Hi Mary,

That's good news on the absence of detectable cancer in the bones and spine! :) That absence alone puts your husband in a better prognostic category! :)

Did the doctor address the issue of assessing bone mineral density and then protecting it while on Lupron? You did not mention this, and it's very important. Back in 2000, my excellent urologist team was not familiar with that need, but the medical oncologist to whom they referred me understood it right away. I think I mentioned before that a qCT scan is apparently much better than the more common DEXA scan if there is a likelihood of arthritis or calcification of the blood vessels, as could well be the case with your husband. Be sure this issue is addressed by one of the doctors! I'm thinking the medical oncologist would be your husband's best bet for this.

About the Lupron and Casodex, both of which I've been on and off for eight years now, you have it almost right. Actually it's the Lupron that makes the body think it's getting too much testosterone so that it shuts down production. The Casodex acts mainly to block the "androgen receptors" for the cancer cells so that testosterone can't dock at the receptors and initiate the cell growth process (simplified view).

Monitoring the liver when you're on Casodex is very important so that you can cope with a serious complication if it starts developing. Fortunately, that complication is rare - nearly all of us are completely unaffected. Even if a patient does start developing it, there are medications that may enable him to continue with the Casodex, or continue after suspending until his system gets back in shape. One of those medications is known as Ursodial. Also, provided the complication is not yet well established, it is reversible by stopping the Casodex or with Ursodial in some cases, as I understand it as a layman. If Casodex just isn't tolerable, there are similar therapies that don't have the same problem.

Using Casodex and following shortly with Lupron now seems a wise strategy to me. Those drugs should put the cancer back on its heels. I personally believe that adding Avodart, or finasteride, is also wise, but many doctors are reluctant to do that as the medical community is not yet up to speed on the value of those drugs in addition to the main drugs. A few research papers have been published about that, and there is much more less formal information based on observations in the practices of individual doctors.

Be sure you and your husband learn about countermeasures for the side effects of Lupron. There is a lot that can be done to make it more tolerable!

Radiation in combination with hormonal blockade is often quite effective. Adding a course of chemotherapy at this point instead of much later is investigational, but it is not a rare approach for challenging cases. It was recommended to me in 2000, in fact, and I would have done that except that shortly after the recommendation my PSA responded so well to triple hormonal blockade (Lupron, 50 mg Casodex, Proscar - now available generically as finasteride).

Take care,

Jim

Thanks Jim - your an invaluable asset to helping me understand Dan's treatments moving forward and I'll never be able to thank you enough. Additionally, your story has been an inspiration to both of us - giving us promise for the future (originally we felt little or no hope in the beginning - cancer is such a scary word). We won't be seeing an oncologist until June 17 but Dan's urologist did mention the monitoring of his bone density. Dr. Emme wants the oncologist's input too. As for monitoring the liver function, we have the test from his original appointment with his general physician on May 2nd, then another urinalysis from his uroloigist (Dr. Emme) on May 13th and we are set to have another CBC and urinalysis on June 9th when he goes for his first Lupron shot - I hope that's a good start. Any thoughts on how often he should have the liver function checked? Also, can you explain a little more about Avodart or finasteride and what they help with? As for Dan's back, his general practioner wants him to have an MRI which is also scheduled for June 17th prior to seeing the oncologist.

Again Jim - thank you for all your information and support. Due to your original post I felt like I was very prepared when I walked into the original findnings consultion with the urologist. This doctor (who we like VERY much) took the time to answer all the questions I had written down and was very pleased that I had been doing my reading and was up to speed on what he was talking to us about.

Please continue to help us through this - again, your input is invaluable.

Mary

Mary,

You are most welcome, and I appreciate your kind comments, and kind comments from our board buddies. :)We all contribute from our own experience and from our own store of common sense. I'll insert some comments in green in excerpts of your post below. - Jim

[QUOTE=MyDan;3595404]... We won't be seeing an oncologist until June 17 but Dan's urologist did mention the monitoring of his bone density. Dr. Emme wants the oncologist's input too.

[COLOR="DarkGreen"]I'm very glad for that. To me it's a good piece of evidence that the doctor is up to speed, that he is keeping up with the field. :) Many doctors do not, something that surprised the heck out of me when I realized it a couple of years after starting on this journey. :( A great many of us on hormonal blockade will lose bone density as a result of the blockade unless that is counteracted with a bisphosphonate drug coupled with calcium and vitamin D3 supplementation (or prescription vitamin D3 - calcitriol, though that seems to have decreased in favor as a general tactic - still useful for some patients; I'm not real knowledgeable about the use of calcitriol related to bone density; maybe another board participant knows).

As for monitoring the liver function, we have the test from his original appointment with his general physician on May 2nd, then another urinalysis from his uroloigist (Dr. Emme) on May 13th and we are set to have another CBC and urinalysis on June 9th when he goes for his first Lupron shot - I hope that's a good start. Any thoughts on how often he should have the liver function checked?

[COLOR="darkgreen"]I believe that monthly "LFT" (Liver Function Test) checks are the standard until it is clear that the patient's liver handles the drug well; that will probably take several months. I haven't had an LFT for a long time as it's clear I do just fine with Casodex.

Also, can you explain a little more about Avodart or finasteride and what they help with?

[COLOR="darkgreen"]They do several things, but the main thing is to prevent the conversion of testosterone into dihydrotestosterone, known as DHT. Preventing conversion is good, because DHT is several times more potent than testosterone as a fuel for prostate cancer; in some men DHT is apparently ten times more potent.

Even after hormonal blockade with Lupron and Casodex, there is still some testosterone remaining, and that can be converted into DHT. When testosterone is inadequately blocked, as happens infrequently but too often with many doctors not even checking it, a lot more DHT results from conversion.

Another thing finasteride and Avodart do is decrease blood supply to tumors in the prostate. There are probably other anti-prostate cancer things they do that have not yet been discovered. Of course, both drugs are known for and approved for their ability to help control BPH, so that is a "side" benefit for prostate cancer patients who still have their prostates (like me). Another side effect, this time a welcome one, is that they restore some hair in some (not all) of the male pattern baldness areas (again me). :D Many doctors have been slow to realize the role and value of these drugs against prostate cancer, :( but that is changing; just today NBC ran a feature saying that follow-up analysis had shown that finasteride SAFELY prevented 25% of prostate cancer and did not promote high grade disease in a few men. :)
...
Mary