8th November 2007
I too lack a crystal ball and am a patient with no enrolled medical education, but I've been battling a challenging case since late 1999, and I have had to learn a lot about the disease. (I'm now doing great - as if I never had the disease - in my second off-therapy period of intermittent triple androgen deprivation therapy (hormonal blockade).
First the bad news, but you and your grandpa have no doubt already guessed it: at this point the prostate cancer is almost surely incurable. That high and rising PSA and the CT scan results show advanced metastatic cancer.
Now the better news: with the great advances that have been made in the past decade and that continue to be made, your grandpa may be able to get his cancer under good control and even achieve a long, perhaps permanent remission. I've heard doctors considered to be experts describe these kinds of strategies: a course of chemotherapy preceding hormonal blockade, or delivered as hormonal blockade therapy is started, or hormonal blockade without chemo to see how well the patient does. Personally, I like the last strategy as the patient may do very well without the chemo. (Note that this is using chemo as a tactic to get the cancer under control and not as an end-stage maneuver.)
For those patients where cancer control is clearly paramount, as in your grandpa's case, my studying the disease has convinced me that a triple pronged hormonal blockade program is best, supported by a bone density/metastasis control program as well as a diet/nutrition/supplements, exercise and stress reduction program. The hormonal blockade program involves three classes of drugs: an "LHRH agonist" (typically Lupron, Zoladex, Eligard, or Viadur, all pretty much equal in effectiveness) given by a shot or implant; an "anti-androgen" (usually Casodex, which is expensive but covered very well by good insurance, or otherwise flutamide, not quite as effective and with a less favorable side effect profile, but much less expensive) given as a small pill(s) (Casodex) or timed pills (flutamide); and finally a "5-alpha reductase inhibitor", either finasteride (cheaper) or Avodart (arguably more effective). For a patient with existing metastases, the cornerstone of the bone program is Zometa, given by infusion on a fairly frequent basis - and carefully the first time at a lower dose to avoid an "acute phase response", probably every three months or more often. There are side effects in the total program, but for most of us they are quite manageable and tolerable if effective, known countermeasures are used. A highly readable recent book on this is "Beating Prostate Cancer - Hormonal Therapy & Diet," Dr. Charles Myers, MD. Another excellent book is "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen Strum, MD, and Donna Pogliano.
Other tactics are also available, such as the drug known as Leukine.
Finding an excellent physician is key, and a "medical oncologist" is the kind of doctor who would probably be most helpful.
There have been amazing remissions, including rolling back and elimination of metastases, with modern approaches, though it is not a cake walk and not a sure thing. The Myers book has excellent examples of dire cases (PSAs in the thousands) with wonderful responses, and a number of expert doctors are reporting many successes with challenging cases.
Keep your spirits up, and good luck to you and your grandpa!
Jim
First the bad news, but you and your grandpa have no doubt already guessed it: at this point the prostate cancer is almost surely incurable. That high and rising PSA and the CT scan results show advanced metastatic cancer.
Now the better news: with the great advances that have been made in the past decade and that continue to be made, your grandpa may be able to get his cancer under good control and even achieve a long, perhaps permanent remission. I've heard doctors considered to be experts describe these kinds of strategies: a course of chemotherapy preceding hormonal blockade, or delivered as hormonal blockade therapy is started, or hormonal blockade without chemo to see how well the patient does. Personally, I like the last strategy as the patient may do very well without the chemo. (Note that this is using chemo as a tactic to get the cancer under control and not as an end-stage maneuver.)
For those patients where cancer control is clearly paramount, as in your grandpa's case, my studying the disease has convinced me that a triple pronged hormonal blockade program is best, supported by a bone density/metastasis control program as well as a diet/nutrition/supplements, exercise and stress reduction program. The hormonal blockade program involves three classes of drugs: an "LHRH agonist" (typically Lupron, Zoladex, Eligard, or Viadur, all pretty much equal in effectiveness) given by a shot or implant; an "anti-androgen" (usually Casodex, which is expensive but covered very well by good insurance, or otherwise flutamide, not quite as effective and with a less favorable side effect profile, but much less expensive) given as a small pill(s) (Casodex) or timed pills (flutamide); and finally a "5-alpha reductase inhibitor", either finasteride (cheaper) or Avodart (arguably more effective). For a patient with existing metastases, the cornerstone of the bone program is Zometa, given by infusion on a fairly frequent basis - and carefully the first time at a lower dose to avoid an "acute phase response", probably every three months or more often. There are side effects in the total program, but for most of us they are quite manageable and tolerable if effective, known countermeasures are used. A highly readable recent book on this is "Beating Prostate Cancer - Hormonal Therapy & Diet," Dr. Charles Myers, MD. Another excellent book is "A Primer on Prostate Cancer - The Empowered Patient's Guide," by Dr. Stephen Strum, MD, and Donna Pogliano.
Other tactics are also available, such as the drug known as Leukine.
Finding an excellent physician is key, and a "medical oncologist" is the kind of doctor who would probably be most helpful.
There have been amazing remissions, including rolling back and elimination of metastases, with modern approaches, though it is not a cake walk and not a sure thing. The Myers book has excellent examples of dire cases (PSAs in the thousands) with wonderful responses, and a number of expert doctors are reporting many successes with challenging cases.
Keep your spirits up, and good luck to you and your grandpa!
Jim