After reading the study about cholera vaccine (see link below), I’ve decided to get It. I’m aware it’s a retrospective study but it makes logical sense to me, and The statistics for survival are so overwhelming and the risks appear to be minimal, that it seems like a good risk reward scenario. So how to get it? The type of vaccine indicated in the study is not offered in the United States. I’ve tried to get it shipped from a Canadian pharmacy I’ve used before, but they won’t ship it because it needs to stay refrigerated. I live in Southern California so my plan is to fly to Vancouver to get it. I’m told the pharmacies there do not require a prescription. If I go to Vancouver, does anybody know if I can walk into a pharmacy and get the vaccine that day? If anyone had any suggestions on my best way to get the vaccine or if anyone has any reason for me not to do it, I’d greatly appreciate your thoughts. nature.com/articles/s41467-...
Schwah
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Schwah
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You can go right into the pharmacy and pick it up same day, a 2 dose pack of Dukoral is about 100 bucks. The vaccine is oral. I had no problems whatsoever. the second dose is supposed to be taken about 3 weeks later, so I just brought it back with me across the border. no one asked and I didnt volunteer.
Here’s a link to what the CDC has to say about cholera vaccine in case you haven’t already read it. I agree that the risk seems very low. Pls keep us informed.
I was hoping you would weigh in tall Allen. Isn’t it at least plausible that the cholera vaccine helps create some immune response that the Prostvac does not? Dr. Scholz says it’s likely a flawed retrospective study where healthier and wealthier people travel more and therefore get more cholera vaccine. And healthier and wealthier people tend to survive longer. I pointed out that the study’s authors claimed to have adjusted for income and other factors that might have skewed the results:
“To mitigate the possibility that patients using cholera vaccine might be healthier and be associated with a high socioeconomic status, multiple logistic regression analyses were conducted for the whole cohort and adjusted all the covariates“.
But Scholz seemed unconvinced. But he is OK if I try it since it appears to have a little risk. My thinking is that the survival advantage is so strong (almost 50%), that it’s hard for me to believe the authors did that bad of a job adjusting for other factors. Would you do it in my position? If not, why not?
Prostvac was probably the best hope at a vaccine-related PC response because it was as highly targeted as can be. If Prostvac didn't work, I have little hope for a non-targeted cholera vaccine. I agree with Scholz - people (not necessarily wealthy) who get the cholera vaccine are attuned to their health (often, in fact, health workers) and monitor PSA and get biopsied and treated earlier. Imagine, for example, a low paid nurse who works with Doctors Without Borders (this is Sweden where charitable participation is high) who gets multiple vaccines (including for malaria, which may have some effect on PC- see below) - how can anything "correct" for that? What effect does immune stimulation by exposue to endemic diseases third-world contries have? What about the microbiome there? The study shows an association with survival, it does not show that taking the vaccine caused greater survival. As I said, I don't see a problem with taking it if it is innocuous.
Chloroquine, an anti-malarial drug, has been found to increase the cancer cell death rate of ADT and may slow down the inception of castrate resistance
Androgen deprivation and androgen receptor competition by bicalutamide induce autophagy of hormone-resistant prostate cancer cells and confer resistance to apoptosis
Safety: Chloroquine has been associated with serious reactions of the skin, eyes, and ears, neuromuscular disorders, neuropsychiatric disorders, and immune suppression.
So you say it Appears that an anti-malaria drug had a positive impact on prostate cancer. Why then can you not see the logic that a cholera vaccine might also help? I get your Drs without borders analogy. But darn, hard to believe there’s enough of those stories to create such a huge survival benefit.
The difference is that Chloroquine has been tested in several trials and the hypothesis how it works is based on studies with mice.
Chloroquine inhibits autophagy in cancer cells, which is linked to tumor suppression and promotion, cancer-drug resistance, and metastasis. ncbi.nlm.nih.gov/pmc/articl...
I took Chloroquine for a while in the hope it may help against cancer three years ago. I did not notice a difference and also had no side effects from it as well.
The dose for malaria prophylaxis is 500 mg/week. The dose for rheumatoid arthritis is about 200 mg/day taken up to six months, however.
To find a reasonable dose for humans trying to fight cancer with this, I looked at this trial (12 patients) in breast cancer: cancerres.aacrjournals.org/... The author wrote to me, that the dose of 250 mg/week worked just as well as the 500 mg/week. "250mg of chloroquine diphosphate was apparently sufficient in reducing proliferation of the DCIS lesion"
So I took 250 mg/week as I expected to take it for a long time, however, I stopped after six months together with several supplements I took. The trials listed on NCT usually use about 100 mg/day if used adjuvant for various cancer treatments. This would be 700 mg/week, just above the dose for malaria prophylaxis.
When I have to start with ADT again, I will give it a new try, based on the study Allan posted.
I agree with GP24. I offered the Doctors Without Borders example as an example, which is why I wrote "for example." The point I was making was about "selection bias." and unmeasured variables. These are reasons why most retrospective studies lead to erroneous conclusions. Sometimes abstract terms like these are incomprehensible to some people, while offering a concrete example can make it real. I'm sorry if you were misled. Wanting something to be true doesn't make it true.
As an example of how misleading such studies can be, take a look at this blog of mine from 2016. In it, I looked at several different retrospective studies on debulking. They all seemed to show that debulking the prostate after metastases occurred had a large and impressive effect on survival. They were all wrong. HORRAD and STAMPEDE (randomized clinical trials) proved that their erroneous findings were due to slection bias.
I believe debulking showed significant benefits in Stampede for oligometastatic patients. That is if zapping the prostate with radiation counts as debulking.
I know nothing at all about whether or why the cholera vaccine might or might not help, however I have a few suggestions for how to go about getting and using it.
First of all, I suggest that you call a few pharmacies in Vancouver and explain what you want. They can tell you if they've got it in stock, what the price is, and whether they've got any problem selling to a U.S. citizen. If you're nervous about such a question, you don't need to give your name.
Secondly, I suggest you get together all the information you have about your condition - especially your current PSA before the first vaccine pill (get a new test if you haven't had one very recently), your current PSA doubling time vis a vis your two most recent PSA tests, your rate of acceleration or deceleration of doubling time, and whatever else you can think of. That will give you some way of measuring the effect of the new drug, something that will be of great interest to everyone here as well as to you.
Hope that helps, and best of luck with the vaccine.
I went to Toronto and got it - Dukoral - sold over the counter -- took first dose while there and brought back second dose on airplane ( in a small soft carry-on cooler with a ziplock bag of ice from the airport food court) and took it 2 weeks later.
So when you went thru security the small zip lock bag of ice didn’t cause TSA to look closer? I ask cause I don’t know how ice fits in with carry on guidelines for liquids. I think the limit is 3ounces for liquids.
Ok please ignore that last question. I see that BruceSF linked to a product brochure stating “Product in the unopened vial and sachet, stored in the outer carton, is stable at temperatures up to 25oC for a period of 14 days.“
Did you do this while on remission? Were you still on medication? Trying to see if anyone knows the timing, or the medicine that could work synergistically with it.
slow rise in psa since surgery May 2016 -- 0.03 to current 0.9 -- (3 and one half years) started taking Avadart 2 years ago-- no other treatment. All scans negative to date -- biopsy 6 cores positive G 4+4 =8 ... 4 of 12 lymph nodes positive post surgery path.
Actually my pre surgery biopsy was graded 4+3 =7 -- then sent to John Hopkins for second opinion where they graded it 4+5=9 --- post surgery Houston Methodist graded it 4+4=8
I, for one, agree with your motivation. This Summer I traveled to Brittish Columbia for a camping / RV adventure trip with my wife. While in Kamloops I walked into a popular chain pharmacy and asked for the 2 dose Dukoral. They only asked if I had a refrigeration pack for the vaccine. Of course I did in the RV. It was about $80 US. I took the oral vaccine that day and the 2nd dose 2 weeks later. My medical/science brain tells me there is no reason to think this will do anything for my PC. I agree with T_A and the others on this. But the choice I made says that I am "the sort of person", for whatever reasons, that would choose to do this. Perhaps feeling healthy enough and positive enough to travel to a country where cholera may exist, (or go to Vancouver to get the vaccine). There will be no way to know whether or not it has made any difference for your PC. But you will know that you said "yes" to something curious (and harmless). For me it was a celebration of being alive.
If you go take a cold pack for travel. You neither need to conceal it nor report it to customs (unless asked).
I picked up the dukoral at a Vancouver pharmacy and took the first dose. The next day we visited Butchart gardens in Victoria and took a seaplane back to Seattle. It was a fun weekend!
The website warns to be careful not to freeze the dukoral so you might want to turn up the fridge a tad while you wait for dose 2.
No food 1 hour before and after each dose. The insert fails to highlight this!
Also, “Product in the unopened vial and sachet, stored in the outer carton, is stable at temperatures up to 25oC for a period of 14 days. At the end of this period the product should be used or discarded.” you can only do this once.
I figured there was no downside; the multivariate regression was not completely convincing - they could not code for ‘adventure travel’ directly as a covariate, so there might be some factor they missed. Also when they tried to do a comparison test with malaria vaccine the opposite result occurred. Nevertheless it seems worth a shot, especially if you get a chance to enjoy Victoria.
Is anyone aware of other effective cancer meds that started out as retrospective studies and later proved effective thru clinical trials? Metformin might be one when the clinical trial is complete.
The Air Force used to give cholera shots but stopped due to the lack of protectiveness. The best way to deal with it is prevention. Don't use unboiled water - no ice. Uncooked food is out. When I've traveled in less developed countries I only drink sparkling water because with that they can't refill the bottle out of the tap. Beer is also good; human pathogens can't survive in low-dose alcohol environments. Brushing your teeth in beer sure tastes funny, but it works.
Due caution and close attention and you shouldn't have a problem.
yes -- it is unrelated, but after reading your bio. it seems like something you might be interested in -- but -- if it were me I would SBRT all visible mets first --- then see where you are -- that is most likely the best life extending approach any of us can do .... all these other promising new drugs still don't seem to be a cure or even make more than a few months longevity.
If I’m not mistaken there is no proof, i.e., proven by a completed clinical trial, that zapping all mets is beneficial. I’m participating in a phase II trial designed to determine that, among other things. If there is such proof then please steer me to those reports. Thanks.
I like this study but in the Oriole study nobody had hormone therapy. The conclusion from the study is that doing radiation improves time until your PSA goes up over doing nothing, which isn't surprising. But in patients who are on hormone therapy does radiation add anything?
They plan to add a new arm "M" to the STAMPEDE trial which shall answer your question. However, they plan to have first results after ten years. So this will not be relevant for my therapy plans.
Therefore I can only say that a low tumor volume will usually be predictive for a long time until castration resistance. E.g. patients with bone mets have a shorter period than patients with lymph node mets. If you have a small tumor volume, there are few cells which are already resistant and fewer cells which can mutate to become resistant. However, whether time to castration resistance is a good indication for overall survival is another controversy.
In the ORIOLE trial they use SBRT or SABR radiation. This means three or five sessions and you are done. Very low risk of side effects if you treat mets. Therefore I prefer to remove mets from my body and not keep them for later.
Do you have a link to the trial you are taking part in?
Schwah, FYI this is what my MD Anderson MO had to say about the study:
“Fascinating study!
I don't understand why it seems to help, because some of the best vaccines specifically designed for the best cancer type for the purposes of vaccines, namely melanoma, have been generally disappointing.
I will propose to my colleagues to present this paper for our journal club so that we can discuss about its merits and flaws, and we can better understand its basic mechanisms and clinical implications.
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Cholera Vaccine Revisited
Hello.I turn to you with hope and a request for help - help me good people find the DUKORAL cholera vaccine.
Cholera shot.
