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  1. Safety at home for patients on chemotherapy Chemotherapy (pronounced kee-mo-ther- a-pee) is a cancer treatment that uses drugs or medicines to kill cancer cells. It is sometimes just called ‘chemo’. Patients can have chemotherapy in different ways. Intravenous (IV) chemotherapy is given into the patient’s vein, and goes straight into their blood. Oral chemotherapy is given by mouth, as tablets, capsules or liquids that the patient swallows. Bush medicine Bush medicine could cause problems for patients having cancer treatment. Your patient should check with their doctor before using bush medicine. There are important safety measures that you should take while caring for patients who are having chemotherapy. You also need to educate your patients, and their families and carers, about safety. This section explains: how to protect yourself, and your patients’ families and carers, from chemotherapy drugs how to support patients who are taking oral chemotherapy at home what equipment you may need, like gloves and spill kits. 6 Chemotherapy safety Safety information for all chemotherapy patients Chemotherapy drugs kill cancer cells but can also damage normal cells. Each time your patient has chemotherapy, it can take up to seven days for the chemotherapy drugs to leave the body. During these seven days, chemotherapy drugs can be in the patient’s body fluids or waste products, including: blood urine (wee) vomit (spew) saliva (spit) semen vaginal secretions sweat stool/faeces (poo). If you accidentally touch any of these fluids, some of the chemotherapy drug could get into your body through your skin. You, and your patient’s family and carers, need to take special care to stay safe for the first seven days after each chemotherapy treatment. The information on the next pages explains how to do this. Important Women who are pregnant or breastfeeding should not touch: chemotherapy medication body fluids (wee, vomit, etc.) of someone having chemotherapy any bedding, clothing, or cleaning cloths with the above body fluids on them. Safety at home for patients on chemotherapy 7 Educate your patient About cleaning up spills If there is a spill of any body fluids (e.g. poo, wee, spew), put on rubber gloves and use a disposable cloth to clean up the spill straight away. Place the cloth in a plastic bag and tie it closed; then place that plastic bag into another plastic bag and tie it closed— this is called ‘double-bagging’. The plastic bag can then be placed in the normal household rubbish. Towels, linen or clothing that have body fluids on them should be machine washed separately in a hot or cold wash, on the longest washing cycle. They can then be dried outside. If there is a spill of body fluids on a bench top or floor, wear rubber gloves and wash it off with lots of water and detergent. About feeling sick and vomiting • It is a good idea to keep a plastic bowl or bag (without holes in it) handy for this. • A bowl used for vomiting, should not be used for anything else. • Wash the bowl out after each use. • Throw it away at the end of the chemotherapy treatment. About going to the toilet After going to the toilet, close the lid, and flush the toilet on full flush. This is so that fluids from the toilet don’t splash out. Men should sit down when using the toilet so there is no splashing. About having sex Your patient and their partner should always wear condoms when having sex in the first seven days after chemotherapy treatment. This is because low amounts of chemotherapy drugs may be passed in the semen or vaginal secretions. 8 Chemotherapy safety Safety information for patients taking oral chemotherapy at home You may need to care for patients taking oral chemotherapy at home. The patient may have to take tablets, capsules or liquid medicine. The information below explains how to do this safely. Make sure your patient knows how to take their oral chemotherapy drugs Most patients will have a written plan, telling them when to take their tablets. It’s a good idea for you to go through this with them to make sure they have understood this information. Make sure the patient knows they must take the oral chemotherapy exactly as their doctor or pharmacist has told them to. This includes taking it on the right day, at the right time, and with or without food, as directed. Check that your patient knows how to store their oral chemotherapy drugs safely It is important that your patient: • keeps the chemotherapy drugs in their original packaging • stores any chemotherapy drugs (tablets or liquids) as the doctor or pharmacist tells them to • stores them safely away from children or animals. Safety at home for patients on chemotherapy 9 Educate your patient How to handle oral chemotherapy drugs safely Your patient: Your patient can handle the oral chemotherapy drugs because the treatment is for them. After taking the drugs, they should wash their hands before touching anything else. You, and the patient’s family or carers You, and the patient’s family or carers, should never touch chemotherapy medicine with your bare hands. This is because some of the chemotherapy drug could be absorbed into your body through your skin. Sometimes you, or someone else, will need to touch chemotherapy drugs to help the patient to take them. You should always wear a pair of rubber gloves to touch or handle chemotherapy drugs. Wash your hands after taking off the gloves. How to take oral chemotherapy drugs safely Your patient should: • take the chemotherapy exactly as directed by their doctor or pharmacist (e.g. this may be with food or on an empty stomach)—it will say on the medicine label on the bottle • swallow the chemotherapy tablets or capsules whole—never crush, cut, chew or bite tablets, and do not open capsules • wash their hands after handling the chemotherapy tablet or capsule. Note: If the patient cannot swallow the tablets, talk to the doctor straight away. 10 Chemotherapy safety Important things to know What if my patient vomits after taking the chemotherapy? If your patient vomits straight after taking a dose of oral chemotherapy, they should not take a replacement dose but contact the treatment team for further advice. If they have been given anti-sickness tablets to stop nausea and vomiting, they should take this medicine as the doctor or pharmacist has instructed, even if they do not feel sick. If they have taken the anti-sickness medication and it does not stop them from vomiting, speak with the doctor about what to do. Make a note to tell the doctor or nurse from the treatment team about any missed or vomited doses. Important What if my patient forgets to take their chemotherapy tablets? • If your patient forgets to take a chemotherapy dose, they should take the next dose at the normal time, as prescribed. • Refer to the eviQ patient information sheet that they may have been given for further information. If the patient is unsure about what to do, speak with the doctor or clinic staff on the next working day. What if my patient has finished chemotherapy treatment but has some tablets left? Leftover chemotherapy capsules or tablets should be returned to the cancer clinic or pharmacy. If your patient is having chemotherapy treatment in hospital, they may see nursing staff wearing protective equipment. This is necessary for some types of chemotherapy administration. It is nothing to be frightened of. Safety at home for patients on chemotherapy 11 Useful equipment Gloves The best gloves to use are nitrile gloves, which are made from synthetic rubber and are resistant to chemotherapy. If you or your patient don’t have nitrile gloves, you can use: two pairs of disposable gloves, or a thick pair of rubber gloves that can be bought from the supermarket. Whichever gloves you use, they should only be used for cleaning up spills (see page 8), or for handling chemotherapy medication (see page 10). Home-made spill kit If your patient does not have a spill kit provided by the hospital, it is a good idea for them to keep a kit at home to clean up spills. It should include: incontinence pad/’inco sheet’ or disposable cloths gloves plastic apron vomit bag/bowl plastic bags. Important Be careful when removing gloves. Do not touch the outside of the gloves with your bare hands. Wash your hands after removing gloves. If using re-useable gloves, these gloves should be stored separately in a sealed plastic bag and thrown away at the end of treatment. With thanks to Cancer Institute NSW under Creative Commons Attribution 4. See also: Dealing with the risk of infection while on chemotherapy with Taxotere (docetaxel):
  2. Last Friday 10 March 2017 the Pharmaceutical Benefits Advisory Committee (PBAC) reached its initial decisions on drugs to go onto the PBS at reduced prices. This included whether to put Xtandi (Enzalutamide) before chemo on the PBS. The company will be told of the result next Friday 17 March 2017. If necessary, negotiations between the PBAC and the company continue for 4 weeks. The final results will be published on the PBAC website 21 April 2017. (If the company is not happy with the result, they have until July 2017 to appeal.)
  3. This video is about a treatment for men who already have prostate cancer. It is about adding an occasional testosterone boost to regular drug therapy to treat prostate cancer. Dr Sam Denmeade reports on encouraging trials of this approach. It is 56 minutes long and has Closed Captions (Cc) for the hard of hearing. Thanks to Rick Davis of the Answer Cancer Foundation for allowing us to post this video. Access the whole presentation, including introductions, questions and answers, at: https://www.ancan.org/bat-presentation The questions and answers begin at about 1hour 4minutes.
  4. This is very encouraging for me. I was diagnosed in February 2015 at the age of 68 with no PCa related symptoms but with elevated PSA of 11.7ng/ml. Needle biopsy confirmed PCa of GL 9. I underwent open RP in March 2015. Post surgery staging : T2c No Mx, GL 4+5=9 and positive surgical margin. 3 weeks after surgery PSA fell undetectable, yet I underwent IMRT and ADT with 50mg Bicalutamide added alongside for a period of 2 years ( continuous protocol ) completing in end April 2017. Throughout this treatment period up to now my PSA checked every 3 months has remained at 0.008ng/ml. My treatment has been adjuvant and not salvage. According to Gim's article I can be very optimistic about my prognosis and most likely to pass 15 years of recurrence free survival when I come off the present treatment regimen. But according to the information I have, it is very doubtful because the treatment with ADT + antiandrogen can only suppress the disease progression whereas Radiation treatment is only localized ( focal therapy ) though curative. But the fact remains that there could have been microscopic cancer cell leakage into my blood and lymphatic systems even before surgery whilst the tumour was within the the capsule of the prostate gland ( micro metastasis ). Higher the GS the more will be this vulnerability. Therefore I am contemplating seriously to go for an early cytotoxic whole body treatment to kill all hidden microscopic cancer cells before they could launch their attack on me. What I really mean is to go for a big hit with Chemo Therapy up front, although my PSA has remained undetectable.All hormone therapies are only palliative and they fail sooner or later and too much dependence on them can deprive us with the early opportunities of taking curative treatments or pushing the cancer into a stable and long term remission. I would appreciate very much if the wise men in this advanced PCa group comment on my above view points. Sisira
  5. Treatment of metastatic prostate cancer has changed recently. In the past doctors would use hormone therapy (ADT) at first, then wait until the disease was very progressed before giving chemotherapy with Taxotere (Docetaxel). The reason for the change? Professor Christopher Sweeney reported on a trial he led (CHAARTED). In CHAARTED, the researchers (an international team of medical oncologists) showed that starting BOTH chemotherapy and ADT at the beginning of treatment gave men a longer life. Members of your Executive Committee were invited to be the audience for an video interview of Christopher Sweeney and his Australian colleague, Professor Gavin Marx, by Anthony Lowe, PCFA CEO. Tony Maxwell, Alan Barlee and Nev Black and I were able to attend. (Paul Hobson had to miss out because of treatment.) Click on this sentence to see all of our videos on our YouTube channel. Note that most videos are in Playlists and you will have to click on each Playlist name to see the videos. Jim
  6. The opportunity There is a chance to have your voice heard on whether the drug Xtandi (enzalutamide) should be available on the PBS BEFORE chemotherapy. Timing Submissions are due Wednesday 8 February 2017, and no late submissions will be accepted. Enzalutamide on the PBS An important drug for men with advanced prostate cancer is Xtandi, also called enzalutamide. The first evidence that enzalutamide worked looked at using enzalutamide AFTER the chemotherapy drug docetaxel. A committee of experts looked at this evidence. They recommended that it was worth spending taxpayer money on. So, now men with advanced prostate cancer can get enzalutamide on the PBS at a low price, AFTER they have had chemotherapy with docetaxel. Some new evidence has arrived showing that enzalutamide works well BEFORE chemotherapy with docetaxel. The same committee of experts is now looking at this evidence to see if it is worth spending taxpayer money to put enzalutamide on the PBS for use BEFORE chemotherapy with docetaxel. This is the second time this has come up for consideration. The first time, the expert committee rejected the application: because the submission was focused on a claim of survival advantage, which was small and uncertain, rather than on outcomes that clinicians and patients considered to be of most value. The purpose of using enzalutamide earlier in the disease pathway would be: 1) to delay symptoms from developing and maintaining a better quality of life for longer in asymptomatic patients for whom placebo, or watchful waiting, is the appropriate comparator; and 2) delaying the toxicities of chemotherapy in symptomatic patients considered suitable for docetaxel. That committee has asked for public submissions for a new application. Enzalutamide BEFORE chemotherapy The first thing you should understand that enzalutamide is not a miracle cure. About half the men on the PREVAIL clinical trial were still alive three years after they started on enzalutamide. Some of the men who responded will have a much longer survival. I have met a man whose cancer has been kept at bay for 6 years so far on enzalutamide. But survival times pre-chemo and post-chemo are not different enough to convince the experts. What is most important about this drug is the quality of life it makes possible during that two or three years. Docetaxel chemotherapy vs enzalutamide side effects The first thing you should understand is the current first treatment at this stage - docetaxel chemotherapy. Many men report coping quite well with their docetaxel, finding the temporary hair loss and other side effects manageable. But some men have a terrible experience with the side effects. It is so bad for some men that they give up the treatment. And, about one man in four hundred dies from the treatment. On the other hand, enzalutamide treatment has far fewer reported side effects. Fatigue and hypertension were the most common. So, the first benefit of starting enzalutamide BEFORE chemotherapy is that a man can delay the start of the docetaxel chemotherapy. The PREVAIL clinical trial In the PREVAIL clinical trial of enzalutamide before chemotherapy, men had to: have metastatic prostate cancer, be castrate resistant, and have no, or few symptoms (like pain). Metastatic means that their prostate cancer had spread to other parts of their body. Castrate resistant means that the primary hormone therapy, with drugs like Zoladex, Lupron, and Eligard, was no longer able to keep the cancer in check by itself. In other words their PSA was rising, despite the hormone therapy keeping testosterone very low. Men in this trial on enzalutamide did not need to start chemotherapy, on average, for more than two years - 28 months. The control group of men had to start chemotherapy after 11 months. So men on enzalutamide had 17 MORE months at a higher quality of life. After 12 months of treatment, 65% of men treated with enzalutamide had scans which showed no progression of their cancer, compared to 14% of the control group. The trial was finished early when it became clear that the enzalutamide was far more effective. At that stage, 29% fewer men had died in the enzalutamide group. The enzalutamide group also had a longer time until the first skeletal-related event (that is, problems with their bones). Most prostate cancer metastases (about 89%) occur in bones. Of the men with metastases away from their bones, complete or partial soft-tissue response favoured enzalutamide 59% to 5%. Time until PSA started going up again also favoured enzalutamide. So did the number of men whose PSA dropped to at least half - 78% to 3%. Submissions The Prostate Cancer Foundation of Australia (PCFA) is making a submission on behalf of its members. Some individual members have told me that they are going to put in an individual submission. If you also wish to have your say, a couple of points: Firstly, while submission sounds grand, it is as easy as filling in a few boxes on a web page: Click on this sentence for the submission form. OR Here. Notes on the boxes on that page: Medicine to which this submission relates: Enzalutamide Date of PBAC meeting: March 2017 Note: This is when the board meets. It is not the due date for submissions which is Wednesday 8 February 2017. First declaration box: Nil (unless you work for the manufacturer, hold shares in the company, etc.) Second declaration box: Say what you are: man with this disease, partner, friend, doctor, etc. Say where you are in your disease: having the drug, missed out on the drug, expecting to be needing the drug in the future. What comments would you like the PBAC ...? • How does this condition/disease affect quality of life? • What would you most like to see from this treatment? Improved side effects? Slowing disease progression? More mobility? Other benefits? • If you have used or prescribed this new medicine, what was your experience of the beneficial effects? • If you have used or prescribed this new medicine, what side effects or toxicities did you experience or observe? • If you haven't used the new medicine yet, what are your expectations of it? • If you use other currently available therapies or medicines you use to manage your condition (or for prescribers, for your patient’s condition), what are the benefits and/ or the challenges? Where did you obtain the information that helped form your views on this treatment? ◦ I have been a patient on this medicine; ◦ Your doctor; ◦ Other patients stories/experiences ◦ Professional colleagues; ◦ Support networks: PCFA, Australian Advanced Prostate Cancer Support Group, JimJimJimJim ◦ Own research; ◦ Other patient resources; ◦ Direct experience as a health professional or carer; ◦ Other – please provide details. When your entry is complete be Very Careful not to press the wrong button. Tick: Agree to terms and conditions Click: Submit Click on this sentence for the submission form. Lets hope for a good result this time! Jim
  7. The Reluctant Brothers in their American teleconference recently discussed the work of Dr Valter Longo regarding fasting and chemotherapy. This discussion was prompted by papers published in July 2016 in the journals Cancer Cell and BMC Cancer by Dr Longo's team. In 2014 we posted about Dr Longo's work : Since 2008 Dr. Valter Longo, a professor of gerontology and biological science at the University of Southern California has been investigating whether fasting reduces some of the side effects of chemotherapy. “Fasting makes things worse for the cancer, when assisted by chemotherapy. It’s the combination of the two treatments which produces the effect. Most people can last for up to 40 days with just water. Normal cells know how to cope with starvation. Cancer cells don’t. They evolved away from starvation.” ABC Science Show 21 April 2012 A transcript of the Science Show’s interview with Dr Longo is available at http://www.abc.net.au/radionational/programs/scienceshow/chemotherapy-and-fasting-to-treat-cancer/3963102#transcript or http://tinyurl.com/jvlxl86 A more technical explanation of why fasting renders cancer cells more sensitive to chemotherapy can be found in a bulletin from the US National Cancer Institute Bulletin of 10 July 2012. This bulletin can be viewed at http://www.cancer.gov/ncicancerbulletin/071012/page5 or http://tinyurl.com/lo28pbf At the 2013 American Society of Clinical Oncology (ASCO) Annual General Meeting Dr Longo and colleagues presented the results of a Phase 1 trial which concluded that “Fasting for up to 72 hours around chemotherapy was safe and feasible for cancer pts and resulted in significant decline in insulin and IGF1 levels.” The abstract is available at http://meetinglibrary.asco.org/content/114231-132 or http://tinyurl.com/lo28pbf Recently Dr Longo and his colleagues have published the results of further research in the 5 July 2014 issue of the journal Cell Stem Cell which showed that cycles of prolonged fasting not only protected against immune system damage — a major side effect of chemotherapy — but also induced immune system regeneration, shifting stem cells from a dormant state to a state of self-renewal. Co-author Tanya Dorff, assistant professor of clinical medicine at the USC Norris Comprehensive Cancer Center and Hospital said: “The results of this study suggest that fasting may mitigate some of the harmful effects of chemotherapy. More clinical studies are needed, and any such dietary intervention should be undertaken only under the guidance of a physician.” More information about this most recent research is available at https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/ or http://tinyurl.com/klqrvxl The Mayo Clinic is currently conducting a clinical trial “Short-Term Fasting Before Chemotherapy in Treating Patients With Cancer”: see http://clinicaltrials.gov/show/NCT01175837 Click here to read about the recent studies reported in the journals Cancer Cell and BMC Cancer. Warning: You should not attempt fasting during chemotherapy without first discussing this with your medical oncologist.
  8. The European Society for Medical Oncology (ESMO) has just had its Annual Conference in Copenhagen. Click here and here for 2 reports from Practice Update about some of the things discussed at ESMO 2016 and the implications for patients.
  9. Treatment of metastatic prostate cancer has changed recently. In the past doctors used to use hormone therapy (ADT) at first, then wait until the disease was very progressed before giving chemotherapy with Taxotere (Docetaxel). The reason for the change? Professor Christopher Sweeney reported on a trial he led (CHAARTED). In CHAARTED, the researchers (an international team of medical oncologists) showed that starting BOTH chemotherapy and ADT at the beginning of treatment gave men a longer life. Yesterday (Sunday, 4 Sep 2016), members of your Executive Committee were invited to be the audience for an video interview of Christopher Sweeney and his Australian colleague, Professor Gavin Marx, by Anthony Lowe, PCFA CEO. Tony Maxwell, Alan Barlee and Nev Black and I were able to attend. (Paul Hobson had to miss out because of treatment.) Being able to question world leaders in advanced prostate cancer treatment was a privilege, and we were able to ask several questions men have raised with us in the past. I have been offered first cut of the video footage. I hope to be able to produce two YouTube videos - one the expert interview, the other on key questions men ask about chemo. Watch this space!
  10. "TAPS stands for “taxane acute pain syndrome”. It is a recognized side effect of treatment with taxanes like docetaxel. It is usually characterized by muscular pain (myalgia) and joint pain (arthralgia) that starts about 24 to 48 hours after taxane treatment and then lasts for up to about 7 days. However, relatively little is known about its incidence and predisposing factors in men with prostate cancer who are being treated with taxane-based chemotherapy..................... The “New” Prostate Cancer InfoLink would suggest that the risk for TAPS is something that needs to be explained to patients prior to their chemotherapy along with guidance about (a) how to address this type of side effect should it occur and (b) the importance of reporting this side effect to their doctors." Click here to read the article from The “New” Prostate Cancer InfoLink.
  11. Some men who are diagnosed with prostate cancer have metastases at the time of their diagnosis. Until recently the primary treatment for these men was Androgen Deprivation Therapy (ADT). Since the CHAARTED and STAMPEDE trials, ADT + Chemotherapy (Docetaxel) has become the standard of care for these men. What about ADT + Chemotherapy + Radiotherapy for these men? Maybe. Removal of the primary cancer has been used effectively in other cancers, either using radiation or surgery to increase cancer-specific survival time. "Whether radiotherapy or surgery is of any benefit after early chemotherapy is still very much an open question" for prostate cancer. Mike Scott and Allen Edel of the New Prostate Cancer Infolink suggest that it's something that a patient who is diagnosed at the outset with metatastes should discuss with their radiation oncologist. Click on this link to read the article.
  12. Jim Marshall (not a doctor) said ... If you have advanced prostate cancer then chemotherapy with a drug like Taxotere (docetaxel) may be part of your treatment. As your body deals with chemo, there is a risk of serious infection. Back in 2013 we published concise advice from a USA government site about avoiding or dealing with chemotherapy infections. Click on this sentence to read that advice on our site, which also has links to the Prevent Cancer Infections site. ... end Jim
  13. Jim was away in Sydney with a swag of other members representing our group at a meeting with Janssen, the suppliers of the drug Zytiga. As a result of this, Jim asked me to chair our phone in conference in his absence. We had no guest speaker at our gathering which made life a little easier for me as our talks would be based on a round table discussion among members. I had the feeling it might be a bit dull without a guest and members be reluctant to come forward and speak on issues. With this in mind I prepared some topics prior to the meeting just in case. I needn't have worried as right from the beginning we were off and running and I threw my cheat sheet into the bin. The meeting never ran out of steam and everyone contributed some great stuff for contemplation so much so that I decided to contribute this summary. I did not record any of our discussions so what I present here is from hurried notes and memory. It is subject to my interpretation and in some areas may be incomplete or inaccurate for which I apologise in advance. I received 8 apologies (most of which were from the members attending the Janssen meeting). There were 6 participants who took part in our meeting and I hope they were happy with the results of our gathering. The session began with a briefing by me as per my understanding of the meeting with Janssen being attended by the cream of our membership and with what little I knew of the nuts and bolts of that meeting I was only able to offer a broad assumption. Jim, I understand will be responding to members with a full report at some time in the future. Two men gave a report on exercise programs they were attending. One man is participating in a study at St Lucia University that includes dietary analysis and different exercise regimes. He intends to post a report on the program when he is able. However he stated that he might need assistance in getting the report ready for posting and has asked if any of the members would be able to assist. I can pass on contact details to any member willing to help out. The second man is on an exercise program at Deakin University Burwood Campus Melbourne that is oriented specifically to prostate cancer patients. In further talks on exercise programs and the relationship with the application of chemotherapy, the subject of a recent “Catalyst” program was raised. As can be seen in the Catalyst program there is a gym adjacent to the chemotherapy section where patients are encouraged to exercise straight after infusion of their chemo. This is believed to help increase blood flow to assist in the uptake of the chemotherapy drugs more effectively and improve the body's own immune system. Here is the link on Iview. this link It was also raised that jimjimjimjim had a guest speaker a couple of years ago during a phone in called Dr Prue Cormie. The minutes of that meeting can be found by clicking on this link. Also an interesting video talk by Dr Prue Cormie can be found by clicking on this link. [Edit - The Catalyst program featured Professor Rob Newton from Edith Cowan University in Perth. Dr Prue Cormie was previously at Edith Cowan but is now at the Australian Catholic University, Melbourne.] One man gave a report on his treatment involving a small trial using Lutetium 177 which is still ongoing. His initial thought was that about 10% patients have reported excellent results while he feels he has had moderate results with little side effects, mainly a sore throat and dry mouth as the radionuclide targets PSMA cells but also effects saliva glands. An interesting issue caught my ear in this discussion, regarding access to results while on a trial. If my memory serves me correctly, it appears that patients taking part in a blind trial are not given access to any pathology test results while on the trial. This is something I have not considered before, but I can see the point in keeping this information secret during a trial of this sort. However it is something to consider for those looking for trials to volunteer for. Perhaps other members may be able to confirm or deny my limited knowledge on this matter, as for Lutetium 177 more can be read by clicking on this link. A man gave a report on his experience with treatment using docetaxel and recommencement of ADT. His experiences were not good and included peripheral neuropathy particularly in legs ankles and feet, constipation, headaches, nausea and fatigue. This has taken 11 weeks to finally start to resolve since completing chemo. It has brought his PSA back down to an acceptable level though. A man also reported he was diagnosed with radiation cystitis some time ago and experienced bleeding and urine blockages, similar to my experience in 2014. He also was treated with hyperbaric oxygen treatment in a decompression chamber but in his case the treatment was successful. I congratulated him and passed the comment that thanks to his report I can consider a 50-50 success rate in this treatment. A bit unfair from me I know but it was written in jest and I include it here to present as a successful case in the use of this treatment for radiation cystitis. A man reported a rising PSA after intermittent ADT over the past 10 years since initial primary treatment. Recently he has been back on Lucrin but his PSA is doubling monthly. He was not looking forward to being advised to begin chemotherapy before being considered for enzalutimide or zytiga. After much discussion it was suggested that he should approach his GP, urologist or oncologist regarding this matter and perhaps a second or third opinion before any choice is made. The meeting concluded approx 1120 hrs. Lee Gallagher (Popeye)
  14. Peripheral neuropathy is a common side effect of chemotherapy treatment for prostate cancer. Patients who suffer from this condition have damage to their peripheral nerves and experience weakness, numbness and pain usually in their hands or feet and occasionally in other areas of the body. Researchers at the Moffatt Cancer Center at Tampa, Florida have found that genetic alterations in the VAC14 gene are associated with an increased risk of docetaxel-induced peripheral neuropathy in prostate cancer patients. This discovery may help scientists to understand what causes docetaxel-induced neuropathy and to develop drugs that can reduce peripheral neuropathy.
  15. Some men may experience a PSA flare when starting docetaxel chemotherapy. The occurrence of PSA flare had no effect on treatment duration or outcome. Joel Nowak at Malecare reports on recent research. Click on this link to read his report. PSA flare is where there is a sharp initial increase in PSA following the commencement of treatment.
  16. Cabazitaxel is a chemotherapy treatment which is used when patients become resistant to chemotherapy treatment with Docetaxel. Cabazitaxel improves overall survival in patients with metastatic castration-resistant prostate cancer (mCRPC) previously treated with Docetaxel. Androgen receptor splice variant 7 (AR-V7) in circulating tumuor cells (CTCs) from mCRPC patients was recently demonstrated to be associated with resistance to Abiraterone and Enzalutamide. A group of Dutch and Belgian researchers investigated whether this was also true for Cabazitaxel. They found that Cabazitaxel was effective even if AR-V7 was present. Reference "Efficacy of Cabazitaxel in Castration-resistant prostate cancer is independent of the presence of AR-V7 in Circulating Tumor Cells" Wendy Ostenk et al Article Information DOI: 10.1016/j.eururo.2015.07.007
  17. Click on this link for a recent article by US oncologist, Mark Scholz, about chemotherapy.
  18. "One almost universal side effect from chemotherapy is the difficulty many of us face in getting enough nutrition. Nutrition comes from eating food yet many of us just don’t feel hungry so eating is difficult. We lose our appetite, food tastes terrible and we battle nausea." Click on this link to read some suggestions from the Malecare Blog about how to maintain adequate nutrition when on chemotherapy.
  19. Chemotherapy can cause peripheral neuropathy (damage to your peripheral nerves). Peripheral neuropathy often causes weakness, numbness and pain, usually in your hands and feet. A study of female cancer survivors found that almost half experience chemotherapy-induced peripheral neuropathy symptoms years after completing their cancer treatment. These symptoms were associated with impacts including reduced mobility and significantly increased risk of falls. The results were presented at the American Society of Clinical Oncology (ASCO) Cancer Survivorship Symposium held in San Francisco. The lead researcher said that it is likely that the findings may be applicable to male cancer survivors as well. Click on this link to read the article.
  20. With increasing options to treat advanced prostate cancer, there is no clear agreement on the order in which these treatments should be given. I attach a chart prepared (following the STAMPEDE clinical trial which recommended early ADT and chemotherapy for certain patients) by an American oncologist setting out his view of what is currently best clinical practice in America. In Australia our options are more restricted: Abiraterone and Enzalutamide are only available on the Pharmaceutical Benefits Scheme after chemotherapy and Provenge is not available on the Pharmaceutical Benefits Scheme. Oldtimer's Disease - I can't remember which publication I found this table in. A prize for anyone who can tell me where it came from.
  21. I got asked by someone about handling the side effects from chemo. Here are some suggestions. Click on this link for some suggestions from the Cancer Council. Click on this link for a research study which looked at the evidence for what works and what doesn’t. Do any members have other suggestions of what worked for them?
  22. Novel combination therapy shows promise in mouse models of advanced prostate cancer Published in News Medicine on April 30, 2015 at 7:00 AM · Chemotherapy can be very effective against small prostate tumors. Larger prostate tumors, however, accumulate cells that suppress the body's immune response, allowing the cancer to grow despite treatment. Researchers at the University of California, San Diego School of Medicine now find that blocking or removing these immune-suppressing cells allows a special type of chemotherapy — and the immune cells it activates — to destroy prostate tumors. This novel combination therapy, termed chemoimmunotherapy, achieved near complete remission in mouse models of advanced prostate cancer. The study was published April 29 in Nature. Advanced or metastatic prostate cancer does not typically respond to chemotherapy. Prostate cancers also fail to respond to a promising new type of immunotherapy drugs, called checkpoint inhibitors, which disable cancer cells' cloaking mechanism so that a person's own immune system can better fight the tumor. This specific resistance is likely due in part to immunosuppressive B cells, which are more common in larger prostate tumors in mice, as well as in advanced and metastatic prostate cancer in humans. As the name suggests, these cells keep the immune system at bay, rendering most therapies ineffective and allowing malignant tumors to grow unchecked. In this study, researchers worked with three different mouse models of advanced prostate cancer. All three models were resistant to low doses of the chemotherapy drug oxaliplatin, which has the unique ability to activate cancer-killing immune cells. But when the researchers blocked the development or function of immunosuppressive B cells or removed them entirely before treating the mice with low-dose oxaliplatin, the prostate tumors were almost completely destroyed by the mice's own immune cells. The team got similar results when low-dose oxaliplatin was combined with a checkpoint inhibitor. "The presence of such B cells in human prostate cancer calls for clinical testing of this novel therapeutic approach," said Shabnam Shalapour, PhD, postdoctoral researcher and first author of the study. Prostate cancer is the second leading cause of cancer-related death in American men. About one in seven men will be diagnosed with prostate cancer during their lifetimes. "In addition to prostate cancer, similar immunosuppressive B cells can be detected in other human cancers," said senior author Michael Karin, PhD, Distinguished Professor of Pharmacology and Pathology at UC San Diego. "This indicates that B cell-mediated immunosuppression might be the reason several other cancers are also unresponsive to checkpoint inhibitors, raising the hope that chemoimmunotherapy will have broader applications for many cancer types." Source: University of California, San Diego
  23. Dr Charles Myers Jnr (nickname Snuffy Myers) is one of the best known medical oncologists specialising solely on prostate cancer in the USA. He produces a free video on prostate cancer treatment each week, and a paid monthly newsletter service. He also writes books. In a recent video (18 September 2014) Dr Myers talked about Taxotere (brand name Docetaxel) and the CHAARTED trial. Whilst the video deals mainly with early Taxotere use in newly diagnosed patients, there are also some interesting comments about Taxotere use in advanced patients. See this Dr Myers Video at: http://askdrmyers.wordpress.com/2014/09/18/early-taxotere-use/?mc_cid=c83f004150&mc_eid=79f1dd2837 OR http://tinyurl.com/qgs7sc5
  24. Paul Edwards (not a doctor) says: This looks interesting. Perhaps Chuck Maack may know more about this? Has anyone discussed it with their oncologist? Since 2008 Dr. Valter Longo, a professor of gerontology and biological science at the University of Southern California has been investigating whether fasting reduces some of the side effects of chemotherapy. “Fasting makes things worse for the cancer, when assisted by chemotherapy. It’s the combination of the two treatments which produces the effect. Most people can last for up to 40 days with just water. Normal cells know how to cope with starvation. Cancer cells don’t. They evolved away from starvation.” ABC Science Show 21 April 2012 A transcript of the Science Show’s interview with Dr Longo is available at http://www.abc.net.au/radionational/programs/scienceshow/chemotherapy-and-fasting-to-treat-cancer/3963102#transcript or http://tinyurl.com/jvlxl86 A more technical explanation of why fasting renders cancer cells more sensitive to chemotherapy can be found in a bulletin from the US National Cancer Institute Bulletin of 10 July 2012. This bulletin can be viewed at http://www.cancer.gov/ncicancerbulletin/071012/page5 or http://tinyurl.com/lo28pbf At the 2013 American Society of Clinical Oncology (ASCO) Annual General Meeting Dr Longo and colleagues presented the results of a Phase 1 trial which concluded that “Fasting for up to 72 hours around chemotherapy was safe and feasible for cancer pts and resulted in significant decline in insulin and IGF1 levels.” The abstract is available at http://meetinglibrary.asco.org/content/114231-132 or http://tinyurl.com/lo28pbf Recently Dr Longo and his colleagues have published the results of further research in the 5 July 2014 issue of the journal Cell Stem Cell which showed that cycles of prolonged fasting not only protected against immune system damage — a major side effect of chemotherapy — but also induced immune system regeneration, shifting stem cells from a dormant state to a state of self-renewal. Co-author Tanya Dorff, assistant professor of clinical medicine at the USC Norris Comprehensive Cancer Center and Hospital said: “The results of this study suggest that fasting may mitigate some of the harmful effects of chemotherapy. More clinical studies are needed, and any such dietary intervention should be undertaken only under the guidance of a physician.” More information about this most recent research is available at https://news.usc.edu/63669/fasting-triggers-stem-cell-regeneration-of-damaged-old-immune-system/ or http://tinyurl.com/klqrvxl The Mayo Clinic is currently conducting a clinical trial “Short-Term Fasting Before Chemotherapy in Treating Patients With Cancer”: see http://clinicaltrials.gov/show/NCT01175837
  25. The U.S. Food and Drug Administration (FDA) has just released a safety warning about the intravenous chemotherapy drug, docetaxel. Docetaxel contains alcohol, which may cause patients to experience intoxication or feel drunk during and after treatment. The FDA suggested that patients should: Avoid driving, operating machinery or doing other activities that are dangerous or require skill one to two hours after you receive treatment with docetaxel. Tell your doctor about all the medicines you are currently taking, as the alcohol in docetaxel may affect other medicines you are using. Notify your doctor immediately if you experience any of the following symptoms while receiving an intravenous infusion of docetaxel and for one to two hours after treatment: symptoms of being drunk, confusion, stumbling, or becoming very sleepy. The FDA suggested to doctors that symptoms of alcohol intoxication may be minimised by: Using a docetaxel formulation with a lower alcohol content ; or Slowing the infusion rate during administration. Source: http://www.fda.gov/Drugs/DrugSafety/ucm401752.htm?
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