My husband was diagnosed with Stage IV metastatic prostate cancer in September 2006 with a PSA of 3400!  Treatment with Eligard brought PSA to .7.  However, at 18 months PSA began to climb again..  Adding Casodex  helped stabilize PSA for another 6-7 months.  When that failed he began ketaconazole which helped for another 8-9 months.  He is now consider hormone refractory.  He began taxotere with prednisone 5 weeks ago.  At 3 weeks his PSA had not dropped, but in fact had risen from 18 to 29.  Complicating all this, about 15 months ago he suffered a severe bout of bacteremia which left him with a vegetation on his pulmonic valve.  The fear of chemo was that the bacteremia would recur.  This morning he is suffering chills and rigors, a clear indication that the bacteremia has recurred.  What options are left?


Obviously, your husband is very ill and his management will be very complex and challenging. In this case, I can only make some suggestions that you might consider. Leukine is a human hormone that increases immune system functioning. By itself, it can slow the growth of prostate cancer. However, Eric Small at UCSF reported a 70% response rate to Leukine combined with Ketoconazole in patients who have failed Lupron and Casodex. In my experience, Dr. Small’s estimate of the response rate is right on the money. Additionally, I have found this combination even works when ketoconazole has previously failed. The fact that Leukine increases immune response seems a particularly advantage, given your husband’s infection. There are some issues to consider. Ketoconazole must be given every 8 hours by the clock. It needs to be taken with an acid beverage like soda or fruit juice, but not grape fruit juice. Vitamin C, 500 mg, can be used instead to acidify his stomach. Ketoconazole interferes with the body’s disposal of half of all prescription drugs. This includes several widely used antibiotics. Your physicians will need to consult available databases before placing you on any antibiotics while on ketoconazole.