Expected response to ADT

[Guest guest]

I am now three months into ADT (bicalutamide followed by triptorelin). I had RPP in November 2009 after which my PSA remained between 2 and 3 and then EBRT in 2010 which also failed to reduce PSA to undetectable levels. When my PSA reached 10.3 with a PSADT of about 4 months I insisted on starting ADT. Tomorrow I get the result of my first blood-test since starting ADT.

Can anyone tell me:

1. What change would be reasonable in the PSA level at this stage. Some studies talk about the PSA nadir after 8 months so is too early to get stressed about it?

2. Whether I am right in requesting the oncologist to prescribe dutasteride in addition to the triptorelin. She is not keen but my GP and urologist think it would a good idea.

Currently I have no obvious cancer symptoms although my lower abdomen remains sore and my left hip is beginning to give me a bit of trouble - OK walking but painful to lie on or when rotated sideways. So question 3 is:

3. Is the hip problem a likely side effect of EBRT or is it more likely to be sign of cancer in the bone?

Any help with these questions would be much appreciated.

Best regards to all of you out there.

Bob

[Guest guest]

You probably don't want to hear this but there is a potential problem with Dutasteride and other 5 alpha reductase drugs. There was a 7 year trial to determine if Finasteride could be used as a preventative for PCa. On the 5th year there was evidence that although Finasteride showed an overall 25 pct reduction in cases of PCa, it also was showing evidence that those in the study who did develop PCa had a much more aggressive form of the disease. Finasteride was already approved for use with BPH and Prostatitis so the study was not get the drug approved. The study was to determne if it should be approved for long term use as a means of preventing PCa in at risk patients.

What made me and many others suspicious was that instead of carrying on the study for another 2 years as planned to determine if this were actually the case, the manufacturer of Finasteride halted the trial immediately upon receiving this information. Then they spent the next 18 months attempting to create plausable explanations for the results without ever explaining why they stopped the trial . Which had it gone on until it's completion would have answered the question conclusively. Now we will never know because no one is going to conduct another 7 year trial. My own personal feelings are that the company knew that had the results actually been confirmed and it was proven that long term use of Finasteride caused more aggressive PCa that the FDA was very likely either to remove the drug from the market altogether or severly restrict access to it's use.

As it stands now, these drugs can still be freely prescribed by doctors for BPH, prostatitis

and perhaps some other urinary problems. Below is an recent article regarding drugs such as Finasteride and Dutasteride. The former acts on one form of 5 alpha reductase. The latter works against both alpha and beta. I hope this helps you in your consideration

and there are other such articles about this long term study on the web along with several speculations as to what the results actually mean put forward by the company and doctors contracted to give an opinion by the company. BOB

Drugs for enlarged prostate raise cancer riskPublished on June 9, 2011 at 11:43 PM ·

By Dr Ananya Mandal, MD

According to health officials, this Thursday, a class of drugs meant to improve symptoms of an enlarged prostate gland may actually increase the chance of getting a more serious form of prostate cancer. However they also said the drugs' benefits outweigh the risks.

The report suggests that drugs in this group include Merck & Co's Proscar and GlaxoKline's Avodar and Jalyn, as well as Merck's Propecia, which is approved to treat male pattern hair loss.

The Food and Drug Administration said it revised the labels on all such drugs, called 5-alpha reductase inhibitors (5-ARI), to include the risk after reviewing two large studies. 5-ARI drugs are known clinically as finasteride and dutasteride and are used to treat benign prostatic hyperplasia (BPH), or prostate enlargement, a common condition in men over 40. Propecia, for male baldness, includes a smaller dose of finasteride.

The results of these studies were the focus of a meeting of the FDA’s Oncologic Drugs Advisory Committee in December 2010. The said studies found that daily use of 5-ARIs for several years decreased the chance of getting lower-risk forms of prostate cancer but made it more likely that patients would get a high-grade prostate cancer, which grows and spreads more quickly. The Prostate Cancer Prevention Trial (PCPT) evaluated daily use of finasteride 5 mg versus placebo for 7 years, and the Reduction by Dutasteride of Prostate Cancer Events (REDUCE) trial evaluated daily use of dutasteride 0.5 mg versus placebo for 4 years. In those two studies, the risk of being diagnosed with prostate cancer was significantly reduced among those randomized to either of the two drugs, compared with those on placebo. But the reduction was because of a lower rate of lower-grade prostate cancers (with a Gleason score of 6 or lower). The risk of higher grade

prostate cancers (with a Gleason score of 8-10) was increased among those who received one of the two 5-ARIs.

The FDA said on its website, “This risk appears to be low, but healthcare professionals should be aware of this safety information, and weigh the known benefits against the potential risks when deciding to start or continue treatment with 5-ARIs in men.†Before prescribing one of these drugs, the statement advises that health care professionals “perform appropriate evaluation to rule out other urological conditions, including prostate cancer, [which] might mimic†benign prostatic hyperplasia (BPH).

The FDA said about 5 million male patients were given a prescription for a 5-ARI from 2002 to 2009. The drugs' benefits in treating BPH still outweighed any risks, it said. Another class of medicines known as alpha-blockers can also be used to treat symptoms of BPH. Drugs of this type include Astellas Pharma's Flomax, Pfizer Inc's Cardura, and Rapaflo from Pharmaceuticals.

Subject: Expected response to ADTTo: ProstateCancerSupport Date: Sunday, June 12, 2011, 6:44 AM

I am now three months into ADT (bicalutamide followed by triptorelin). I had RPP in November 2009 after which my PSA remained between 2 and 3 and then EBRT in 2010 which also failed to reduce PSA to undetectable levels. When my PSA reached 10.3 with a PSADT of about 4 months I insisted on starting ADT. Tomorrow I get the result of my first blood-test since starting ADT.

Can anyone tell me:

1. What change would be reasonable in the PSA level at this stage. Some studies talk about the PSA nadir after 8 months so is too early to get stressed about it?

2. Whether I am right in requesting the oncologist to prescribe dutasteride in addition to the triptorelin. She is not keen but my GP and urologist think it would a good idea.

Currently I have no obvious cancer symptoms although my lower abdomen remains sore and my left hip is beginning to give me a bit of trouble - OK walking but painful to lie on or when rotated sideways. So question 3 is:

3. Is the hip problem a likely side effect of EBRT or is it more likely to be sign of cancer in the bone?

Any help with these questions would be much appreciated.

Best regards to all of you out there.

Bob