Once we become hormone refractory (HRPC) there remains only one approved drug to treat our prostate cancer, docetaxel. As with hormone therapy (ADT) docetaxel also stops working after a period. There have been different strategies used to try to deal with this untenable situation, including the use of docetaxel on an intermittent schedule.
A recent study at Klinik für Urologie und Kinderurologie, Philipps-Universität Marbur was designed to reevaluate both the toxicity and efficacy of intermittent -docetaxel-chemotherapy in patients whose cancers progressed after successful first-line docetaxel therapy.
Forty six (46), eighteen (18) , and five (5) patients with HRPC received one (1), two (2), or three (3) cycles of docetaxel based chemotherapy. Both the toxicity of the docetaxel as well as the PSA response and general conditions were evaluated systematically. SPSS 15.0 was applied for statistic analysis.
Fifty six (56 %) patients achieved a PSA response of > 50 %, another ten (22 %) patients of up to 50 %; and ten (22 %) patients progressed despite the reintroduction of the docetaxel. The median overall survival of the whole cohort calculated from the first docetaxel application was sixteen months(3-60 +). Tolerance, toxicity and general condition were crucial for the administration of a second cycle (n = 18); in contrast, age or the degree of the PSA decline in cycle 1 did not seem to be of importance. The -median overall survival of all patients who received at least two cycles were 35 months; and 13 of 18 patients achieved a biochemical response in cycle 2. Toxicity did not rise significantly. Five patients were given a third docetaxel cycle, three of whom responded.
Intermittent docetaxel therapy is well tolerated and shows high response rates in the sec-ond and third sequences of treatment in select HRPC patients who presented with low docetaxel toxicity, good clinical condition and responded to prior docetaxel-based treatment.
Conclusion: If you did respond to an initial cycle of docetaxel and did not suffer with significant toxicity issues you might benefit from additional cycles after a rest period.
Reference:
Aktuelle Urol. 2009 Apr 15. Epub ahead of print.
doi: 10.1055/s-0028-1098888; Olbert PJ, Weil C, Hegele A, Hofmann R, Schrader AJ.
PubMed Abstract : PMID:19370533
Joel T Nowak MA, MSW
My PSA is rising after 18 months of untraceable PSA with hormone therapy. What comes next?
Pinkey,
I know that it is depressing and difficult to acknowledge that your cancer is progressing. A rising PSA while on active hormone therapy does signal a possible move to the next step. However, it does not mean that you are facing an immediate calamity.
The first thing you need to do is be sure that you are being treated by an oncologist (not a urologist) who specializes in and has a lot of experience in treating prostate cancer. Many well meaning doctors do treat men with advanced prostate cancer, but they do not understand the nuances of utilizing the best treatment tools available.
Always get a second opinion from another doctor who is unaffiliated with your primary doctor. Two heads and two artists are better than one.
If the hormone therapy has stopped working there are a number of additional measures available to treat your cancer.
Not knowing the specifics of your therapy (what drugs you are taking) puts me at a disadvantage. If the therapy does not include a drug to block the receptors on the surface of the cancer cells (i.e. casodex) simply adding it to the treatment protocol can have a positive effect.
One of the most simple next steps might actually be stopping the hormone therapy. Some men do experience a drop in their PSA by simply stopping the therapy.
There are secondary hormone blockade drugs available (one example is Ketocanozol – search for it on this blog) which operate differently from the typical primary blockade drugs and can have a positive effect.
You might also consider joining a clinical trial, there are a number of them available which I believe can have a very positive effect on your cancer. You can learn about the available trials on this blog by going to the resource section and clicking on the clinical trials link.
I am very hopeful that by the middle of 2010 Provenge will be approved by th FDA and available. Provenge is an immunological therapy that has demonstrated good results and statistically extends live. Read about the Provenge on this blog by searching for it. II have written a lot about the treatment and the struggle we have had with obtaining FDA approval.
We also have taxotere as well as other more traditional chemotherapy drugs available. These drugs have gotten a bad and not deserved knock.
Winding your way through the mine field of treatments is complex, as you can see. That is why it is so vital to have an excellent oncologist with a lot of experience treating prostate cancer.
I would also recommend that you join my internet group that focuses on advanced prostate cancer. You can join at http://health.groups.yahoo.com/group/advancedprostatecancer/join
I hope this helps you along and good luck.
Joel
I am 73..just..and was put on 50mg of Casodex + 5 mg of Finasteride 3 months ago. My PSA was 2.1 and doubled in 6 months from 1.0. Radical prostaticomy? performed 12/13/04. w/ T3@NOMO Gleason 4+3=7 at that time. No detectable PSA after surgery. Then started to rise 3 years later.
My question is: What happens if I stop ADT now? I am now fatigued daily to the point I just can’t do much physical activity at all without heavy breathing.. (No increase in heart rate)..and wanting to sit or lay down. I am quite active and work in shop 3 to 4 hours daily….I have to push myself to do this. I am 177 and holding. Other side effects are the normal stuff I have read when on ADT.
I would really appreciate your comment on continuing or discontinuing ADT until PSA rises again. (No, I don’t know if PSA has gone down)..Transaminases test is next week.
THANK YOU!
JT
JT,
The side effect you described, fatigue, is not a common effect of either casodex or finasteride. It is certainly possible that these drugs are causing the issue, but they might not be the problem.
Your medical history having advanced prostate cancer, and or your age, might be the actual culprit. Having cancer, especially advanced cancer is depressing and often a symptom of depression is fatigue.
I would suggest that you find a good support group and spend some time with other men whoare in a similar position. I don’t know about your family relationships or friends, but they too can help you get through this situation. Of course, you might also consider finding a counselor to help you come to terms with your feelings about having cancer, it is a hard thing to deal with for anyone.
You can also speak with your doctor about modifying your drugs. I hope you are being treated by an oncologist who has experience with men with advanced prostate cancer, this is important. Discuss with the doctor eliminating the casodex now and having a lupron shot along with the finasteride.
Good luck and let me know how you are in the future.
Joel