Good morning, my dad (70 years old) was diagnosed with prostate cancer (stage 4) in June last year, he had plasma surgery to remove his prostate and cut off his testicles. In March of this year, his PSA rose to 16. In June due to an injury problem, an MRI was performed on his spine in which it was seen that there was a pathological lesion and they told him that he had bone metastasis. This was verified with a bone gameography, because we do not have more resources, we are undergoing treatment at the national hospital and the procedures and appointments take a long time. As treatment, he was prescribed ABIRATERONE and with that his PSA dropped from 22 PSA in August to 9 PSA in November. Now for the pain they told him that he should have radiotherapy for the lumbar area (spine). The diagnosis they gave us is that his cancer is very advanced and that there is no solution. You can only do pain care. Please could you guide me with certain doubts: Would it be good to undergo RADIOTHERAPY in the condition you are in? In Peru they only prescribe ABIRATERONE, is there any medication that is being used that gives better results?
Do you know of any alternative treatments or vitamins that could help? I appreciate your time, if you could advise me on anything else, the process is complicated for my family.
If anyone is interested and wants more information. I have all your results in digital format, you can write to me at:
diego.ferrua@gmail.com
Thank you, greetings from Peru.
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DiegoFerruaPE
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If your father has only one bone metastases he has low disease volume. In this case radiation of the prostate will extend his life: esmo.org/newsroom/press-rel...
Usually Abiraterone is given in combination with a three-monthly injection of leuprorelide or similar. If Abiraterone does not work anymore you can take a different drug.
To add to the previous comment, (1) Abiraterone (an "ARPI") it's almost always given with a steroid such as prednisone - you can read up on why but it's important; (2) you didn't mention ADT - the previous comment mentioned a 3-month lasting repeated injection of Lupron (known by various names) - degarelix is another kind of ADT; (3) and chemo - if you want to go with the latest and greatest add to the above two categories chemo, for example Docetaxol.
The research is at the combination of all three, known as triplet therapy, has substantial benefits over any one or two therapies on their own. If your Dad already has access to Abiraterone - which is the most expensive by far - then at least adding the ADT would be hugely helpful, all things being equal.
The research shows that really punching down the cancer with multiple therapies all at once is much superior to punching it with one therapy at a time which then fails and then sequentially you move to the next therapy.
As has been pointed out above, our friend in Peru has had an orchiectomy, also known as surgical castration. I overlooked this in my review of Diego's Dad's and therapies. And thus on the surface of it ADT is not needed.
So I just spent a half hour on ChatGPT and learned some fascinating things. Maybe I'll make a post. It's not completely clear to me that surgical castration is as inferior to ADT chemical castration as we are all led to believe.
Consider: In many circumstances the idea of reversibility, in the hopes of resumption of intimate relations, is laughable. And the side effects of ADT contribute to a shortened lifespan. And after metastasis we're only expecting if we're lucky maybe five years anyway. And mixed into this are the huge financial incentives both to Pharma and to regular ADT administration procedures. And then there's the phony concern for the feelings of the patient - but I think most people are not even presented with a sensibly summarized choice.
One thing I don't understand is how significant are the small amounts of testosterone that are produced outside the testes. And of course another confounding factor is evolution to progression without testosterone. (Notice I didn't use the word "resistance".)
I also did some more research. (I'm beginning to think that our friend in Peru has the advantage.)
Dr Quoc-Dien Trinh (Harvard Medical School, 2015) from the Medscape article below:
"Unfortunately, for a multitude of reasons, most of which are unjustified, urologists and medical oncologists no longer offer the option of orchiectomy.
This is in spite of guidelines continuing to recommend orchiectomy as a first-line treatment for men presenting with metastatic prostate cancer.
I find it disconcerting that a perfectly reasonable, cost-effective surgical treatment...has disappeared from medical practice for non-scientific reasons."
All the best to our friend in Peru! And glad that this topic was inadvertently revealed here. Bravo MC SPC Forum.
P.S. If this has been discussed here on the forum previously are on any of the standard references that we often refer to, I would be a grateful for any references.
Sorry to hear you are going thru so much pain. Im dealing with metastatic prostate cancer over 8 years. Many ups and downs' soon as we had things under control then in a year or so more spread of cancer. Originally started in prostate, spread thru seminal vessels and to bones. 4 places. Had 45 days of radiation to prlvic and prostate. 2 years later I had more cancer attack my left hip badly, Illiac area and effected my blood cells red severelyRadiated that area to stop the severe pain. Most recently i had radiation done a few weeks to my sacrum S-2 as cancer attacked area very aggressively
All this was happening while I was taking Firmagon then Ellegard a form of Lupron, along with Zytiga and Prednisone . Plus I have been on Clinical Trial, Propel for about 1& 1/2 years.
Yes my PSA was down to .01 most times. but it would climb. It went to1.0 then 2.34, then 3.20 then 4, 43. over the time span. PAIN levels at times were so bad I couldn'tp or sit properly. Trouble walking etc.
Finally had a Metronic Morphine Pump (Automatic Pump Doses) implanted in abdomen with tubing and catheter put into my spinal column to almost mid back. Really a blessing for my pain. Huge help controlling pain.
Although recently with the last spread, the pain was so intense I was hospitalized again. For 4 days straight I was on additional morphine IV treatments and other pain injections. My blood pressure was 223 over 117 NOT GOOD They couldn't bring it down for fear it would go way too low as pain would eventually subside and blood pressure would get better.
I still have more cancer spread to my T-12 Spine area and my right Ribs a few locations. As well as it is showing more cancer return to my right side Prostate bed. This will be a challenge. The S-2 they cannot guarantee full cancer cell kill. I was disappointed and let Oncologist know about it, How can we fix this if its still there? We cannot have radiation twice in same areas as it can never heal all around tissue or organs hit. Tough spot to be in.
Currently taking Zytiga and Prednisone only along with 3 month injection of Ellegard and Injection of exgeva to help bone structure somewhat.
I'm 75 year old. and would like to see my Only grandson Graduate. that is about 6 years.
I would be 81 then . I would be ok just to make it til then.
Heart problems thru all this as well. I wish you well and maybe you could look into the Morphine pump for pain control. IT REALLY WORKS . Dses can be controlled thru your Doctor if more is needed for pain control .
We are all warriors in this Cancer Battle. We all will win in some way, Keep Fighting and never give up. Barry
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