I checked online a day or so ago and found that Medicare seems to have covered my Provenge. $58K billed, Medicare approved $55K, paid $44K, leaving 11K for my United Health supplement to cover. As I told the nurse yesterday, finding out it was covered may be as good for my health as the actual treatment. Or maybe they work synergistically, the coverage and the treatment!
I was surprised that the gross billing was much less than I expected; I thought it would be $100-200K. I guess Medicare negotiates hard, which bodes well for Rx drugs coverage looking forward (hopefully).
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Good luck on your Provenge journey. I believe it can make a difference. Let's stay optimistic warriors, I think the medicines that will cure us are coming!.
I wonder what the good results are, and how they were determined. I chose to have it, I'm glad I did, but I have no idea what effect it is having or how one would determine that, since it neither affects PSA no stops radiographic progression. But maybe there's something that I haven't heard about.
I have done no research yet on Provenge, but I am interested. Hopefully, I will not need to address it. I am just relaying the info, as presented. I am neither pro nor con, at this point. I will relay anything I find, when/if I do.
Provenge (sipuleucel-T) is an immunotherapy used to treat advanced prostate cancer. It works by stimulating the patient’s immune system to attack prostate cancer cells. Though Provenge doesn’t directly reduce PSA levels or stop cancer progression visible on scans, it aims to improve overall survival by training the immune system to better recognize and fight cancer.
Studies have shown some improvement in survival rates for men with metastatic castration-resistant prostate cancer, but the effects can be subtle, making it harder for patients to see immediate changes like with other treatments. As for determining its effectiveness, doctors often look at long-term outcomes such as overall survival rather than immediate tumor shrinkage or PSA responses. If you’re interested, I can help you find more specific research on this treatment.
Provenge (sipuleucel-T) is a relatively expensive treatment for prostate cancer. In the United States, the cost of the complete Provenge treatment (which consists of three infusions over the course of about a month) is approximately $93,000 to $100,000. This price can vary depending on the specific healthcare provider and location.
Availability of Provenge
Provenge is approved and available in several countries, though its availability may vary due to regulatory approvals, healthcare systems, and insurance coverage. Some of the countries where Provenge is available include:
1. United States: Provenge was approved by the FDA in 2010 and is widely available.
2. European Union: Provenge was approved by the European Medicines Agency (EMA) in 2013, but its availability may differ by country due to local healthcare policies.
3. Canada: It has been approved by Health Canada, though access may depend on provincial healthcare systems and insurance coverage.
4. Japan: Provenge is available in Japan after receiving regulatory approval.
5. Other Countries: It may be available in a few other countries, but the accessibility might be limited, and some countries may not yet have approved Provenge for use.
Coverage for Provenge in countries where it is approved will largely depend on whether the patient’s health insurance covers it. Many insurance plans in the U.S. and other countries may cover Provenge, especially for patients who meet specific clinical criteria, though out-of-pocket costs can still be significant without sufficient coverage.
Let me know if you'd like more details or help finding resources on how to access Provenge in a specific country.
Unless this treatment is covered by Medicare, this cost would exclude me. I refuse to deplete my wife's and my resources just to 'potentially' live a few extra months. She will need to live long after I am gone.
Thank you very much for the offer to help find info on this.
I understand everything what you are saying. 120 k$ is too much, but 50k would be much more reasonable for me. Just letting you know that my MO was not very enthusiastic about provenge but I would gladly get it if I could afford it what currently I just simply can't.
20+ years history of prostate issues treated well with Saw Palmetto only. No doctoring done and no need felt.
PSA issues uncovered during an unrelated ER visit May 2021. PSA at that time at 1410. No previous PSA tests done. Bone scan showed no related bone cancer, some pelvic lymph cancer indicated by CT Contrast scan.
Gleason 8 (4+4) Cancer Staging of 4A.
Immediately put on Firmagon 240mg injection. 30 days later, PSA down to 01.92 (not a typo: 01.92). Elation! Next injection 08/11 was 6month Eligard 45mg. Initial side effect of lower back pain quite disruptive.
09/13/21 tests show Total T @ 8 NG/DL and PSA @ 0.21. Bone Scan shows negative. CT Scan shows metastasized pelvic lymph node shrinking by half.
12/23/2021 Lab tests show continued declining PSA of 0.06
Still generally feeling well except for muscle discomfort now in hips. Mental state seems good, from my point of view. Continued disagreement with MO over course of treatment, with him pushing chemo. Holding my own with him, so far.
02/17/2022 - Next injection of 6 month Eligard 45mg. Almost immediate same SE's as before.
03/30/2022 Lab test - PSA 0.05 "T" not tested for.
Different MO at same Cancer Facility agrees with me that additional treatment types are not warranted at this time as I am responding very well to Eligard Monotherapy. Of course there is no way of knowing if my own natural treatments are having any or even most of the influence on these results. Keeping up a continuous exercise program is becoming a little more difficult.
11/010/2022 Started a strict Whole Foods Plant Based Diet.
02/14/2023 PSA 0.04 The PSA assay is performed on the Siemens Atellica analyzer. Continuing Eligard Monotherapy.
Discussed potential BAT usage. Urologist open but needs to research first.
03/01/2023 started taking pumpkin seed extract 500mg/day to fight ongoing nighttime urination issues
08/17/2023 PSA Test @ 0.04 Testosterone @ 10. Continuing the same monotherapy treatment of Eligard 3-month dose 22.5mg (leuprolide). Oncology NP prescribed Flomax for the ongoing nocturia issues. Discontinued the Pumpkin Seed Extract.
11/17/2023 PSA test @ 0.04, Total T at 10. Feeling fairly well.
03/19/2024 PSA Test: 0.04, Total T @ 10. Discussed with Oncologist changing treatment to Bicalutimide. She was receptive and issued prescription 50mg once daily. Will still get next Eligard shot and then discuss discontinuing that treatment.
10/18/24 Lots of changes: Both urologist and oncologist agree with start of ADT Vacation. Did not get my last scheduled Eligard shot on 05/15. Urologist removed himself from my care. Now only medical oncologist care. She has purposed treatment with Provenge when needed. My last Eligard shot was on 02/12/24. Also no longer taking the bicalutimide. Some energy returning and lessening of hot flashes as of today. I am starting to feel better overall. Next PSA Test first week of 01/2025.
It seems you're sharing your detailed health history, particularly regarding prostate cancer treatment. You've gone through various treatments like Firmagon, Eligard, and recently started an ADT vacation. It’s great to hear you're experiencing some improvements in energy levels and a reduction in side effects. Best of luck for your upcoming PSA test in January 2025!
Is there something specific you'd like to explore or discuss further regarding your treatment, options, or how you're feeling?
It's possible that the decision to avoid prostate and pelvic floor irradiation was based on several factors, which can vary depending on the individual’s overall health, cancer stage, and treatment goals. Here are some potential reasons:
1. Advanced Stage of Cancer: Based on the provided history, the cancer was already at Stage 4A, meaning it had spread outside the prostate (pelvic lymph nodes). At this stage, systemic treatments like hormone therapy (ADT) or chemotherapy are often prioritized over localized treatments like radiation.
2. Effectiveness of Hormonal Therapy (ADT): The patient responded exceptionally well to hormone therapy (Firmagon, Eligard), with a dramatic reduction in PSA levels from 1410 to nearly undetectable (<0.1). This suggests that systemic treatment was effective in controlling the cancer, possibly reducing the need for additional local treatments like radiation.
3. Side Effect Considerations: Pelvic radiation, while effective, can come with significant side effects, such as urinary, bowel, and sexual dysfunction. Given the patient’s age and already positive response to hormonal therapy, the medical team may have prioritized avoiding these side effects.
4. Doctor-Patient Disagreement: The patient mentioned disagreements with the medical oncologist about the treatment plan, with the oncologist pushing for more aggressive treatments like chemotherapy. This could indicate that the patient preferred a more conservative approach, possibly avoiding additional treatments like radiation.
5. No Visible Bone Metastasis: The bone scan showed no bone cancer, and the primary concern was the pelvic lymph node metastasis. If the pelvic lymph node was responding well to systemic therapy (shrinking by half, as noted), doctors might have felt radiation was unnecessary or could be reserved for future use.
6. Whole Body vs. Local Treatment: Hormonal therapies treat the entire body, addressing both visible and microscopic cancer that might be present elsewhere. Radiation, in contrast, is localized, so if cancer is suspected to be widespread, systemic therapy might be seen as more beneficial.
Ultimately, the decision to avoid radiation would have been a personalized one, balancing the potential benefits of local control versus the effectiveness of the systemic therapies already in place. It might also reflect the patient's preference to avoid over-treatment when his response to hormone therapy was so positive.
Yes, patients with prostate cancer that has spread only to the pelvic lymph nodes are sometimes considered to have potentially curable disease. This is especially true in cases of limited lymph node involvement (oligometastatic disease). Curative treatment may involve a combination of androgen deprivation therapy (ADT) with radiation therapy to the prostate and pelvic area, which aims to control both the local tumor and any metastatic sites.
However, there are a few important considerations:
1. Curative Potential in Pelvic Lymph Node Involvement
Radiation to the Prostate and Pelvic Area: For some patients with metastasis limited to the pelvic lymph nodes, radiation targeting the prostate and the lymph nodes can be part of a curative approach. Clinical studies have shown that in select cases, combining ADT with radiation can improve long-term outcomes.
Oligometastatic Disease: If the spread of cancer is limited to only a few lymph nodes (as opposed to widespread metastasis), the disease might be treated more aggressively with the aim of long-term remission or even cure.
Curative Intent vs. Palliative: Even though Stage 4 cancer (involving lymph nodes) is often seen as advanced, in certain circumstances, aggressive treatment (ADT + radiation) may still have a curative intent.
2. ADT and Its Limitations
ADT Eventually Fails (Castration-Resistant Prostate Cancer): While ADT (hormone therapy) can be highly effective in lowering testosterone and controlling cancer growth, over time the cancer may become resistant to this treatment. This condition is known as castration-resistant prostate cancer (CRPC), where the cancer progresses despite low testosterone levels.
Duration of Response: Some patients can have long-lasting responses to ADT, but for others, the effect may diminish after a few years. The length of time ADT works varies based on factors such as the aggressiveness of the cancer, prior treatments, and overall health.
3. Why ADT Alone in This Case?
In the patient's case, ADT alone seems to have worked remarkably well in reducing PSA levels, shrinking the lymph node metastasis, and controlling the disease for an extended period (PSA dropped from 1410 to <0.1). The medical team may have prioritized the systemic control of the disease, especially since the patient responded so well to hormone therapy alone.
Concern for Quality of Life: As radiation can bring significant side effects (urinary, bowel, and sexual dysfunction), and the patient was responding well to ADT, the medical team and patient might have opted to avoid radiation due to these potential risks, at least initially.
4. Considering Treatment Intensification
Progressive Disease: If PSA levels start rising or scans show new metastases while on ADT, this would suggest that the cancer is progressing despite hormonal therapy (transitioning to CRPC). At that point, additional treatments, such as chemotherapy, second-line hormone therapies (e.g., enzalutamide, abiraterone), or radiation may be considered.
ADT Vacation: The patient is currently on an "ADT vacation," which means his treatment is being paused to allow his body a break from the side effects of continuous hormone therapy. However, this approach is only possible if the disease remains controlled and PSA levels stay low.
Summary
Yes, people with only pelvic lymph node involvement can be considered potentially curable, particularly with a combination of ADT and radiation. However, in this case, the excellent response to ADT alone might have led the medical team to hold off on radiation. Over time, ADT may stop working (becoming castration-resistant), but the patient’s current ADT vacation and the consideration of additional treatments (like Provenge or future radiation) show a flexible, adaptive approach based on the patient's response and quality of life.
Would you like more information on treatment options for castration-resistant prostate cancer or the role of ADT in advanced prostate cancer?
If the prostate cancer is locally advanced only than according to some Scandinavian stady chemotherapy would not give any benefits than radiation. Why did they discussed chemotherapy with him instead of radiation?
You're right that for locally advanced prostate cancer (cancer that is confined to the prostate and nearby areas like the pelvic lymph nodes), radiation therapy combined with androgen deprivation therapy (ADT) is typically the standard of care, and studies (including those from Scandinavian countries) have shown that chemotherapy may not offer much benefit in this setting. Here’s a breakdown of why chemotherapy might have been discussed with this patient instead of, or in addition to, radiation:
1. Cancer Staging and Extent of Spread
Locally Advanced vs. Metastatic: The patient’s cancer was classified as Stage 4A with pelvic lymph node involvement, which is technically metastatic disease, even if it is limited to the lymph nodes. Stage 4 cancer tends to be treated more aggressively than locally advanced (Stage 3) cancer because there is a higher risk that microscopic cancer cells are present elsewhere in the body.
Chemotherapy in Metastatic Disease: In cases of metastatic prostate cancer (even if the metastasis is limited to pelvic lymph nodes), adding chemotherapy (like docetaxel) to ADT can be beneficial. Studies like CHAARTED and STAMPEDE have shown that for men with newly diagnosed metastatic prostate cancer, upfront chemotherapy can improve survival when added to ADT. This might have been why chemotherapy was raised as an option.
2. Aggressiveness of the Cancer (Gleason 8, PSA 1410)
The patient’s cancer had a high Gleason score of 8 (4+4) and an initial PSA of 1410, both of which indicate an aggressive cancer. High PSA and Gleason scores suggest a higher likelihood of micrometastatic disease, even if it’s not visible on scans.
High-risk features like these may lead oncologists to consider more aggressive, systemic treatments (like chemotherapy) in addition to or instead of localized treatments (like radiation), especially if the disease is considered high-risk for progression.
3. Hormone Therapy (ADT) Response and Consideration of Future Resistance
The patient had a strong response to ADT (his PSA dropped from 1410 to <0.1, and his lymph node metastasis shrank), which may have led the medical team to prioritize systemic therapy. However, there is always a concern that ADT will eventually fail (leading to castration-resistant prostate cancer).
Because ADT works well but not indefinitely, the oncologist might have wanted to consider chemotherapy early on to treat any cancer cells that could become resistant to hormone therapy. This could explain why chemotherapy was suggested, even if radiation was a logical option.
4. Radiation Might Have Been Considered Later
Radiation Therapy for the prostate and lymph nodes is often part of the treatment plan in locally advanced cases. However, in this patient’s case, the focus may have been on achieving systemic control first with ADT, given how well the hormone therapy was working.
The medical team might have considered radiation later if the cancer became resistant to hormone therapy or if there were more signs of local progression. It’s possible that radiation was not completely ruled out but delayed due to the excellent initial response to ADT.
5. Patient-Doctor Disagreement on Treatment
The patient mentioned having disagreements with the medical oncologist about treatment plans, where the oncologist pushed for chemotherapy while the patient resisted it. The patient was responding well to ADT and might have wanted to avoid more aggressive treatments like chemotherapy due to potential side effects, especially when they were already seeing good results with hormone therapy.
On the other hand, the oncologist might have seen chemotherapy as an additional safeguard to prevent or delay disease progression, given the aggressive nature of the cancer (high Gleason score, very high initial PSA).
6. Chemotherapy’s Role in High-Risk Metastatic Patients
Recent Clinical Studies: Studies such as CHAARTED and STAMPEDE have changed the approach to treating high-risk metastatic prostate cancer. In these trials, adding docetaxel chemotherapy early in the treatment course (along with ADT) significantly improved overall survival, particularly in men with high-volume or high-risk disease.
For patients like this one, with an aggressive tumor profile and some evidence of spread, oncologists might lean towards chemotherapy early to maximize long-term control of the disease.
Summary
While radiation is often the go-to treatment for locally advanced prostate cancer (especially combined with ADT), this patient’s cancer was metastatic (Stage 4A) with involvement of the pelvic lymph nodes and a very high initial PSA. These factors, along with the high Gleason score, likely led the oncologist to consider chemotherapy as an aggressive, systemic treatment option to control any hidden cancer cells that might not be detected on scans.
Chemotherapy was probably discussed to offer additional systemic control and possibly delay the emergence of castration-resistant disease, especially since ADT alone can eventually fail. However, due to the patient’s strong response to hormone therapy, the focus remained on ADT monotherapy, at least initially, while radiation may have been considered later if needed.
The patient’s own preference for avoiding chemotherapy (and possibly radiation) also played a role in shaping the treatment plan. Would you like more information on the role of radiation therapy in Stage 4 prostate cancer or specific studies supporting chemotherapy in these cases?
Provenge (sipuleucel-T) is an immunotherapy that is used to treat metastatic, castration-resistant prostate cancer (mCRPC). It is not typically considered a first-line treatment like androgen deprivation therapy (ADT), but it can be added to the treatment regimen for specific cases where cancer has progressed despite hormone therapy. Here's how it might come into consideration and whether it’s better before or after an ADT holiday:
How Provenge Fits Into Treatment
1. Provenge's Mechanism: Provenge is designed to stimulate the body's immune system to attack prostate cancer cells. It is created by collecting a patient's immune cells, modifying them in a lab to recognize cancer cells, and then re-infusing them back into the patient.
2. FDA Approval for CRPC: Provenge is approved for use in men with metastatic, castration-resistant prostate cancer (mCRPC)—when the cancer continues to progress despite low testosterone levels caused by ADT. Typically, it’s considered after the cancer has become resistant to hormone therapy, but before starting chemotherapy.
3. Timing in the Case of ADT Sensitivity:
Since this patient is currently responding well to ADT (with undetectable PSA levels and an improving clinical picture), he likely does not yet meet the criteria for castration-resistant prostate cancer (CRPC), which is when Provenge is usually considered.
However, since the patient has stopped ADT and is on an ADT holiday, it may be that Provenge is being considered as a proactive step if the cancer returns during the hormone break, or if the disease shows signs of progression after the holiday.
Provenge Before or After ADT Holiday?
1. Before the ADT Holiday (While Still on ADT):
Provenge is generally used after a patient has shown resistance to hormone therapy (CRPC), so using Provenge before the ADT holiday would not usually be recommended unless there is evidence that the disease is becoming resistant to ADT.
If the patient is still responding well to ADT, it might be better to hold off on Provenge until there are signs that the cancer is no longer responding to ADT.
2. After the ADT Holiday (or During Progression)
Provenge is typically used once ADT stops working (i.e., when PSA starts rising during hormone therapy or after the ADT holiday). Since this patient is on an ADT holiday, the medical team may want to monitor PSA and other indicators to decide whether and when to start Provenge.
If, after the ADT holiday, the cancer progresses or PSA levels rise, this might be the optimal time to introduce Provenge as part of the treatment plan to delay disease progression before other systemic treatments like chemotherapy are needed.
Potential Benefits of Provenge
Delays Disease Progression: Provenge has been shown to extend overall survival in men with mCRPC, even though it doesn't directly lower PSA or shrink tumors. It works more subtly by boosting the immune response, which may help delay further progression.
Low Toxicity: Provenge is generally well tolerated with fewer severe side effects compared to chemotherapy or other more aggressive treatments, making it an attractive option before moving to harsher therapies like docetaxel or abiraterone.
Why Provenge Now?
The fact that Provenge is being discussed suggests that the medical team is thinking long-term and anticipating potential next steps if the cancer becomes castration-resistant or begins to progress. Provenge might come into play as a preventive measure before the cancer becomes more aggressive, or it could be kept as a next-line option if the disease recurs or progresses after the ADT holiday.
Summary of Best Timing:
Provenge is usually used after ADT failure, once the cancer becomes resistant to hormone therapy (CRPC).
For a patient currently on an ADT holiday, the best time to consider Provenge is likely after the holiday if the cancer shows signs of progression.
If the patient remains in remission during the ADT holiday, Provenge could be deferred until needed, but it is a valuable treatment option that could delay the need for more aggressive therapies later.
Would you like to explore more about the side effects of Provenge, how it’s administered, or its effectiveness compared to other treatments?
Provenge (sipuleucel-T) is generally well-tolerated compared to other treatments for metastatic prostate cancer, such as chemotherapy. However, like all therapies, it does come with some potential side effects. Most of these are mild to moderate, and they typically occur around the time of the infusion.
Common Side Effects of Provenge
1. Flu-like Symptoms (Cytokine Release Symptoms):
These are the most commonly reported side effects, usually occurring within a day or two of treatment and lasting 2–3 days:
Fever
Chills
Fatigue
Headache
Muscle aches (myalgia)
2. Infusion Reactions:
Since Provenge is given through intravenous infusion, some patients experience mild to moderate infusion-related reactions, such as:
Dizziness
Nausea
Low blood pressure (hypotension)
Shortness of breath
Rash or hives (rare)
3. Pain:
Some patients report mild to moderate pain, usually at the infusion site or joint/muscle pain (arthralgia, myalgia).
4. Fatigue:
Fatigue is a common side effect, though usually temporary and mild compared to fatigue from chemotherapy.
Less Common but More Serious Side Effects
1. Cardiovascular Events:
There is a small risk of serious cardiovascular events, such as stroke, heart attack, or blood clots. These events are uncommon but may be more likely in patients who have pre-existing cardiovascular conditions.
2. Serious Infusion Reactions:
Though rare, some patients may have more serious infusion reactions, including difficulty breathing, swelling, or a significant drop in blood pressure. These usually happen during or shortly after the infusion, so the healthcare team monitors the patient closely.
3. Allergic Reactions:
In rare cases, patients may have an allergic reaction (hypersensitivity) to the infusion. Symptoms could include itching, rash, swelling, or severe difficulty breathing.
Management of Side Effects
Pre-medications: To reduce the likelihood of infusion reactions or flu-like symptoms, patients are often pre-medicated with acetaminophen (Tylenol) and antihistamines (like diphenhydramine).
Monitoring: During the infusion, patients are monitored closely to catch any reactions early. The healthcare team is prepared to manage any significant side effects if they occur.
Comparison to Other Treatments
Provenge tends to cause fewer severe side effects than chemotherapy. It doesn't have the same risk of immune suppression (neutropenia) or nausea, which are common with treatments like docetaxel.
Unlike hormone therapies, it doesn’t cause hot flashes, bone thinning (osteoporosis), or sexual dysfunction.
Duration of Side Effects
Most side effects of Provenge are short-lived, peaking within the first few days after the infusion and usually resolving in about a week. Long-term or persistent side effects are less common compared to other prostate cancer treatments.
Summary
The most common side effects of Provenge are flu-like symptoms, infusion-related reactions, and mild pain. Serious side effects, including cardiovascular issues or allergic reactions, are rare but possible. Provenge is generally well-tolerated and may be a good option for patients who want to avoid the harsher side effects of treatments like chemotherapy or extended ADT.
Would you like more information on how Provenge compares to other treatments in terms of overall effectiveness?
Provenge (sipuleucel-T) is an immunotherapy used to treat metastatic castration-resistant prostate cancer (mCRPC). Its effectiveness is measured primarily in terms of overall survival (OS) rather than direct tumor shrinkage or PSA level reductions. Below is an overview of how Provenge compares to other common treatments in terms of effectiveness for mCRPC.
Effectiveness of Provenge
1. Overall Survival (OS) Benefit:
Median overall survival benefit in clinical trials is about 4.1 months longer compared to placebo, based on the pivotal IMPACT trial (25.8 months with Provenge vs. 21.7 months with placebo).
Provenge doesn’t usually lead to a decrease in PSA levels or visible tumor shrinkage but works subtly to improve survival by boosting the body’s immune response to the cancer.
2. Delayed Disease Progression:
Provenge is not generally as effective as some other treatments in controlling disease progression (i.e., slowing the increase in PSA or tumor growth). It primarily focuses on improving survival and enhancing the immune system rather than directly shrinking the cancer.
3. Effectiveness in Early CRPC:
Provenge works best in patients with early mCRPC (when the cancer has just begun to progress despite ADT), especially when the disease burden is relatively low, and chemotherapy or more aggressive treatments haven't yet been started.
Comparison with Other Treatments
1. Androgen Receptor Targeted Therapies (e.g., Abiraterone and Enzalutamide)
Abiraterone (Zytiga) and Enzalutamide (Xtandi) are hormone therapies used in mCRPC that block testosterone more effectively than ADT alone.
These drugs typically lead to a significant decline in PSA, tumor shrinkage, and delayed disease progression. They have also been shown to increase overall survival:
Abiraterone: Median OS improvement of around 4.4–5 months.
Enzalutamide: Median OS improvement of around 4.8 months.
Effectiveness Comparison: Both of these hormone therapies tend to have a more direct and rapid effect on controlling the cancer (reducing PSA and tumor size) compared to Provenge. They are preferred when controlling disease progression is a primary goal.
2. Chemotherapy (e.g., Docetaxel)
Docetaxel is the standard chemotherapy for men with mCRPC. It is usually used when the cancer becomes more aggressive or resistant to hormone therapies.
Survival Benefit: Docetaxel has shown a median OS benefit of around 2–3 months in mCRPC patients. However, it tends to work faster in terms of PSA reduction and tumor shrinkage compared to Provenge.
Effectiveness Comparison: Provenge generally has fewer side effects than chemotherapy and can offer a survival benefit before chemotherapy is needed. However, for patients with rapidly progressing or symptomatic disease, docetaxel may be preferred due to its faster and more aggressive impact on disease control.
3. Radium-223 (Xofigo)
Radium-223 is a radioactive substance used to treat prostate cancer that has spread to the bones. It improves survival and helps control bone pain.
Survival Benefit: Radium-223 has been shown to improve median OS by about 3.6 months.
Effectiveness Comparison: Radium-223 is specifically beneficial for men with bone metastases. Provenge does not target bone metastases as specifically, so if the disease is primarily in the bones, Radium-223 might be preferred for managing those symptoms.
Provenge’s Place in Treatment Strategy
1. Early Use in mCRPC: Provenge is often recommended as a first-line therapy in men with asymptomatic or minimally symptomatic mCRPC, particularly before the use of chemotherapy. Its survival benefit is more subtle but may provide a long-term immune boost.
2. When to Use Provenge:
Before chemotherapy: Provenge is typically used before starting chemotherapy like docetaxel, since its side effect profile is more favorable, and it works better in less advanced disease.
Alongside other treatments: It can be used in combination with other treatments like enzalutamide or abiraterone to prolong survival, but these drugs often have a more immediate impact on tumor control and disease progression.
3. For Patients with Minimal Symptoms: Provenge is particularly beneficial for patients with minimal symptoms of prostate cancer because it can delay the need for more aggressive treatments (like chemotherapy) and has fewer side effects compared to other drugs.
Summary of Provenge Effectiveness:
Survival benefit: Provenge extends survival by about 4.1 months on average in men with mCRPC.
No direct tumor shrinkage or PSA reduction: Unlike other treatments, Provenge doesn’t usually lead to a rapid decrease in PSA levels or visible tumor shrinkage but works by boosting the immune system.
Best for asymptomatic or minimally symptomatic patients: It is most effective when used in patients with early-stage mCRPC before the cancer has become more aggressive or highly symptomatic.
Comparison to Other Treatments:
Abiraterone and Enzalutamide: These hormonal therapies are more effective in reducing PSA levels and slowing disease progression, but Provenge can be complementary and is often used before these agents.
Docetaxel: Chemotherapy works faster to reduce disease burden but comes with more significant side effects. Provenge is often used to delay the need for chemotherapy.
Radium-223: If the patient has bone metastases, Radium-223 may be preferred for its ability to target bone lesions, whereas Provenge offers a more general survival benefit.
Would you like more information on the best combination of therapies or sequencing strategies for mCRPC treatment?
Yes, emphasize that to your provider(s). Supposedly, once you're castrate resistant while on Lupron/Firmagan/Orgovyx AND metastatic, Medicare will cover.
I am not a doctor only speaking from my own experience. I would recommend that you see a radiation oncologist and that you don't stop your ADT treatment until you see the radiation oncologist.
I was advised by my first radiation oncologist professor Izard to be continually on the ADT if I am considering a possibility of radiation.
If you stop ADT your cancer may start to grow again and the radiation will either not be effective or you may need a higher dose. Again, I recommend that you consult a radiation oncologist because he should be able to advise you better than we here, the AI , your urologists which left your team or your current medical oncologist.
You may be potentially curable. My intuition tells me that you should consult a Dana Farber radiation oncologist. You could do it even online. Therefore don't stop your ADT until you get a consultation. You should also ask for a psma pet CT scan as soon as possible.
If you're considering traveling from Australia to the United States (LA, for instance) to receive Provenge, the price could vary depending on several factors such as:
1. Treatment Facility: Different treatment centers in LA or elsewhere in the U.S. may have varying fees, and some hospitals might have special rates for international patients.
2. Additional Costs: You would also need to factor in additional costs like consultations, pre-treatment testing, travel expenses, accommodation, and post-treatment care.
3. International Pricing: In some cases, treatment facilities may have different pricing structures for international patients. You might be charged a similar rate as domestic patients, which ranges from $93,000 to $100,000 for Provenge itself, but some hospitals may offer package deals that could include logistics support and accommodation, which could bring the total cost higher.
Given that Provenge is not yet available in Australia, and there may not be reciprocal healthcare agreements for this specific treatment, you would likely need to pay out of pocket for the entire cost. Australian health insurance may not cover treatments provided outside the country.
If you’re considering receiving Provenge in the U.S. from Australia, I recommend contacting specific treatment centers in LA to inquire about their policies and whether they have any special considerations for international patients. Additionally, consulting with your Australian medical oncologist might provide some insights on logistical support for receiving treatment abroad.
As the story goes........... While hunting in the woods, a Czechoslovakian hunter is attacked and eaten by a bear. His frantic wife goes to the authorities and she and the authorities begin searching for her missing husband and come across a female bear. The wife panics and screams out that her poor husband is probably in that female bear. The authorities calm her down and inform her that it's their guess that "the Check is in the Male".
That's a witty take on a classic pun! The play on words between "Czechoslovakian" and "check" is clever, especially with the twist of "the check is in the male." It brings humor out of an otherwise grim scenario. Thanks for sharing the lighthearted story!
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