As you no doubt know, HRPC means Hormone Refractory Prostate Cancer; in layman's language, it means that the cancer is no longer controlable by hormonal therapy. There is a small community of like-thinking doctors specializing in treating prostate cancer in North America, especially advanced disease and challenging cases, that I am convinced has become much more expert and knowledgeable than most doctors treating the disease advanced disease. In particular, they have more or less reached a consensus in applying hormonal blockade. I am in my tenth year as a survivor, doing very well, following their advice on the particular approach known as intermittent triple hormonal blockade (with a bisphosphonate drug in support, a statin drug to help my odds of success, and a lifestyle program involving diet/nutrition/supplements (keyed around a Mediterranean diet), exercise and stress reduction). At diagnosis my PSA was 113.6, Gleason 4+3=7, all biopsy cores positive, most 100% cancer; however, a bone scan, a CT scan, and a ProstaScint scan were all essentially negative. I have twice achieved a PSA of less than (<) 0.01 using an ultrasensitive PSA test before switching to the "off therapy" phase. I'm giving this background so you will have an idea of my viewing point. I am a now savvy patient, but I have had no enrolled medical education. Was there treatment in addition to the orchiectomy? That operation eliminates testosterone that is produced from the testes, but it does not control other sources of testosterone, its docking with cancer cells, or prevent its conversion to more dangerous DHT (dihydrotestosterone). The experts I follow would not consider a patient to be in the refractory HRPC state until he no longer responded to a combination of hormonal blockade, not just an orchiectomy or its medical equivalent. Your father may be able to find a doctor who understands this approach and could put it to work now, and see how your father responds. These experts would insist on also using a drug in the "antiandrogen" class to block most of the docking with cancer cells as well as to create other beneficial effects. In the US, the preferred drug is Casodex; it is expensive, but it is more effective, more convenient, and better in its side effect profile. The most common alternative in the same antiandrogen class is flutamide. Other options that may be available are Nilandron (nilutamide) and Androcur (cyproterone acetate - not available in the US, I believe because of greater risk of cardiovascular complications). They would also insist on adding a third class of drug, known as "5-alpha reductase inhibitors" (5-ARI). In the US, most of the experts favor Avodart, though finasteride, formerly known as Proscar, is also available (and is the drug I have been on). A few men do not respond well to Avodart because of a genetic problem, but they will respond to finasteride. (Incidentally, the first generic version of Proscar - finasteride - that I took was manufactured by the company run by the Indian doctor known as Dr. Reddy.) These 5-ARI drugs are highly effective in preventing conversion of any remaining testosterone to DHT, and they also cut down the supply of blood needed for tumor growth. This program combined hormonal blockade program is compatible with chemotherapy. He was treated from Jul 2008 to Jan 2009 for HRPC by weekly Chemotherapy , and simultaneously received injections every month for bone thickening . Most likely he was getting infusions of a bisphosphonate drug. Aredia (Pamidronate) is the infusion drug that was commonly used until a much more powerful drug, Zometa, was approved by the US FDA (Food and Drug Administration) in 2001. Now that would be the strongly preferred drug for a case like your father's. It is quite expensive, but in the US it is usually well covered by insurance. It does have some potential side effects, especially when used frequently and long-term, but countermeasures can help to a degree. He should be taking calcium and vitamin D3 daily in support of the bisphosphonate therapy. His PSA dropped to 7.72. He was on Hormanal therapy since then till Jun 09. His PSA started risign 100 % every month from Jan itselt, and has reached 132 now. What a great response to chemotherapy! Since he had an orchiectomy, that is a permanent form of hormonal therapy. Were other drugs added since sometime last year? This is where using the full batch of drugs might make a critical difference. If not, the experts I follow switch to a more powerful antiandrogen, specifically ketoconazole with hydrocortisone in support. If that does not work, they will often try estrogen delivered through patches that are placed on the skin (known as "transdermal estrogen"). They may also use other agents, such as leukine. In support of this, the doctor I follow most closely, Dr. Charles "Snuffy" Myers, MD, strongly advocates a lifestyle program. Two excellent books describe hormonal therapy, other options I've mentioned, and the lifestyle program. They are: "A Primer on Prostate Cancer - The Empowered Patient's Guide," Dr. Stephen B. Strum, MD, and Donna Pogliano, and "Beating Prostate Cancer: Hormonal Therapy & Diet," by Dr. Myers. There's a new drug that is highly likely to be approved by the FDA in the next six months in the US for men in your father's condition. It is known as Provenge. It is given by epheresis. It is also very expensive, but hopefully for US patients, insurance should help. I have not heard anything concrete about its international availability, but I do know that Dendreon, the company that developed the drug, is working on that. At present he has an urge to pass urine every after 1/2 an hour, but he cannot empty the bladder full. Every time during urination, a little stool also comes out. It someone can help me to know, if there is any way to stop the PSA rising, and if frequent urination problem can be treated? The 5-ARI drugs were originally approved by the FDA for treating benign enlargement of the prostate. It's quite possible that they might help with the urination problem, and it's also possible that the enhanced hormonal blockade therapy might reduce the cancer in a way that would help with urination. I hope that your father finds something that works. Take care and good luck to you and your father, Jim  |
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