December 3, 2016 - Decision time

Well, Les has now seen his Scripps oncologist and an oncologist at Moores Cancer Center and the prognosis is the same.  Both are prescribing Androgen Deprivation Therapy (Lupron or equivalent) to lower testosterone levels as close to zero as possible, combined with chemotherapy (Dosetaxel) every three weeks for 6 sessions.  Lupron will first be administered in a one month dose and then three month doses, depending on how his body responds from reducing testosterone levels.

The oncologist at Moores was most interested by the fact that his PSA was so low, given the progression of the cancer into his bones.  The oncologist is going to look at the pathology of Les’s original biopsy 20 years ago to see if there is any anomaly that could explain this.  IMHO questioning this tells us that the medical profession puts too much credence in the absolute value of the PSA and not enough in the rate of change.

We discussed with the doctors what might happen if Les doesn’t do anything.  The Moores oncologist said Les would have maybe one or two years of gradually increasing pain in his bones and eventually he would succumb to it.  The Scripps doctor was less definitive on the timing, but described a similar quality of life.  Since the ADT and chemo on average has given patients at least 4.5-5 years, not doing anything is not an option.  Both doctors have said that because Les is in pretty good physical shape, his chances of a good outcome are high.

Les asked about the advantages of going to a big name, big facility.  The main answer is that there is some likelihood that a clinical trial could be taking place at one of these facilities.  This could or could not have an impact on Les’s treatment.  On the negative side, the treatment experience itself would likely be less personal.  This was his experience at Memorial Sloan Kettering 20 years ago.  In this light, Les is going to continue researching clinical trials but is likely to start treatment locally, now that it is pretty clear that the standard of treatment seems to fit his case.

Les has been doing is usual research into both the medical therapies and the alternative therapies.  Studies have shown improved results using some of the alternative therapies, although little has shown that alternative therapies alone will stop Stage IV prostate cancer.  Combinations of standard and alternative therapies make sense, but neither doctor has experience with combinations of chemo and alternative therapies.  This appears to be the case with most all treatment centers, but Les will continue to search for combination therapies.  My PSA has decreased from 2.89 to 2.11 in the last month, which I believe is due to a combination of the Saw Palmetto, Stinging Nettle Root, and Modified Citrus Pectin.  Diet may also be a factor, but from my reading, diet may explain the increase in testosterone from 180 to 254 during the period that we have changed diets.  This is because high sugar, refined foods, etc. tend to reduce testosterone levels.  PSA reduction is most important since PSA is generated by the cancer, so we aren’t going to change our diet unless Les starts losing too much weight.  It is very important to maintain a healthy diet during this.  Les has lost 4 pounds so far.

One thing is really important to understand.  No two types of cancer are the same, so the treatments and the drugs can be very different with equally different results.  For example, immunotherapy (the use of the body’s own defenses to fight the cancer) has worked in some types of cancers but apparently is iffy at best with prostate cancer.  Also, body’s reactions to chemo prescribed for one type of cancer can be totally different from a different chemo treatment for a different cancer.  Docetaxel, which is used for prostate cancer, generally doesn’t cause pain or even nausea.  It does cause (hopefully temporary) loss of hair and fatigue.  The side effects of the ADT are much worse, including muscle loss, depression, heightened moods, night sweats, loss of sexual function, etc.  Les is not looking forward to these side effects.

Les is scheduled to get his ADT shot on Wednesday of next week, assuming he decides to stay with Scripps.  There are logistical advantages to Scripps such as being 15-30 minutes closer and a much less frenetic environment.  Since the treatment at both centers is the same, it comes down to personal preference.  Kathe was impressed by the bedside manner of Moores (coffee, friendliness, etc.).  Les likes the responsiveness to out-of-appointment questions, and seeming willingless to learn about alternative therapies on the part of the doctor at Scripps.  We’ll see, but Les is eager to get going on the treatment out of fear that the minor lower back pain he is feeling is caused by the cancer and will get worse.