I just wanted to share with my brothers a treatment that has worked pretty well for me.
Having read the Lancet article "Ketoconazole Therapy For Advanced Prostate Cancer", I decided to give it a try. sciencedirect.com/science/a...
which discusses a trial from 1999 to 2010.
The 'Prostate Cancer community' have been blessed with several new powerful treatments in the last few years. Zytiga/ Xtandi/ Xofigo/ Provenge/ Olaparib to mention the most important. With the exception of Xtandi I have had them all.
As we sequentially go through these wonder drugs we keep an eye to what's next?
May 2017 I decided to re-evaluate my situation. At the time I was on Firmagon, Xgeva, Zytiga and Olaparib simultaneously. Unfortunately, the main side effect for me was severe fatigue and I found myself taking longer and longer mid-day naps. I concluded that the way things were going I'd be gone by Christmas. So what to do?
I had read about BAT (Bipolar Androgen Therapy) and decided to give it a go. After 2 months my PSA started to go down and I was regaining my lost energy. No question, the high testosterone levels felt really good after almost 9 years of castrate levels.
The neat thing about the BAT is that it may well re-sensitize you and make 'old' drugs work again. Zytiga has been a wonder drug for me. I was on it for about 4-5 years with few side effects. Has anyone here re-tried a drug after BAT?
I had earlier come across the above mentioned Lancet article which intrigued me and I decided this approach would be next after BAT. Ketoconazole is inexpensive and the guys in the trial were, in my opinion, getting impressive results.
So I started in January with 200mg x3 Ketoconazole and 40mg hydrocortisone daily (as pr trial). I don't take any other drugs! Now, almost 6 months into this and my PSA has only gone up 0.6ng/ml which is fantastic!!
The next step is to double the Ketoconazole to 400mg x3 as described in the trial. I'm hoping this should take me to the end of the year.
If anyone else has been down this path I would sure love to hear about your experiences.
Kind regards
Terje
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Terje
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I was on high dose keto for a few years, It was important to be fasting when you took it, which was a bit of a pia because you had to take it 3 times a day, It also required the stomach to be acetic for better absorption, this was accomplished by taking it with a pepsi or coke which has a ph of 2. It was found to last a lot longer if it was started with a psa of 10 or less. In the old days it was Lupron/casodex, ketoconazole, then chemo and you were finished, we were so glad when xtandi and zytiga were approved. Zytiga was supposed to be the new and improved keto, it was much easier to just need to take it once a day instead of 3 times a day with keto. Keto was actually used by many of us, and it was very common ,but was actually not approved for prostate Cancer, it was approved as an antifungal. There are many studies on Keto in th eprostate cancer literature ,in particular by EJ small et all, and by wk oh et al.
I am certainly not in the medical profession; however I did under go a six month chemo trial in 2004. The trial:
Each course of chemotherapy lasts for 8 weeks. Patients were treated in weeks 1, 3, and 5 with doxorubicin 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with ketoconazole 400 mg orally 3 times a day daily for 7 days. In weeks 2, 4, and 6, treatment consisted of paclitaxel 100 mg/m2 intravenously on the first day of every week in combination with estramustine 280 mg orally 3 times a day for 7 days. 30 mg of Prednisone everyday through the three courses of chemotherapy.
As I understand it, each drug has cancer killing properties. Good luck.
Ketoconazole is a a CYP17A1 inhibitor, just as Abiraterone acetate (Zytiga) is.
Unfortunately, it also inhibits CYP27B1 (25-Hydroxyvitamin D3 1alpha-hydroxylase). "The enzyme catalyzes the hydroxylation of calcidiol (25-D) to calcitriol (1,25-D) (the bioactive form of Vitamin D)." [1]
PCa cells downregulates this enzyme, which normal prostatic cells use to make hormonal vitamin D, as needed, so we are dependent on kidney production. Unfortunately, Ketoconazole inhibits this source.
On a brighter note, Ketoconazole inhibits another P450 enzyme: CYP24A1 (Vitamin D3 24-hydroxylase). It is present in normal prostatic cells and acts to limit the active life of calcitriol. The enzyme is upregulated in PCa.
In 2001, Donna Peehl (Stanford), who has written extensively on vitamin D, suggested combining Ketoconazole & calcitriol. [2]
In 2002, she was involved in a cell study to test the hypothesis [3]:
"Ketoconazole, calcitriol ... each inhibited the growth of prostatic cancer cells. In combination 0.1 microg./ml. ketoconazole potentiated growth inhibitory activity of calcitriol 50-fold ... Induction of 24-hydroxylase by calcitriol ... was partially blocked by this level of ketoconazole."
I was on that. I think anything you have not tried before is worth looking at. Watch out for the liver. I was prescribed Urosodiol to help with that problem when I was on high dose Keto. Keto is considered "off label" treatment. My Keto was combined with a daily 250 mcg Leukine injection, 1 aspirin per day, Vit D, and estrogen patches, all of them considered "off label" and quite a battle of memos from outside doctors to justify it and finally to get find a Kaiser doctor who would go along with it and give me the meds. It was the Dr Charles Myers protocol and it worked great for about 2 years. When I lost my Kaiser COBRA insurance I had to go Medicare, and Medicare unfortunately, would not pay for Leukine, so I had to switch to other meds that they would pay for.
Very interesting that you responded to HDK after zytiga. Keto is not used much anymore, maybe it should be considered as an additional therapy. We never know what will work and for who.
Hi BBruce, go to sci-hub.nu (this site will get you around the pay wall for any study you want to read) and put sciencedirect.com/science/a... into the space for the url and you'll get the full content. Happy reading
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PSA quickly rising while waiting for trial to start
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