Triple Hormone Blockade

[Burk]

Hi, I'm new on this forum. I'm am looking for any information on Triple Hormone Blockade treatment for Prostate Cancer. Does anyone have any experience with this treatment?

[Tall_Allen]

That's a relic of the past. Please provide more info. You are posting to an advanced prostate cancer forum, so I assume you have been diagnosed with distant metastases? How many metastases and where are they? What is being irradiated? Prostate? Metastases? Both?

[Burk in reply to Tall_Allen]

CAT, Bone & MRI have yet to prove mets, but due to my numbers I my RO assumes that my cancer has metastasized. I am being treated accordingly.

[Tall_Allen in reply to Burk]

Are you saying your PSA was over 20? What was your Gleason score? Anything felt on DRE? Are you in LA? If you are high risk, you can try to be randomized to a PSMA PET scan:

clinicaltrials.gov/ct2/show...

Or, if you can shell out $3000, you can pay for one there without worrying about randomization. Detection of distant metastases makes a big difference in your treatment decisions.

If you are indeed metastatic, and the metastatic burden is low, you can receive a dose of prostate radiation that will slow progression but will not be curative. ADT will be lifelong and will be accompanied by an advanced hormonal (Zytiga, Xtandi or Erleada). That's why "triple blockade" is an outmoded concept.

If the PSMA scan confirms that you are high risk (localized), but not metastatic, you should have brachy boost therapy (EBRT+Brachytherapy+18 months of ADT).

IMHO, Liebowitz is a bit of a quack - his "phenomenal" results are not published in peer-reviewed journals - at least not since 2009.

[GP24]

This therapy was recommended by Robert „Bob“ Leibowitz, Stephen B. Strum, Mark Scholz, Steven Tucker and Charles „Snuffy“ Myers.

You can add Bicalutamide to Lupron for a combination therapy but I would not add Finasteride to that to get the Triple Blockade. I heard that Finasteride lowers the PSA value but has no effect against the cancer.

[Burk]

Thanks for the quick response. I have been reading the work of Dr Leibowitz. Sounds too good to be true. I am looking for affirmation to know whether or not to pursue it. I have been on Firmagone for two months and am scheduled for radiation next month. This sounds like a viable alternative to radiation. My baseline psa was 33 before Firmagone; it is currently 2.37 My T is <3. My Gleason score is 4+3. PC in 11/12 cores. Should I consider ADT3?

[GP24 in reply to Burk]

You can get the Triple Blockade after the radiation but this is no alternative to that.

[Burk in reply to GP24]

Hey thanks, This is all so new to me and confusing, I'm trying to find my way.

[GP24 in reply to Burk]

The triple blockade can just stop the tumor from growing while it has not developed resistance against this treatment. This is the case usually after two to three years. The radiation will kill the cancer cells in your prostate and these will not be able to become resistant.

[Fightinghard]

Hi Burk

From your bio I am guessing that you are taking the lupron pre-radiation good step to improve chances of success of the radiation.

My advice - find a highly rated cancer center within driving range, call and ask them for appointment with one of their MO docs.

Then follow their guidance for your specific case.

Best of luck in your journey.

We are all on the bus, just different seats

[Burk in reply to Fightinghard]

Actually I'm on Firmagon. Lupron is not currently available.

[billyboy3]

I too have been on the relic combo, sorry T but it still works for me, not so much now but for a long time, also did intermittent which has proven to be as effective and longer term impact. Hit it hard Burk!!!!! The earlier you knock the bastard back, the longer you will live!! Good luck in the war.

[treedown]

Not sure if this was a result of being treated at a non-center of excellence but the coordination between my MO and RO left a little to be desired. I didn't talk to my RO until almost 2 months after starting Lupron and I think it would have gone better off I had spoken to both day one. Just my opinion.

[Patrick-Turner]

I feel Tall Allen has the best answers for you.

My own experience with Pca was based on best known protocol in years after diagnosis in Dec 2009, age 62, Psa 6, Gleason score 9, 9 / 9 positive samples from PG biopsy.

In attempted open RP inn April 2010, docs could not remove PG because there was too much Pca wrapping around PG. So they took more biopsy samples and found zero spread, and CT scans showed none.

Next step was to give 2 years ADT with Eligard, and shrink size of PG full of Pca, and give 70 Grey of EBRT, ( high power X-rays ) at 8 months after attempted but failed RP.

Psa went from 8 before RP to nadir 0.08, but I stopped ADT at 2 years and Psa went back to 8.0 after 6 months showing that my Pca seemed to be radiation resistant, and that ADT didn't kill any Pca cells.

I've been on ADT ever since, but it failed in 2016 so Cosadex was added and it gave 6 months slow down in Pca growth, but maybe no Pca cell death. I had 31 Grey extra salvation IMRT and that also appeared to do nothing. Then Zytiga was added to ADT and Psa went down then up to give 8 month slow down of Pca growth. I had 5 shots of Docetaxel chemo in mid 2018, and the several PsMa scans after 2016 showed continued increase in mets and size and onset of bone mets. Chemo failed. I began Lu177 in Nov 2018, and Psa 25, and now, after 7 doses of Lu177 and 9 PsMa scans, Psa is 7, and mets have gone low, then come up, then gone low again, and ADT is have zero effect and if I quit ADT now, its likely my testicles could not make Testosterone at all, and probably my Pca is making all the testosterone it needs because that's what advanced Pca does.

No matter what treatment is given, many men have Pca that mutates to avoid being killed by anything any doctor can do. Our immune systems don't see out Pca as an enemy cell type, and in fact may help Pca grow.

Much was written about suppression of Testosterone from testicles and adrenal glands in 2009, and it was thought very thorough suppression of testosterone made Pca cells die. I saw no such thing, and then it was discovered that Pca makes its own dy-hydro-testosterone, much more powerful than the plain plain old testosterone made in testicles, so no matter how we try to suppress testosterone, it does not stop Pca growing.

The think that has worked best to kill my Pca cells has been Lu177, and its targeted beta particle radiation, the sort of ionizing radiation created in a nuclear bomb.

I cannot have too much Lu177, so I don't yet know if docs will give me more Lu177.

Research experts at PeterMac Hospital in Melbourne say I may be able to have more Lu177, maybe 10 doses, thus get about 4 years of suppressed Psa growth but after that I have no clue what I have to do, maybe have Ra223, maybe more chemo, but right now my Psa is flat lining and so effect of Lu177 is now mild, and I have some mets with high PsMa avidity and low PsM avidity, and its not easy for docs at Theranostics Australia to decide exactly what comes next. I might get an answer in about a week.

Some men have Pca that is a very weak form of Psa; they have a bit of EBRT, a few shots of ADT, game over, Pca in remission. But that is very rare. I was told I had aggressive Pca cell type just after diagnosis. I now understand what the analysis meant.

I'm 73, can cycle 200km a week, have no Pca symptoms, and can work on housework and on crafting in my shed, all good, but I just could be dead in 2 years.

My 9th PsMa scan 3 weeks ago showed I have no soft tissue mets but still have lots of mets in bones. But the overall scan showed less met size than last July.

So you may want to hit Pca hard with every known thing, but it may not make any difference to your time for overall survival.

Patrick Turner.

[Burk in reply to Patrick-Turner]

Thanks to all you guys for your helpful insight. There's nothing like a word from someone who has been down the road. I think I have my answer regarding THB-3 - not a substitute for EBT. Thanks, and God bless us all.

[EdBar]

I’ve been on it for over six years now, I originally learned about it by being a patient of Snuffy Myers. I was dx with metastatic disease and my PSA remains undetectable and has been for over five years.

None of my current doctors including Dr. Sartor who I just saw again last week have told me to stop. Quite the contrary, he recommended that I stay the course.

Ed - aka “the relic”

[Burk in reply to EdBar]

I'm grateful for you. Did you have any localized treatment - RP or RT?

[EdBar in reply to Burk]

Yes I had my prostate and several lymph nodes radiated about 6 months after dx. I was on ADT from day one. You can click on my profile to see my history.

Ed

[Burk in reply to EdBar]

Read your profile. Quite a journey. How could we do it without the power of prayer and the strength that God gives! Fish are biting

[Burk in reply to EdBar]

Have you been on HB for six years? I thought Dr Bob recommends only 13 months.

[EdBar in reply to Burk]

Been on it since dx in March 2014.

[Burk in reply to EdBar]

In what city is Dr Myers located?

[EdBar in reply to Burk]

Dr. Myers has retired, he retired about 3 years ago. He still puts out a publication called Prostapedia and is doing research in his retirement. He is a 17+ year survivor of metastatic PCa. This gave him tremendous insight and empathy of what it was like living with this disease. Nobody like him. He has many videos on YouTube.

I now see Dr. Oliver Sartor in NOLA who is also excellent and one of the top docs specializing in the treatment and research of PCa. He works out of Tulane University. He coordinates my treatment with my local MO.

Ed

[j-o-h-n]

Greetings Burk, I know you have answered some of the following questions but please do so again.

Please tell us your bio. Age? Location? Treatment(s)? Treatment center(s)? Scores Psa/Gleason? Medications? Doctor's name(s)? Thank You!!!

All info is voluntary, but it helps us help you and helps us too. If you do respond copy and paste it in your home page for your use and for other members’ reference.

Post on this site.... lots of good info.....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 11/17/2020 10:07 PM EST

[Burk in reply to j-o-h-n]

Greetings j-o-h-n, Thanks for your interest in my situation. I'm glad to share details with people who care. I am 62 yrs old and I live in Chambersburg, PA. My PSA was 24 in March; 31 in April. A bio in May revealed adenocarcinoma in 11/12; gleason of 4+3.

My URO referred me to Dr Behari Ashish a distinguished URO LAP surgeon here locally at Wellspan. They wanted to do RP. I requested time to get a second op.

I contacted Dr. Misop Han @ John Hopkins. JH did a slide review. They upgraded one core to 4+5. Dr Han said to me, "Surgery will not fix your problem. You need to see an RO".

In July I visited CTCA In Philadelphia. I met with Dr. Francis Schanne a surgeon. Nothing new. I also met with Dr. Curt Heese an RO. Good news! RT can do everything that surgery can do with reduced risk of side effects. Bad new! Daily treatments for six weeks. Philly is 4 hrs from home.

Next I visited Dr Whoon Kil a local RO. Sure, he can provide RT, but first you need to go on HB. Three months of HB before RT and then stay on HB for two years. Back to my URO for HB. I've been on Firmagon now for two months. I go for my third injection tomorrow.

It's not a bad life on Firmagon. I mean, if you can life without sex it's not too bad. Hot flashes about once per hour, but they only last 5 min at the most. Plans are to fry my prostate next month, .... but now I have been introduced to Dr Robert Leibowitz's THB protocol.

I refused RP because I needed a more broad spectrum treatment. Now I am wondering if RT is adequate. If I am going to be on HB for the next two years should I be doing THB? Is THB effective? Should I do TBH instead of RT?

CT in June.. no evidence of cancer. Bone Scan in July... no evidence of cancer. MRI in Sept... no report yet. Isn't that strange to make a guy wait two months for an MRI report? Most recent labs show T <3 and psa 2.37. Hopefully that is good news, but it's not 0.0 psa.

In retrospect, If I would have had RP, I'm certain that I would have been referred to an RO for RT who would have prescribed HB. What level of treatment do I need to kick this thing?I'm more concerned about the side effects than the treatments. Do I need to jump through all three hoops... cut it out, burn it out, then starve it out?

I know this is a forum for advanced cases and you guys probably think I'm a chicken. I'm new at this and am trying my best to make informed decisions. Who knows better than those who have been there??

[Fightinghard in reply to Burk]

Burk

Great job seeking different opinions and options from good docs.

One opinion to keep in mind - The risks of surgery are more immediate, while the risks of radiation are more future. But IMO both carry similar risks.

Uro docs like to operate and the ROs like to beam. Usually each will feel their specialty is the best option.

I have had both and both have left me some side effects.

Good luck and God bless

[j-o-h-n]

Hello again Burk,

Thank you for your quick and DETAILED response. It would be a good idea to copy and paste your history on to your home page for easy reference.

You are not a chicken.... we all were chickens when we were first diagnosed. Post here for any questions you may have. Do not post to me... post to the room...... Everyone here is very cordial and helpful.... Keep fighting.... you have plenty of company here...Birds of a feather...

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 11/18/2020 11:17 AM EST

[Fightinghard in reply to j-o-h-n]

J-o-h-n

I am still a chicken!! Just keep clucking

[j-o-h-n in reply to Fightinghard]

Ok.... but remember don't cross the road....

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 11/20/2020 7:23 PM EST

[immunity1]

Do your disgnostic imaging first then get back to us to share the nos, then advice.