag" party....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/29/2019 8:45 PM DST

Reply

Agree. These numbers can drive one nuts

Reply

Give us $200,000 and we will extend your life by 3 months (maybe)...What a deal ! Where do I sign up for that.?..Oh, and you might not feel to good during those 3 extra months...

8 likes
Reply

Right, and this is exactly what I'm trying to write a blog post about. Elizabeth Warren is saying healthcare is a basic human right but nobody is talking about controlling costs, or having discussions about cost/benefit, etc.

It's great that we're all living longer, but the cost per month is also going up. That $10K a month drug will keep you alive until the $25K a month drug comes on the market. Rinse, lather, repeat. "Medicare for all" by itself won't solve this problem.

Did I mention I'm an independent with a bit of lean to the left?

9 likes
Reply

I am looking forward to your blog!

1 like
Reply

Likewise, I look forward to reading your blog.

Reply

Hi pleinairpainter, klaas40, since you expressed interest, see link in new forum post: healthunlocked.com/advanced...

1 like
Reply

Hello tom67inMA, Read 𝚈𝚘𝚞𝚛 well-written and thoughtful article. Thank you for sharing. I tried to leave a comment but was unable. My only thought was you may wish to clarify further the concept of “financial toxicity “ ,that it has credibility, and is not only a product of your fine mind.

Reply

I say sneak (walk) in over the southern boarder and get all your medical costs free.....

Did I mention I'm an independent with a bit of lean to the right?

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/29/2019 12:36 PM DST

1 like
Reply

Just call me Charlie Brown.

1 like
Reply

And, I like to read Scott Adams' blogs. Listen to them is more accurate.

Reply

I have said without anybody contradicting me that the finest health care insurance in the world is worthless if you can't find a doctor. Where are the incentives for people to go into that field?

Consider: you graduate from college. 22 years old. Four years of medical school, internship, residency - you're 29 years old and a quarter of a million in debt and you haven't made a dime yet. I've run these numbers by the CEO of Samaritan Health Services and he confirmed them. He said one of his biggest admin problems is helping the younger doctors in his system with their debt. And all anybody talks about is cutting practitioners' compensation. Already 1/3 of the doctors in California won't take new Medicaid patients; they'd lose money on them.

You've probably noticed that, after initial diagnosis you're more likely to see a physician assistant (PA) or nurse practitioner (NP) than an MD.

Other specialties are worse. There's an infant mortality problem in the US; primarily due to a severe shortage of OB/GYNs. Their malpractice insurance premiums are astronomical so new MDs don't want to go into that field. Midwifery is making a come back.

Nobody is doubting demand for medical services is increasing. It is past time we started thinking about supply. You don't create new practitioners overnight.

2 likes
Reply

You are right on the money. It all starts with the education system. Doctors should get a free education. Whoever scores highest on tests gets to be a doctor. A nice comfortable salary after that. The student debt is the next crisis. I don't think we should have to pay for the $250,000 someone charged up for basket weaving while partying it up and having their rent paid.

Reply

Doctors can get a subsidized education. All they have to do is commit to a few years of military service. Surprised more of them don't.

Reply

I’ll take ‘em if you don’t want them. Just say’in

Reply

Good point. I'm always amazed at the people that do this for me I plan on taking the money that I have and giving it to other people that can use it in their lives instead of wasting it on myself in the last few years.

Reply

As a patient placed on early Zytiga, I am interested in the survival rate of oligometastatic patients that have stereotactic radiation to their met lesions early...will this push OS above 64% and slow recurrence/failure... I am sure an answer is in the works... Thanks for posting...

Don Pescado

4 likes
Reply

Overall survival could be influenced by many other pathologies affecting the patients in the study. Many people in those studies died from causes other than prostate cancer. Younger and healthier people with metastatic prostate cancer treated with ADT and Zytiga may have better chances of survival than those indicated by the curves. Those curves do not show a stratification by age or associated pathologies.

6 likes
Reply

When I was diagnosed, I talked to the oncologist about survival statistics, as I'm sure we all did. I asked him if my chances were better because I was younger (55) and in better shape than many men who get prostate cancer. He told me that, while logic would make us think that way, the statistics don't really support that. It really depends on how our individual cancers respond to the different treatments.

8 likes
Reply

When I was diagnosed back in October, during my first meeting with my onc doc I tried to ask him about potential survival time ...... he interrupted me to bring in my wife and introduced us to the Hospice nurse . Dunno f that was an answer to my question or not yayahahaha. Still here tho, and doing better than ever ( ever since I got sick that is ). My onc doc likes to say “ everyone is different “ , guess that’s so.

Reply

Since you are younger and healthier than most patients I believe you could probable live longer than the mean OS shown on those curves. Overall survival curves are influenced by age and health status of the people participating in the study. If you do the study of ADT and Abiraterone with people 95 years old or more with multiple associated pathologies the OS would be different when compared with a group of 50 years old patients without associated pathologies treated the same way. Many people in the first group will dye of heart attacks, stroke, pneumonia, old age and some from the cancer. Because of the influence of all these other causes of death the overall survival of that group will be poorer than the overall survival of the second group. Overall survival is not specific death by prostate cancer.

1 like
Reply

To MarkBC 's point, I suspect that younger, healthier men tend to have more aggressive cancers. This would be due to faster metabolism, more growth hormone, etc. So while they won't be as likely to die of a stroke, they also won't last as long with a marginal response to treatment. Just a thought from a 51 year old with an aggressive cancer.

1 like
Reply

Think about it. Chemo and other agents at 75+ years ....

I felt pretty cappy with surgery, radiation, and chemo all in one year. Each one individually was difficult to bear physically let alone mentally.

And I was 57 in great health when the nightmare started.

1 like
Reply

How are you today after the side effects have subsided? I’m talking about the initial side effects from each treatment. I’m not including the ADT. I know those aren’t any better.

Reply

Hey, that's the boat I am in. Stage 4 metastatic, and taking zytiga. Cancer team allowed me to receive radiation to the prostate and bone met as well as this treatment just showed benefit in a trial last year. I figure with the early zytiga, and radiation I might live 7 or 8 years!

3 likes
Reply

I'm also in that boat, but without any radiation to the prostate. I don't have any specific idea how long I will live, but know that it could be for years. That's long enough for things such as diet and exercise to have a significant effect. It's also long enough for new treatments to be approved and new studies to begin.

I can almost guarantee that if you do make it to 7 or 8 years with current treatments, there will be new ones waiting for you to add on even more time.

8 likes
Reply

Yup, a member of my medical team made basically the same point. If we can’t cure it now, the goal then is to keep you around till a cure for it does come.

1 like
Reply

Marc, where was your radiation done?

Reply

Portland Oregon at Kaiser Interstate; I think they have 4 rapid arc machines.

Reply

What was the trial that showed promise for zapping Mets?

1 like
Reply

Here is a link to it:

clinicaltrials.gov/ct2/show...

SABR-COMET

2 likes
Reply

Thank you

1 like
Reply

There are trials going on for stereotactic radiation in oligometastatic disease--initial diagnosis and for recurrence....could possibly buy several years....see page 4:

cancer.gov/about-cancer/tre...

Here is the Phase 2 with Dr. Heron:

astro.org/News-and-Publicat...

All the best

Fish

Reply

Dr Heron is working on Phase 2 of this trial....it had more prostate cancer patients than SABR-COMET ...looks good so far....

astro.org/News-and-Publicat...

All the best,

Fish

Reply

I have a really good chart prepared by the STAMPEDE team at 3 years which shows the vast difference in OS. Personally, I’m approaching 8 years after a dx PSA of 571. Currently immeasurable.

Unfortunately I can’t find a way to post the image in a response.

1 like
Reply

Ill be a little more hyperoptimistic than you Tom....at 54 mnths the 'zytiga' graph seems to flatten...dare I say those who make it 54 months can expect a very long survival...lets see what the five year extention looks like...very promising..Thanks for this

1 like
Reply

My husband has been on zytiga for 8 months and psa continues to drop. What is the average time zytiga works? You aren’t saying zytiga works 54 months? He’s already had chemo .

Reply

There appears to be no upper limit for how long it can work. We have members that have been on it for 8 years and it's still working. You won't find stories beyond that yet because the drug is too new.

1 like
Reply

No..I think you're answering your own question...the zytiga is working if his PSA continues to drop...what I'm hearing is your worried its not working fast enough? We all respond uniquely if so. Whats important is zytiga works well when administered promptly...

The graph is boldly telling us early zytiga treatment outpaces monotherapeutic ADT by 20% at 54 months...50% better results when combined....it gives us no indication of its early results wrt PSA/etc...this is an overall survival graph...the gold standard for treatment evaluation.

1 like
Reply

I live my life now one day at a time , I love my family and pray daily to thank God for another day. We all have an experation date and only he knows when our milk will spoil.

Trust in your medical team to weigh out your options. I've been in Zytiga, Eligard, Xgeva since day one of diognoses that was 17 months ago PSA 0.1 since first month treatment. I feel pretty good with the usual lifestyle changes that go along with ADT. The trade off is I'm still alive. Never give up never surrender. Leo

3 likes
Reply

❤️

Reply

I have recently started zytiga based on this research. MO said she has started new patients this year on zytiga based on this research but has to provide this research to the insurance company to get approved.

Reply

Made my fucking day

Reply

Fucking Amen....It may just be science...not prayers may be the answer....and a little luck in our choice of parents

1 like
Reply

Hate seeing that chart. I know my days are numbered. Should choose my words more carefully. My apologies.

Reply

Sorry, it was not my intention to remind you of your mortality, just to highlight that the statistics are improving with time.

1 like
Reply

I understand, sorry..

Reply

No problem, you were just beginning honest about your feelings.

1 like
Reply

I had Zytiga as part of a clinical trial. It gave me the longest response I had with medications to this point but lasted about 20 months before PSA started rising. Like it has been stated earlier, everyone is an individual and their cancer will respond as such. The longer you stay around the greater the chance a new Med will show up that will be helpful. Be blessed!

2 likes
Reply

Am I correct that those same studies also looked at early use of taxotere instead of Zytiga? Is there a similar graph for OS in that case?

Reply

Yes, there's a large number of arms in the study, using letters up to "k" last time I looked. As I recall, the results for Docetaxel were similar to the results for Zytiga, but I couldn't find a graph in a quick web search.

Reply

No graph, but it stated there was an OS overall survival of 81 months VS 71 targetedonc.com/news/doceta...

I was Dx with Stage IV PCa in 01/2015, but 10/14/2014 was when I had a PSA @555.2, so using that as my Dx day. 15 Taxotere chemos and 30 months ADT, on Metformin and Lipitor, back on Lupron and PSA went back down to 3.9(840 at Dx)

Fight on y'all

Reply

Good news👍🏻

Reply

Hope so. No person is Guaranteed five years of life cancer no cancer I realize his cancer is terminal and it breaks my heart. New medicine is coming out all the time it may not work for him but hopefully you work for someone else don’t know I know my husband is older and five years sounds really good. I realize if you’re in your 50s or 60s five years is not the best but like I said before no one is guaranteed more than the day you wake up I know that I pray every night for every man That’s on this crappy journey

Reply

I think it's time for Humor.....

And the Lord said unto John,

"Come forth and you will receive eternal life"

But John came fifth, and won a toaster.

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/29/2019 12:45 PM DST

6 likes
Reply

But it was a cheap Chinese toaster; short circuited the same day and burned his house down.

3 likes
Reply

And John huffed and puffed but alas the pigs house burned to the ground.. and he had pig knuckles and rice that night...

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 06/29/2019 8:50 PM DST

1 like
Reply

From reading the studies it appeared to be that xtandi resulted in allot more cardiac events than zytiga/pred but my oncologist recommends xtandi before zytiga for me because i have coronary artery disease. What an i missing?

Reply

You may also like...