questions

[Guest guest]

Hello, I've posted some questions about my father some time ago. Now the situation has

evolved (in worst) and I do have new questions.Could you help ?He started abiraterone in February, I was expecting a decrease of PSA and it's still increasing.What does it mean ?Is this treament unefficient (I thought abiraterone worked pretty well) or is PSA measure not a good indicator ? Here is his clinical history :->2003 prostatectomy -Gleason 8->April 2004. PSA rise : treatment

with Casodex (Bicalutamide) + radiotherapy->June 2006 : hormonotheray with Casodex and Decapeptyl (triptorelin).->December 2010 : Gosereline and

Casodex->April 2011 : PSA rises from 3.4 to 7.9 ng/ml + bone progression. Stop Casodex->June 2011 : Start Phase III clinical trial with mdv3100 or

placebo + Decapeptyl (triptorelin) 11,25 mg->July 2011 : PSA 44->Aug 2011 : PSA 63->Sept 2011: PSA 98->Oct 2011: PSA 152 - Chemiotherapy->Nov PSA 162 - Chemiotherapy->Dec PSA 90 - Chemiotherapy ->Jan : Chemiotherapy interrupted because of tachycardia->Feb PSA 133 start Zytiga (abiraterone)->March PSA 171 Zytiga (abiraterone)->April PSA 256 Zytiga (abiraterone)Thanks very much for your help.Regards.n.

[Guest guest]

>

> Hello,

>

> I've posted some questions about my father some time ago. Now

> the situation has evolved (in worst) and I do have new

> questions.

> Could you help ?

> He started abiraterone in February, I was expecting a decrease

> of PSA and it's still increasing.

> What does it mean ?

> Is this treament unefficient (I thought abiraterone worked

> pretty well) or is PSA measure not a good indicator ?

>

> Here is his clinical history :

> ->2003 prostatectomy -Gleason 8

> ->April 2004. PSA rise : treatment with Casodex (Bicalutamide) + radiotherapy

> ->June 2006 : hormonotheray with Casodex and Decapeptyl (triptorelin).

> ->December 2010 : Gosereline and Casodex

> ->April 2011 : PSA rises from 3.4 to 7.9 ng/ml + bone progression. Stop

Casodex

> ->June 2011 : Start Phase III clinical trial with mdv3100 or

> placebo + Decapeptyl (triptorelin) 11,25 mg

> ->July 2011 : PSA 44

> ->Aug 2011 : PSA 63

> ->Sept 2011: PSA 98

> ->Oct 2011: PSA 152 - Chemiotherapy

> ->Nov PSA 162 - Chemiotherapy

> ->Dec PSA 90 - Chemiotherapy

> ->Jan : Chemiotherapy interrupted because of tachycardia

> ->Feb PSA 133 start Zytiga (abiraterone)

> ->March PSA 171 Zytiga (abiraterone)

> ->April PSA 256 Zytiga (abiraterone)

>

> Thanks very much for your help.

> Regards.

> n.

Bonjour n,

I am very sorry to hear of your father's condition.

I am not a doctor or expert of any kind, but it appears to my

layman's mind that your father's cancer is completely independent

of testosterone. Even if he had zero testosterone in his body,

his cancer would keep growing.

I don't know if that's true, but if it is, then none of the

hormone therapies will work. That means that Gosrelin,

Decapeptyl, Lupron, Casodex, Nilutamide, Ketoconazole, Zytiga,

MDV-3100, ARN-509, etc. will all be useless.

The doctors tried chemotherapy, which does not involve hormones.

It was working but chemotherapy usually only works for a little

while and, in your father's case, the side effects were too great

and might have killed him if they continued the chemo.

At this point there are very few other possible therapies and

none of them is likely to do more than delay final progression

and death for a little while. One possibility is vaccine

therapy. Provenge may be available in France. It's very

expensive and not very effective. There's some doubt about

whether it works at all, but it does use a completely different

mechanism than hormone therapy or chemotherapy and seems to help

some patients. A better vaccine therapy might be the new drug

" Prostvac " , which is in clinical trials. However I don't know if

Prostvac trials are open to new patients at this time or whether

your father would be accepted into them.

Another possibility is Alpharadin. It is an injectable solution

containing radioactive particles bound to molecules that are

incorporated into growing bone. It only kills cancer in the

bones, nowhere else, so it doesn't prolong life very much, but it

can help reduce the pain and disability of metastatic cancer in

the bones.

You might investigate Prostvac and Alpharadin, and might look at

other clinical trials. However it seems possible that your

father might die within a year or so no matter what anyone can

do. In that case it might be good just to try to find ways to

make his last year as enjoyable and productive as possible.

For him, that might mean visiting people or places that he wants

to see. He might like to write some memoirs or speak to a tape

recorder or video camera for his children and grandchildren. He

might want to go through family photographs and make notes on the

backs (have him use pencil, not ink, because ink can bleed

through the paper and damage the photos) so that, after he's

gone, the rest of his family will know who the people in the old

photographs are.

He should also be sure that his financial affairs are in order.

He should have a good will, have transferred any financial assets

he has to other members of the family, and so on. In the U.S. it

would be desirable to create a " power of attorney " that

authorizes his children or someone else to act for him as his

legal representative.

Someone should also investigate hospice care and pain management.

A good doctor and a good hospice can make cancer patients

reasonably comfortable even in their last stages. This requires

specialist knowledge. All doctors know a little about pain

medication but very few have a real understanding of cancer pain

- which requires very strong pain medication, properly balanced

for chronic pain and acute " breakthrough " pain.

I think the end of life is always sad for everyone, but I believe

it's important for all of us, both the dying person and his

family and friends, to use the time in as positive a way as

possible, and not to give in to depression and despair.

I wish the best to your father and to you and the rest of his

family.

Bon chance.

    Alan