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A chemical treatment scenario for my prostate cancer


JimJimJimJim

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JimJimJimJim

A chemical treatment scenario for my prostate cancer

A work in progress.

Scans, other non-PSA blood tests, and clinical signs noted by my doctor may alter this outlined progression. The availability of different drugs under trial may also alter the course. Non-chemical treatments like spot radiation, surgery, cyrotherapy are not mentioned.

Note: I am not a doctor.

These are my notes for my interest.

Consult your doctor for what will suit you best.

Major prostate cancer treatment steps - Very short

Major prostate cancer treatment steps

  1. Active Surveillance
  2. Primary treatment
  3. Hormone therapy
  4. Secondary hormone therapy
  5. Chemotherapy drugs
  6. Post-chemotherapy drugs
  7. Palliative only treatment­­

These are the 1 – 7 headings I use below

  • In steps 1 to 6 the treatment usually has the intent to extending your life.
  • All of us with prostate cancer hope that whichever of the steps we are currently on, this is where we will stay.
  • You move up the list based upon evidence of progression based upon one or more of:
    • Blood tests like PSA
    • Scan results such as X-ray
    • Doctor's interpretation of how the prostate feels to his finger and the symptoms you display or report like pain.

Major prostate cancer treatment steps - More detail

1. Active Surveillance

  • Regrettably I missed this step.

2. Primary treatment

  • radiation + hormone therapy

3. Hormone therapy

  • Hormone therapy – continuous since diagnosis
    • LHRH agonist
    • anti-androgen
    • 5-alpha reductase inhibitor

    [*]Nibbling – things that may have a small effect on some prostate cancers

    [*]Monitoring

    [*]Continue until PSA rises while Testosterone at castrate level

4. Secondary hormone therapy

  • Continue LHRH agonist
  • Continue 5-alpha reductase inhibitor
  • Stop anti-androgen
  • When PSA rises
    • Anti-androgen cycle
      • Substitute different anti-androgen
      • When PSA rises, repeat with new anti-androgen

    [*]Continue until PSA rises while Testosterone at castrate level

5. Chemotherapy drugs

  • Taxotere (Docetaxel) is the only life extending chemotherapy drug available in Australia, except under trials.

6. Post Chemotherapy drugs

  • No post-chemotherapy drugs are available in Australia, though Zytiga (abiraterone acetate) and Jevtana (Cabazitaxel) are currently being considered.

7. Palliative-only treatment

  • Treatment no longer intent to prolong life – just to make it more comfortable.

Major prostate cancer treatment steps – Even greater detail

1. Active Surveillance

  • Regrettably I missed this step. Though I had annual PSA and DRE tests, my cancer grew large and outside the prostate with quite low PSA, as sometimes happens with quite aggressive cancers.

2. Primary treatment

  • radiation + hormone therapy
    • I had 23 x 2Gy doses of external beam radiation and a boost 3 x 6.5Gy doses of high dose rate brachytherapy
    • Hormone therapy as below

3. Hormone therapy

  • Hormone therapy – continuous since diagnosis
    • LHRH agonist
      • Also called LHRHa, GnRH agonist, GnRH–A
      • I had Zoladex (Goserelin)
      • Others are Lupron (leuprolide), Eligard (leuprolide), Suprefact (buserelin), Suprecor (buserelin), Synarel (nafarelin), histrelin (Supprelin), Suprelorin (deslorelin), Ovuplant (deslorelin), Triptorelin

      [*]anti-androgen

      • I had Cosudex (bicalutamide)
        • Note continuing Cosudex after the first few weeks is not standard treatment, and so not covered by PBS in Australia for reduced pricing (except if you are metastatic). An extra benefit has been shown, but this benefit must be balanced against extra health risks and price.
        • Others are Anandron (Nilutamide), Nilandron( Nilutamide), Eulexin (Flutamide), all nonsteroidal, and Androcur (Cyproterone, a steroid), Nizoral (Ketoconazole)

      [*]5-alpha reductase inhibitor

      • I had Avodart (dutasteride) which inhibits types I & II
      • Adding this third hormone treatment has not directly been studied in this area, so many doctors will be reluctant to add this to your treatment. Some doctors do believe that other studies of its use hint that it should be useful. For example, men who took this during breaks from other hormone treatment had significantly more time off treatment (15 months extra off, on average). Price is also a factor.
      • Others are Proscar (Finasteride), Propecia (Finasteride) which inhibit only type II

    [*]Nibbling – things that may have a small effect on some prostate cancers

    • See our forum - Every little bit helps - on our main page.

    [*]Monitoring

    [*]Continue until PSA rises while Testosterone at castrate level

4. Secondary hormone therapy

  • Continue LHRH agonist
  • Continue 5-alpha reductase inhibitor
  • Stop anti-androgen
  • When PSA rises
    • Anti-androgen cycle
      • Substitute different anti-androgen
      • When PSA rises, repeat with new anti-androgen

    [*]Continue until PSA rises while Testosterone at castrate level

5. Chemotherapy drugs

  • Taxotere (Docetaxel) is the only life extending chemotherapy drug available in Australia, except under trials, at time of writing (12 September 2011).

6. Post Chemotherapy drugs

  • No post-chemotherapy drugs are available in Australia,though Zytiga (abiraterone acetate) and Jevtana (Cabazitaxel) are currently being considered.

7. Palliative-only treatment

  • Treatment no longer intent to prolong life – just to make it more comfortable.

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