RE: My Father

[Guest guest]

Bonjour n,

I'm not a doctor or expert of any kind. The ideas I have are

strictly those of a layman and should not be taken as accurate,

but for whatever they are worth, here are my thoughts about your

questions:

> The medical team will reeavaluate the situation by the end of

> the month with full exams (scintigraphy) to decide if they stop

> the mdv3100/placebo and start a chemiotherapy.

....

> -> Why the medical team is combining a Phase III clinical trial

> with an uneffective (or no more effective) treatment :

> triptorelin. I thought a Phase III clinical trial was suppposed

> to be in addition to the " best available treatment " . What

> happens my father get the placebo (which seems to be the case,

> according to his PSA) ? Is it ethical ?

The " best available treatment " is problematic in this case.

Many, probably most, prostate cancer patients are given the kind

of hormone therapy that your father got, and nothing else. They

die when it stops working. All of the other available treatments

are less effective than hormone therapy and have more toxic side

effects. When they are tried, they are usually given in a series

of trial and error attempts. Try this, then try that, if the

response is good, wait, then try something else.

That kind of approach would completely invalidate a clinical

trial. Each patient would get something different. There'd be

no way to know whether MDV 3100 worked.

However there are other treatments and if it's clear that the

trial is not working for him, maybe he needs to drop out of the

trial and try something else.

He should NOT do that without talking to the trial doctors. I

hope he can stay in the program until the end of the month. It

would be a real shame if he just needs one more week or one more

PSA test, or something like that, to enable his data to be useful

for the trial, and he doesn't stick with it. By participating in

the trial he has done something for all cancer patients and it

would be a shame to lose that contribution.

> ->Is Chemotherapy the next step or are they other options to

> try before. I read the article

> http://www.prostate-cancer.org/pcricms/node/208 but I'm not

> sure to understand what it implies in this case.

Unfortunately, very few men with prostate cancer are treated by

experts. Most are treated by oncologists who treat every one of

the 300 or so kinds of cancer and don't have any experience with

the advanced therapies listed in that article.

I suggest that you and your father print out the list of

therapies from that article and make appointments with various

doctors. Try to find one who has experience with them. If you

can't find anyone, try to find someone who is willing to read

about and try some of these treatments. There are risks involved

because a doctor who has never used a drug before may not know

what the right dose is or what special tests he should perform to

find out if the drug is toxic for the patient.

Will they work? As I understand it, (and remembering that I am

far from being an expert in this), the answer is - maybe. Some

men get months or even years of extra life from some of the

therapies with very few side effects. Some get hardly any

benefit at all and have bad side effects.

I think (remembering that I'm not an expert) I might want to try

some of the other therapies - ketoconazole, estradiol, and maybe

some others, before trying chemotherapy.

> ->What is roughly the survival estimation range for someone

> starting Chemotherapy in this case?

According to the latest published data from the U.S. National

Cancer Institute (NCI):

http://www.cancer.gov/cancertopics/pdq/treatment/prostate/HealthProfessional/All\

Pages

" If prostate cancer has spread to distant organs, current

therapy will not cure it. Median survival is usually 1 to 3

years, and most such patients will die of prostate cancer.

Even in this group of patients, however, indolent clinical

courses lasting for many years may be observed. "

I seem to recall reading in the NCI statement that chemotherapy

provides a modest additional median survival on the order of 10

to 20 weeks. But I can't find it right now. However, although

your father is likely to fall near the median, there are lucky

men (if a man with cancer can be called lucky) who have very long

lasting responses.

> ->Should I take a second opinion ?

Yes. That never hurts. If your father has a personal doctor who

is not the same as the clinical trial doctor, ask for a

consultation with the clinical trial doctor. I think that

doctors who conduct clinical trials are often more knowledgeable

than most clinicians.

Research hospitals at universities are often a place to find the

best doctors.

Bon chance a vous et votre pere.

Alan

[Guest guest]

Hello n,I have to say that my father was diagnosed May 2010 and had a very similar clinical history to yours. (84 years old, Gleason 9, Metastatic disease spread to the bone, PSA: 98, General health good ) In the Portuguese Oncology Hospital they started Casodex – Failed, then they tried Ciproterone Acetate – Failed, started DEStilbenol (no longer given because of its cardiovascular risks) – Failed. Through this whole process he kept his monthly Decapeptyl (still does). We where now in December 2010 and his PSA was now 800 and he started having severe bone pain and they wanted him to start chemotherapy (Taxotere). After investigating a LOT on the disease I found out there was another option in second line hormonal therapy with High Dose Ketoconazole- I also found out there was this talented Oncology Doctor named Dr Myers in Charlottesville - USA. We went to see Dr Myers in January 2011 and he started him on High Dose Ketokonazole + Hidrocortizone, Estradiol patches (Similar to DES but without it’s dangerous cardiovascular side effects), Avodart and a series of different supplements like Resveratrol, Pomegranate capsules, Vitamin D, Lycopene, Curcumin, Cayenne Extra Hot and Lecithin. He also started Biphosfanates (Zometa) for Bone Integrity and Radiotherapy to control his pain and to treat his bone lesions. At the moment he his free of pain, his PSA dropped to 173 and he’s general health is good and more important, he still hasn’t started Chemoterapy, we still have that weapon available when the time comes. With this I have to say that you should ALWAYS seek a second and a third opinion and investigate deeply the disease and it’s possible treatments. r Myers says that “Prostate Cancer is like Golf, you have to play it where it lays”. I couldn’t agree more. For lots of info on Pca I truly recommend Dr Myers Blog http://askdrmyers.wordpress.com/ Good luck to you and your dad, Pedro De: ProstateCancerSupport [mailto:ProstateCancerSupport ] Em nome de julien mollereauEnviada: quinta-feira, 8 de Setembro de 2011 22:38Para: ProstateCancerSupport Assunto: My Father Hello, I'm new on PCS and would greatly appreciate your advices and recommendations about my father case. My father is 74 year old and has a hormone refractory prostate cancer with bone metastasis and PSA of 98, his general health is not bad for now. 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 The medical team will reeavaluate the situation by the end of the month with full exams (scintigraphy) to decide if they stop the mdv3100/placebo and start a chemiotherapy. My questions are : -> Why the medical team is combining a Phase III clinical trial with an uneffective (or no more effective) treatment : triptorelin. I thought a Phase III clinical trial was suppposed to be in addition to the " best available treatment " . What happens my father get the placebo (which seems to be the case, according to his PSA) ? Is it ethical ?->Is Chemotherapy the next step or are they other options to try before. I read the article http://www.prostate-cancer.org/pcricms/node/208 but I'm not sure to understand what it implies in this case.->What is roughly the survival estimation range for someone starting Chemotherapy in this case? ->Should I take a second opinion ? Any thoughts, advice or recommendation would be appreciated.I don't know a lot about prostate cancer so my questions may be inappropriate, in such case feel free to explain me what is wrong in my thinking.Thanks very much for your help.Regards.n.