Here is the 2019 guide from the Prostate Cancer Foundation.
Section One deals with General Information and Medical Basics. Section Two provides valuable information for those who are newly diagnosed. Section Three describes treatment options for localized or locally advanced prostate cancer. Section Four discusses aspects of living with and after prostate cancer. This guide is a valuable resource for any man with any interest in prostate cancer. Please circulate it.
Earlier this year, a series of informative videos dealing with several prostate cancer topics were produced by the Prostate Cancer Research Institute (PCRI). These included:\
1. The Best Prostate Cancer Diet by Dr. Mark Moyad;
2. HDR Brachytherapy (temporary seeds) for Intermediate Risk by Dr. Mark Scholz:
3. How Immune Therapy Works to Treat Prosate Cancer by Dr. Eugene Kwon;
4. Intensity-Modulated Radiation Therapy (IMRT) by Dr. Mark Scholz: and,
5. Impact of Lifestyle and Exercise on Prostate Cancer by Dr. Mark Moyad.
For more information, one can subscribe to the PCRI YouTube Channel for weekly videos. See the following link.
Study Suggests Enzalutamide (Xtandi) Better and Cheaper Than Abiraterone (Zytiga) for Metastatic, Hormone-Resistant Prostate Cancer.bjgabrielsen : May 29, 2019 12:49 am : 2019, Treatment Information
A recent study presented on May 3-6 at the American Urological Association’s 2019 Meeting found that treating metastatic, hormone-resistant prostate cancer (mCRPC) patients (who had not received chemotherapy) with Xtandi (enzalutamide) leads to better survival outcomes and lower healthcare costs than Zytiga (abiraterone acetate).
While therapies that lower male sex hormones (testosterone) — required for prostate cancer to survive and grow — are a mainstay of therapy for advanced prostate cancer, most patients will eventually acquire resistance to such approaches. This often happens because the cellular receptor for these hormones, called the androgen receptor, becomes constantly active, even in the absence of androgens. Therapies that inhibit the androgen receptor — such as Pfizer and Astellas’ and Xtandi and Janssen’s Zytiga — have largely improved the overall survival of prostate cancer patients, and are now approved for mCRPC patients in the U.S. and Europe. However, which treatment brings the most benefits or the lowest healthcare costs has not been addressed.
In this study, researchers performed a retrospective study to compare the overall survival and healthcare costs associated with these two second-generation androgen receptor inhibitors. They examined data from 3,174 adult men with mCRPC who had not received chemotherapy for at least one year before starting treatment with either Xtandi or Zytiga. Patients had been treated between April 2014 and March 2017, and their data were recovered from the Veterans Health Administration (VHA) database. Overall, 1,945 patients, mean age 73, received Zytiga, while Xtandi was administered to the remaining 1,229 patients, mean age 74.
After examining outcomes of these patients, researchers found that those on Xtandi lived for a median of 30 months, compared to 26 months for Zytiga. This represented a significant 17% reduction in mortality risk with Xtandi. Xtandi-treated patients also required fewer outpatient visits — both overall and cancer-related — than those treated with Zytiga, indicating that Xtandi led to a reduced use of medical resources. In line with this, Xtandi patients had fewer healthcare costs than Zytiga patients. In total, a patient treated with Xtandi would have a monthly healthcare cost of $8,085, compared to $9,092 for Zytiga. Prostate cancer-related costs were also lower for Xtandi — $6,321 versus $7,280.
Thus, researchers concluded that “chemotherapy-naive mCRPC patients treated with Xtandi had better survival, significantly lower resource use and healthcare costs than patients treated with Zytiga.”
The above appeared in the e mail Prostate Cancer News Today, May 16th, 2019.
I have not made such a request before on this website, however a situation has arisen with a good friend. Jim (not his real name) is a 60 years old man with advanced prostate cancer. He has received a number of customary treatment options none of which have curtailed the cancer. He is currently seeking to enroll in a clinical trial of a treatment regimen described earlier on this website. Please pray that if this treatment could be of help to Jim, that he would be accepted into the trial. Please pray for wisdom for his excellent physicians, and that God would extend Jim’s life, provide good quality of life and that God would be glorified in Jim’s treatment and disease. Jim shares his Christian faith openly with other men. Pray also for his family and the support they provide so well.
I was raised by wonderful Christian parents who took me to church regularly. I learned about God, Jesus, and well-known Biblical characters such as Noah, Moses, David, Jonah etc. This served as a good moral foundation but at one point, I realized that I knew about God and Jesus intellectually but did not know Him personally. That all changed when I realized that no matter how much of a “nice person” I could be, my good actions would never be enough to match God’s standard of perfect justice and holiness. It was then that I put my entire faith and trust in the fact that God’s Son, Jesus, had lived a perfect life and then given His life as a sufficient payment to God for all my sins and those of the entire world. At that point in time, I asked Jesus to come into my life, and thereby a personal relationship with God began. My life has never been the same since that day. As an “added bonus”, I was given the extraordinary gift of eternal life according to the famous verse John 3:16. “For God so loved the world, that He gave His only begotten Son (Jesus), that whoever believes in Him, should not perish but have eternal life.”
As the years have passed, I have come to realize that when I yield various aspects of my life to the loving and perfect will of a personal God and His glory, His best plans for me are a result though they might not always be the plans I had intended. For example, God has blessed my career, given me a wonderful wife, and even a fulfilling retirement. His presence has also been manifested in my health, even though I was diagnosed with early stage prostate cancer in 1995 and now am classified as having advanced prostate cancer though asymptomatic. The major lesson I have learned is that if I yield control of any area of my life to a personal and loving Heavenly Father, His best outcomes in accordance to His will are a result. They may not always be what I would personally choose, and many times life can be difficult, but God’s overwhelming peace and direction transcends every situation. In the words of the Old Testament prophet Jeremiah 29:11-12, “‘ For I know the plans that I have for you’, declares the Lord, ‘plans for welfare and not for calamity to give you a future and a hope. Then you will call upon Me and come and pray to Me, and I will listen to you.”‘
As a cancer patient, areas of my life to which I must daily present and yield control to God are my body, my mind and my overall health. To do that, I have found it very useful to pray the words written by the apostle Paul in the Bible in Romans 12:1-2 and insert my own name in the appropriate text as follows. “I urge you therefore, ——– (insert ones name), by the mercies of God, that you (I) present your (my) body as a living sacrifice, holy and acceptable, which is my reasonable service of worship. And do not be conformed to this world, but be transformed by the renewing of your (my) mind, that you (I) may prove (demonstrate) what the will of God is, that which is good and acceptable and perfect.” While this is not a guarantee of total earthly healing of my disease, who best to control my body than the One who created it in all its masterful complexity. While my cancer has not been healed, I can see God’s protective hand in my disease all these years through His power and often manifested by the excellent medical support which I have received. The ultimate healing will come when I will spend eternity in a new heaven and a new earth with a new body. Meanwhile, as Paul admonishes, I “press on.”
So if you have a personal relationship with God and are dealing with medical issues, I would sincerely suggest that you pray Romans 12:1-2 daily, yielding the direction and outcomes to the Lord. If you are not sure of your relationship with God, see the following link.
I am grateful for all of you who subscribe to receive my blogs by email the day after they are posted. However, it has come to my attention that on occasion the Godandprostate blogs end up in spam instead of my inbox. It has happened to me on a few occasions. Therefore, please check your spam folders occasionally to see if this has occurred. Thank you for your continued support.
Radioactive Lutetium-177 Compound Shows Promise As Therapy For Metastatic, Hormone-Resistant Prostate Cancer.bjgabrielsen : May 10, 2019 4:16 pm : 2019, Treatment Information
Treatment with the radioactive molecule lutetium-177-PSMA-617 (LuPSMA), which binds to the prostate-specific membrane antigen, is a potential therapeutic strategy for patients with metastatic castration (hormone)-resistant prostate cancer (CRPC), results from a Phase II pilot study suggest.
Prostate-specific membrane antigen (PSMA) is found at high levels in prostate cancers, particularly in patients with hormone-resistant disease — a form of cancer that no longer responds to hormone therapy and continues to progress. More research is assessing the potential of using agents that target this protein to deliver radioactive compounds directly into cancer cells. The LuPSMA molecule is composed of an anti-PSMA antibody bound to the radioactive compound Lutetium-177. Its safety and efficacy are being assessed in a pilot Phase 1/2 study by researchers at the Peter MacCallum Cancer Centre, Melbourne, Australia.
The trial enrolled 50 metastatic CRPC patients whose tumors were positive for the PSMA factor. Their cancer had progressed after standard treatments, including hormone therapy and chemotherapy, and they were offered four doses of LuPSMA, each given six weeks apart. Participants had rapidly progressing disease, taking 2.6 months to double their PSA levels — a marker of prostate cancer. Most patients had received the chemotherapies docetaxel (Taxotere; 84%) and cabazitaxel (Jevtana; 48%). Hormone therapy with Zytiga (abiraterone), Xtandi (enzalutamide) or a combination of both had been given to 90% of patients.
The study’s primary goals were to measure the number of patients whose PSA levels dropped and the treatment’s toxicity. Additional objectives included imaging responses, time patients lived without disease worsening, overall survival, and quality of life scores.
Investigators reported a reduction in PSA levels by at least 50% in 64% of patients, including 44% who experienced a reduction of at least 80%. Among the 27 patients with measurable disease at the study’s start, 56% experienced a partial or complete tumor reduction. The median time patients lived without disease worsening — measured through a rise in PSA levels — was 6.9 months. Their median overall survival was 13.3 months. A total of 14 patients received additional LuPSMA doses after their disease progressed. In nine of these patients (64%), PSA levels reduced by at least 50%. The most common side effects were dry mouth, nausea, and fatigue. Serious side effects were rare and included abnormally low levels of platelets and anemia, both detected in 10% of cases.
Overall, these early findings confirm the “high response rates and low toxicity with LuPSMA in men who had progressed after standard therapies,” even “in patients who subsequently progressed and were administered further LuPSMA,” the researchers wrote. “These results have provided the basis for randomised controlled trials currently underway,”
These findings were shared in a poster presented at the 2019 Genitourinary Cancers Symposium, Feb. 14–16 in San Francisco.
Darolutamide Delays the Spread of Prostate Cancer in Men with Non-Metastatic, Hormone-Resistant Disease.bjgabrielsen : April 25, 2019 8:38 pm : 2019, Treatment Information
Results from a Phase 3 clinical trial reveal that adding the androgen receptor inhibitor darolutamide to androgen deprivation (hormone) therapy (ADT) extends by 22 months the time men with hormone-resistant prostate cancer live without metastasis and without increasing the incidence of adverse events. The treatment also extended survival, time to pain progression, time until chemotherapy was needed, and kept patients alive and progression-free for longer periods than ADT alone, researchers reported.
The investigational drug darolutamide can help delay the spread of prostate cancer to other parts of the body in men with non-metastatic, hormone-resistant disease, according to results from the ARAMIS clinical trial. In addition, trial results showed that the drug appears to lack some of the side effects seen with similar drugs used to treat men with this form of prostate cancer.
Until recently, there had been no effective treatment options for patients with non-metastatic, hormone-resistant prostate cancer. These men have prostate tumors that continue to grow even after receiving androgen deprivation (hormone) therapy (ADT) to keep androgen (testosterone) levels in the body extremely low or undetectable. But over the last 2 years, two drugs have been approved by the Food and Drug Administration (FDA) to treat this form of the disease and some researchers expect that, based on the results of this new trial, darolutamide may be next.
The darolutamide findings, from an interim analysis of the ARAMIS clinical trial, were published in the New England Journal of Medicine and presented at the American Society of Clinical Oncology Genitourinary Cancers Symposium in San Francisco on February 14.
The drug has a very favorable safety profile. The incidence of side effects was generally similar between the darolutamide group and the placebo group, noted study coauthor Karim Fizazi, M.D., Ph.D., of the Gustave Roussy Institute, University of Paris, who presented the results in San Francisco. Darolutamide was not associated with a higher incidence of side effects such as seizures, falls, fractures, cognitive changes, or hypertension. The ARAMIS climical trial results “strongly support the use of darolutamide” in patients with non-metastatic, hormone-resistant prostate cancer, said William Dahut, M.D., head of the Prostate Cancer Clinical Research Section of the National Cancer Institute’s (NCI) Center for Cancer Research.
Darolutamide, jointly developed by Bayer and Orion, belongs to a class of oral drugs called androgen (testosterone) receptor inhibitors. It prevents the binding of testosterone to the androgen receptor on a cell, thus blocking signals that prostate cancer cells require to grow and proliferate. In the body, these agents compete with androgens for binding to the androgen receptor, which reduces the ability of androgens to promote the growth of prostate cancer cells.
In 2018, the Food and Drug Administration (FDA) approved both apalutamide (Erleada) and enzalutamide (Xtandi) for men with non-metastatic, hormone-resistant prostate cancer. In the clinical trials that led to these approvals, the drugs were shown to improve the median time from random assignment until the tumor spread or the patient died—known as metastasis-free survival—in men with this form of prostate cancer. Treatment with both drugs, however, was associated with side effects related to the central nervous system, including fatigue, falls, and cognitive changes. In both trials, treatment with the respective drugs more than doubled metastasis-free survival compared with men who received a placebo: 40 versus 16 months in the apalutamide trial and 36.6 versus 14.7 months in the enzaluatmide trial.
The ARAMIS trial, which was sponsored by Bayer and Orion Corporation—the co-developers of darolutamide—included men whose prostate-specific antigen (PSA) levels were rising at a rate that has been associated with an increased risk of metastasis and death in previous studies. Metastasis-free survival was the primary endpoint of the trial; secondary endpoints included overall survival and the amount of time until a patient’s pain worsened.
The randomized trial included more than 1,509 men with non-metastatic, hormone-resistant prostate cancer whose PSA levels were rapidly rising while receiving hormone therapy. These men were considered to be at increased risk of having the disease spread to other parts of the body. All participants received ADT plus either darolutamide or a placebo. At a median follow-up of 17.9 months, the median metastasis-free survival was 40.4 months for patients receiving darolutamide plus ADT, compared with 18.4 months for patients receiving placebo plus ADT. The risk of metastasis or death from any cause was reduced by 59%. While more than half of patients were alive at the time of the analysis, the interim analysis pointed toward a 29% reduction in the risk of death for patients taking darolutamide. Also, the treatment extended the time patients lived without disease progression — 36.8 months versus 14.8 months — representing a 62% reduction in the risk of disease worsening or death. The 3-year overall survival rates were 83% in the darolutamide group and 73% in the placebo group, the researchers found. The median overall survival has not yet been reached in the study. The median amount of time until a patient’s pain got worse was longer in the darolutamide group than in the placebo group (40.3 months versus 25.4 months). It lowered the risk of needing a chemotherapeutic medication by 57%. The time to first skeletal event — such as radiation therapy to the bone, bone fractures, spinal cord compression, or bone surgery — was also longer with darolutamide.
Darolutamide has a different chemical structure than apalutamide and enzalutamide whose structures as similar, which the study authors believe may explain why it has fewer side effects. Darolutamide basically does not penetrate the blood-brain barrier, whereas apalutamide and enzalutamide do. The low incidence of central nervous system-related side effects seen in the trial was consistent with its rodent studies. Side effects likely to be related to the drug reaching the central nervous system include fatigue, dizziness, cognitive impairment, and seizures, according to the researchers. There was no detectable difference in the incidence of these side effects between patients treated with darolutamide and those who received a placebo, he added, noting that patients with a history of seizures were not excluded from the trial. In the trial, fatigue was the only side effect that occurred in more than 10% of participants in either group. A low incidence of side effects is particularly important for men who do not have symptoms of the disease, researchers noted. The percentage of participants who stopped taking either the drug or the placebo because of side effects was similar, i.e. about 9%.
In the coming years, researchers and patients hope to learn more about patient preferences for darolutamide, enzalutamide, and apalutamide. For example, an ongoing clinical trial is comparing two of these androgen receptor inhibitors, darolutamide and enzalutamide in men with metastatic hormone-resistant prostate cancer to determine which drug patients prefer based on their responses to a questionnaire. Patients will first take one drug and then the other. In the meantime, darolutamide has already received Fast Track designation by the U.S. Food and Drug Administration for the treatment of non-metastatic, hormone-resistant prostate cancer patients.
The information above appeared in the National Cancer Institute (NCI) e mail periodical, NCI@updates.cancer.gov, dated March 15th, 2019.
I recently received an e mail from the Cancer Treatment Centers of America (CTCA) entitled Health, Hope and Inspiration. These periodic e mails contain 30 minute interviews with Rev. Percy McCray, spiritual coordinator for CTCA. The latest interview entitled “Can God Use Cancer?” grabbed my attention. Rev. McCray’s immediate answer to the question was a resounding “yes”. During the interview, he cited a resource from CTCA entitled Cancer Ministry Scriptures, a compilation of Biblical references focused on leadership and inspiration, comfort, hope, God’s compassion, healing and strength, peace, and encouragement. This resource is similar to the section of this Godandprostate website entitled “Spiritual Medicines” to which I refer often. I was inspired to compile the latter after being told first-hand of God’s healing of a woman I knew from a brain tumor. Her son had compiled a short list of scripture verses which his mother cited and prayed daily in addition to taking her prescribed medicines. Her healing was confirmed by her surgeon at Johns Hopkins in Maryland.
During the interview with Rev. McCray, he focused on Philippians 1:12 wherein the apostle Paul cites a list of negative circumstances such as imprisonments, beatings, shipwrecks etc. but which all eventually had positive outcomes, namely that God used these events to further the propagation of His divine plan. Paul writes “now I want you to know brethren, that my circumstances have turned out for the greater progress of the gospel.” The things that happened to the apostle Paul and to ourselves can serve as a furtherance of God’s plan for us both personally and impersonally to those with whom we come into contact. Thus, God can use a cancer diagnosis for positive results. When one receives the initial diagnosis of cancer, there is often an emotional shock. But soon, we can realize that God did not give us the cancer but He has empowered us to accomplish something positive with this diagnosis. Cancer can open doors to share what God has done in our lives and the abundant life we have in Him through faith in Jesus. In John 10:10, Jesus proclaims that He comes to give us an abundant life. But a translation of the word “abundant” means an ability to rise above our circumstances. Had we never received a cancer diagnosis, we may have never considered it a ministry. God can show us elements of ourselves or ministry to others thru cancer. We are led to seriously consider the main bedrock purposes of our life. God can show us our strengths and especially our weaknesses thus enabling us to see that He Himself is the source of all our needs. We can see ourselves as little children who, when hurt, run to a loving parent for comfort. But now we see that God is that loving Father when we run to Him in faith and need. God’s promises in Scripture become alive as never before.
So what are the changes in my life and attitudes toward myself and others around me that have occurred as a result of a cancer diagnosis? Do we now focus more on actions that may have eternal results or consequences? These are questions we should prayerfully consider. For me personally, this website would never had been written had God cured me of prostate cancer during my initial surgery in 1995. But His care continues to permeate my life as it can any of us who have a personal relationship with God through Jesus Christ as described in the following link. In conclusion, may we be able to say with certainty that “we know that God causes all things to work together for good to those who love God, to those who are called according to His purpose.” (Romans 8:28).
In Psalm 55:16-17, King David says “As for me, I shall call upon God, and the Lord will save me. Evening, morning and at noon, I will complain and murmur, and He will hear my voice.” God’s ears are open to our cries and His shoulders are wide enough to carry our burdens. He is sovereign over the universe, so He is certainly capable of working out our problems and meeting our needs. I recently read an exercise that helped make casting my cares on Him a practical act.
First, take a piece of paper and write down the things that cause your anxiety. For me, as a 77- year old prostate cancer patient, my first item was that my cancer continue to be controlled, and that I not die of this disease. Upon further thought, there were other items that were cheating me out of peace but I will focus on the cancer here.
Next, pray each issue into God’s care. For me, praying the words of Romans 12:1, and inserting my own name as follows, is a daily act. “I urge you therefore” ____(your name), “by the mercies of God, to present your (my) body, a living and holy sacrifice, acceptable to God, which is my spiritual” (some versions say rational) “service of worship.”
Finally, as you pray, visualize placing the situation into God’s omnipotent hands. Imagine handing our bodies over to the Lord, while saying, “Father, I give you my disease or condition. You are more than sufficient to handle it, and I trust You to guide me.”
Some people may resist this suggestion because certain pseudo-spiritual movements have a method they call visualizing. But above, the term refers to the beautiful word pictures throughout the Bible, which God intended to help us understand our relationship to Him. This type of visualizing creates a mental snapshot of God doing just what He says He’ll do in Psalm 55:22, “cast your burden upon the Lord and He will sustain you. He will never allow the righteous to be shaken.” He also says “do not be anxious for your life as to what you shall eat, or what you shall drink, nor for your body.” (Matthew 6:25).
When you have transferred all your worries to God’s hands, wad up the paper and then destroy it. In doing so, you symbolize the transaction that just took place. Your cares are no longer yours – every one of them belongs to the Lord. Then walk away in perfect peace.
If you are not sure whether you have such a personal relationship with God, see the following.
Much of the post above, was published in the January 5th, 2019 In Touch devotional, written by Dr. Charles Stanley.
This post is a bit out of the ordinary but I first want to thank all of you who read this website. As many of you know, anyone can subscribe to automatically receive the blogs by e mail as they are posted by entering an e mail address on the right side of the home page. The posts cover a wide variety of prostate issues including general patient information, screening, diagnostics, genetics, imaging, and treatment at various stages. Also included are posts dealing with encouragememt from a Christian perspective which I have found useful during my own disease journey. I want to ask you faithful readers to send this blog to any men in your community who could possibly benefit from reading this site and tell them they can subscribe. Word-of-mouth is the best way to disseminate the information to as many men as possible. They can sign up and read only those posts that apply to their individual interests. Thank you in advance for doing this.
Meanwhile, I want to share the funniest story I know dealing with urological issues. A 90-year old man goes to his urologist for a checkup. Physically, he passes with flying colors. During the exam, his urologist asks, “how are you mentally?” “Oh”, the man exclaims, “I am as sharp as a tack for my age. I remember names, dates, and hardly ever misplace anything.” “Amazing”, proclaims the urologist, “and how are you spiritually?” “I am glad you asked”, the man confidently responds. “God and I are like that”, he said crossing his fingers. “We are tight. In fact, I’ll give you an example. At night, when I get up to go to the bathroom, a surreal glow guides my path. Upon finishing and returning to bed, the surreal glow dissipates”. The urologist listens intently, shakes his head in amazement and at the end of the visit, he tells the man how extremely fortunate he is for his age. Several weeks go by and the urologist accidently runs into the man’s wife at a local supermarket. He greets her and says, “congratulations on your husband. Physically he is fine, he is mentally sharp and spiritually, he related to me a most unusual phenomenon. He says that when he gets up at night to use the bathroom a surreal glow guides him and when finished to return to bed, the surreal glow dissipates.” Upon hearing this, his wife’s face droops, eyes widen, mouth opens, as she exclaims, “oh my goodness, he’s peeing in the refrigerator again.”
According to Dr. William Oh, Deputy Director of the Tisch Cancer Institute, Chief of the Division of Hematology and Medical Oncology, and Professor of Medicine at the Icahn School of Medicine at Mount Sinai in New York, there are six myths about chemotherapy.
Some prostate cancer patients shy away from or choose not to utilize chemotherapy. Their hesitation may result from an outdated understanding of chemotherapy’s side effects and its effectiveness against prostate cancer. In this blog, Dr. Oh explores the myths driven by common misperceptions about chemotherapy and replaces them with some facts.
MYTH #1: Chemotherapy is a last resort.
“Some patients believe that we use chemotherapy when we are out of options. Far from a last resort, there are currently promising studies utilizing chemotherapy earlier in the treatment of prostate cancer. For instance, in men with newly diagnosed metastatic disease, chemotherapy significantly improves survival.”
MYTH #2: Chemotherapy is a single and outdated option.
“Chemotherapy is not a single drug. In fact there are many “chemotherapies”, both oral and intravenous, and new chemotherapies are being developed and approved regularly.
In prostate cancer, there have been continuous improvements over the past few years. In the past, an older drug called mitoxantrone was approved by the FDA to relieve cancer symptoms only. Then something important happened in 2004: docetaxel (taxotere) chemotherapy was shown to be the first drug to improve overall survival for men with metastatic prostate cancer that became resistant to hormone treatments. This was a critical milestone, as no drugs to that point could lengthen survival. In 2010, the FDA approved another chemotherapy drug for prostate cancer called cabazitaxel.
Far from being outdated, these advancements allow me as an oncologist to have a larger toolbox to treat cancers which adapt to different types of treatments. For instance, resistance often develops to drugs like abiraterone or enzalutamide, which target the androgen receptor. Chemotherapy may more effectively kill those resistant cancer cells.
Finally, ongoing research will determine how best to combine chemotherapy with other drugs and radiation as well as use biomarkers to personalize treatment. We thought chemo might go away with newer treatments, but we use it as often as we did before as men are living longer and better lives with advanced prostate cancer.”
MYTH #3: Chemotherapy has no role in an era of immunotherapy and precision medicine.
“Some people believe chemotherapy is a ‘shotgun’ approach. Patients want more targeted therapy specific to their cancer. The fact is we do have specific chemotherapy to kill prostate cancer cells called taxanes. Taxanes stop cancer cells from dividing and also may interfere with androgen receptor signaling in prostate cells as well.
In fact, when a patient stops responding to drugs such as abiraterone or enzalutamide, a blood test for a biomarker called ARV-7 predicts greater benefit from chemotherapy than to continue the androgen pathway drug. This test is now approved in the U.S.” (See a recent blog on this website describing AR-V7 testing.)
MYTH #4: I’ll be nauseated and vomiting throughout my chemotherapy.
“Chemotherapy induced nausea and vomiting (CINV) can be very scary and intimidating and many patients have known or heard about someone who has had it. Two things are really important to understand about CINV.
First, there are many types of chemotherapy and their ability to cause CINV varies widely. In fact the drugs used in prostate cancer are unlikely to cause this. The American Society of Clinical Oncology (ASCO) Guidelines consider cabazitaxel, for instance, as a ‘low risk’ drug for causing CINV.
Second, modern antiemetics have revolutionized the treatment of CINV. Antiemetics are drugs used to prevent nausea and vomiting and there are a host of agents available to use. Typically I will incorporate one of these on the day of therapy and prescribe something for home, but most patients do not need it.”
MYTH #5: I won’t be able to function day-to-day while on chemo.
“Some men believe their quality of life will drastically suffer while on chemotherapy. Fortunately, these newer drugs have much fewer side effects. The most common side effect in day-to-day life is fatigue. This is usually mild to moderate and I find that most patients are able to continue many of their regular activities. For instance, they may continue to work, spend time with family, and exercise.”
MYTH #6: I’ll permanently lose all my hair after chemo.
“It is true that many prostate cancer patients experience temporary hair loss while undergoing chemotherapy. Some patients won’t lose their hair at all. Others will experience thinning hair.
In nearly all patients, the hair loss is reversible once chemotherapy is complete. If you experience hair loss, your hair should grow back several months following your chemotherapy treatment.”
FACT: Chemotherapy is a key treatment in the fight against advanced prostate cancer.
“Battling prostate cancer may be the hardest fight you’ve encountered. Certainly, the side effects of some of the treatments you’ve received have been difficult. There is no question that chemotherapy comes with its own set of challenges.
However, it is critical to understand how important chemotherapies used to combat prostate cancer can be in extending and even improving your life. Many studies have shown that drugs such as docetaxel, cabazitaxel, and others can play a key role in treating metastatic prostate cancer, cancer that has spread beyond the prostate.
Please ask your oncology team about any specific concerns you may have before starting any treatment regimen. Knowledge is the most effective tool in the battle against prostate cancer.”
See the following link from Zero-the Fight to End Prostate Cancer, published Jan. 10, 2019.
Blood tests that examine circulating tumor cells, CTC’s, (cells that shed from the tumor or metastasis into circulation), for the presence of a mutated AR-V7 protein, could help determine if a patient with advanced prostate cancer would fare better with chemotherapy or with medicines such as enzalutamide (Xtandi) or abiraterone (Zytiga) that target the androgen receptor (a cellular protein that binds male hormones). But as happens with many medications, tumors often develop a resistance to such therapies that target the androgen receptor. Resistance develops because the medicines target a domain of the receptor that is missing in the AR-V7 version.
When a patient is first diagnosed with metastatic hormone-resistant prostate cancer, the preferred treatment involves androgen receptor inhibitors like Xtandi or Zytiga. But if a patient fails a first-line treatment with these inhibitors, there is no guarantee he’ll respond to a second inhibitor. In such cases, researchers need biomarkers that help them select which patients should receive a second androgen receptor inhibitor, and which should switch to chemotherapy.
One international team of researchers tested whether AR-V7, measured by a blood test in circulating tumor cells could predict the best treatment approach for each patient. The test they used, called Oncotype DX AR-V7 CTC nuclear protein test, was developed by Epic Sciences and Genomic Health. (A similar test has been developed at Johns Hopkins University and is called CTC AR-V7 RNA test.)
In one study of 142 patients at three institutions, all had been treated with one of the androgen receptor inhibitors (Xtandi or Zytiga) without success. Seventy patients were then moved to another round of treatment with an androgen receptor inhibitor, while 72 patients were treated with taxane-based chemotherapy — Taxotere (docetaxel) or Jevtana (cabazitaxel). Patients were followed for up to 4.3 years.
As expected, researchers found that patients who were negative for AR-V7 survived significantly longer with an androgen receptor inhibitor (19.8 months) than with chemotherapy (12.8 months). Conversely, chemotherapy was a better approach for patients who were positive for AR-V7, nearly doubling survival times compared to the androgen receptor inhibitor — 14.3 vs. 7.3 months. Overall, these results suggest that assessing AR-V7 levels in circulating tumor cells through a blood test may help identify the best second-line therapy for patients with metastatic hormone-resistant prostate cancer. These results were published in an issue of JAMA Oncology.
Meanwhile, in a second study, investigators at the Duke Cancer Institute designed a multi-center study — called PROPHECY (NCT02269982) – to evaluate how well both blood tests above predict the effectiveness of these hormone therapies.
A total of 118 men were enrolled at five medical centers to provide external validation for the two tests. For both tests, AR-V7 detection correlated with worse progression-free survival (PFS) — the length of time during or after treatment without disease progression — and overall survival (OS). While the Johns Hopkins test appeared to be more sensitive and flagged more non-responding patients, the Epic test seemed to be more specific, leading to no false-positive data.
“We have therapies to treat recurrent, metastatic prostate cancer, but they don’t work on everyone, and cross-resistance is a major emerging problem in our field. It’s important to know who will be more likely to respond and who has little chance of benefiting in order to rapidly provide alternative, more effective therapies or to develop new therapies for these men,” said Andrew Armstrong, MD, associate director for clinical research in the Duke Prostate and Urologic Cancer Center. “Having this predictive power could spare many men from undergoing therapies that would simply not benefit them, saving time, money and a great deal of emotional distress,” Armstrong said. “The results of this study are clinically useful in guiding care, particularly in men with high-risk disease and those who have already tried enzalutamide or abiraterone.”
Both of the studies were summarized in articles published online in Prostate Cancer News Today, August 8th and June 18th, 2018 respectively.
I received an e mail describing a host of cancer-fighting recipies for every meal. They include breakfast, dinners, side dishes, snacks and beverages. This comes from a site called health, hope and inspiration. For the recipies, see the following link.
Today was my PSA blood test, a ritual I must undergo every four months or so in order to check if the drug I am currently taking is still effective in controlling my cancer. I was always somewhat apprehensive when test day occurred even earlier in my 23-year history of prostate cancer. But now, as my therapeutic trail contains fewer options, this day takes on its own measure of stress. However, I received an unexpected message of assurance from Dr. David Jeremiah in his February 11th devotional message entitled “Stress and Thanks”. His message was based on three short Biblical verses in 1 Thessalonians 5:16-18 where it states “rejoice always, pray without ceasing, and in everything give thanks.”
“It’s not a law of physics, but it is a law of common sense: No two objects can occupy the same space at the same time. That makes perfect sense to us and we have no reason to try to prove that idea wrong. We move one thing if we want to set another thing in its place. Strangely, we are not as convinced of this law when it comes to spiritual things. For example, we are willing to worry about a problem and proclaim our faith in God at the same time. We don’t have a spiritual law that invalidates our effort, but our experience says it’s contradictory to worry and to praise God simultaneously. In 1 Thessalonians 5:16-18, the apostle Paul says there are three things we can do simultaneously since they support one another—rejoice, pray, and give thanks. The prayerful practice of joy and thanksgiving leaves no room for stress or worry. At the first sign of stress, pray and give thanks to God for the joy that comes from trusting Him in all things. Not for all things, but in all things.”
So the next time I encounter a critical stage or testing, do I choose faith in a God and His promises (medicines), or will faith be supplanted with doubt? They cannot share the same space. As the Apostle Paul writes in 2 Timothy 1:12, “for I know whom I have believed and am persuaded that He is able to keep that which I have committed.”
As always, if you are unsure of your own relationship with God, see the following link.
The National Cancer Institute (NCI) of the National Institutes of Health (NIH) publishes an e mail blog entitited Current Contents to which one can subscribe. On January 23rd, their blog focused on non-opiod methods of managing cancer pain (see below). Pain is a common and much-feared symptom among people being treated for cancer and long-term survivors. Cancer pain can be caused by the disease itself, its treatments, or a combination of the two. It may be short-lived or chronic, and for some people it can persist long after treatment ends.
The most common cancer types, such as breast, lung, prostate, and colon cancer, rarely cause pain at the site where they originate. One of the most common types of cancer pain is bone pain. Cancer-induced bone pain occurs when metastatic tumors of cancers that start in other parts of the body grow in the bone marrow, the sponge-like tissue in the center of most bones. In fact, bone pain may be the first symptom of several forms of cancer, including prostate and lung cancer.
Researchers have found that “tumors in bone stimulate the sprouting of pain-transmitting nerve fibers near the tumor. Once tumor cells are established in the bone marrow, they hijack the molecules that regulate cells involved in breaking down bone, called osteoclasts. As a result, the osteoclasts get bigger and then they avidly digest bone. To digest bone, osteoclasts create an acidic environment that is almost like pouring battery acid on bone. The causes of bone cancer pain are twofold. First, sensory neurons, or nerve fibers, in bone “detect the acidic environment and signal it as pain. Second, excess osteoclast activity results in microfractures or full fractures of bone that can cause extreme pain.”
Denosumab (Prolia) and bisphosphonates like alendronate (Fosamax), are both first-line therapies for cancer-induced bone pain caused by metastatic cancer. Both denosumab and bisphosphonates, which were originally developed to treat osteoporosis, help maintain bone integrity by reining in osteoclast activity. A potential new treatment for bone pain due to metastatic cancer is an antibody called tanezumab, which blocks the activity of a pain-signaling molecule called nerve growth factor (NGF). Researchers found that in mice, tanezumab blocks nerve-sprouting in bone and reduces the development of late-stage cancer pain. Tanezumab is now being tested in phase 3 clinical trials for cancer-induced bone pain. A related approach seeks to block the actions of NGF by blocking its receptor, known as TrkA (tropomyosin receptor kinase A), on sensory nerve fibers. There is also keen interest in using cannabinoids, chemicals found in marijuana, to treat cancer-induced and other types of bone pain but this research is still in the stage of animal testing.
The NCI article below also describes chemotherapy-induced peripheral neuropathy (CIPN), often an undesirable side effect of chemotherapy. This is often the reason that patients must reduce their chemotherapy dose or stop treatment prematurely. Other sections in the NCI blog include non-drug approaches to relieving pain and other challenges to pain management.
The entire NCI blog can be found at the following link.
The Prostate Cancer Research Institute (PCRI) has produced several short videos covering many aspects of the disease including, imunotherapy, brachytherapy, intensity-modulated radiation therapy (IMRT), sexual disfunction, testosterone levels, and more. The speakers include Dr. Mark Moyad, Dr. Eugene Kwon from the Mayo Clinic and others. It is my understanding that such videos will become available on an on-going basis. One can obtain these videos by subscribing to Google below.
“If you want to feel small, just imagine moving at 34 thousand miles per hour for forty years and getting—astronomically speaking—nowhere. Late last year, the Voyager 2 space probe became the second craft to ever leave our solar system. Now 11 billion miles from earth, it is one of the farthest-flung man-made objects in existence. And it was launched in 1977.
Because there are different ways of defining the solar system, we should be precise. The American Geophysical Union in Washington reports that Voyager 2’s sensors recently detected a sudden dip in radiation and magnetism, which marks the boundary of what astronomers call the “heliosphere,” our sun’s protective bubble of particles and magnetism. In other words, the probe is now beyond our star’s most significant influences and is hurtling into interstellar space—literally “the space between the stars”—at 34 thousand miles per hour. Its departure from the heliosphere is big news because, unlike its twin, Voyager 1, Voyager 2 is still transmitting data back to us here on earth, providing “first-of-its-kind” observations of the nature of this unexplored space. Voyager 2 was originally designed to observe the gas giants Jupiter, Saturn, Uranus, and Neptune—a mission it completed back in 1989. But scientists now think the aging probe might hold together as late as 2027, depending on how long its plutonium fuel source provides power.
The accomplishment of both Voyager probes is unparalleled. Still, astronomically speaking, they’ve only just stepped outside our front door, and barely entered the larger stellar neighborhood. It will take Voyager 2 another 40 thousand years to approach the nearest star to our sun—which together occupy only a fraction of the Orion Arm of the Milky Way galaxy. The Milky Way, in turn, is just one of at least 100 billion galaxies in the visible universe.” Makes one feel small doesn’t it.
“In the distant reaches of space, there are stars so much bigger than our sun they defy description. The longtime record-holder for largest known star is VY Canis Majoris, a red hypergiant over two thousand times the size of our sun. To give you an idea of the scale we’re talking about, if VY Canis Majoris replaced our sun, it would engulf most of the inner planets of the solar system, including Earth.
Voyager 2’s journey is a constant reminder to us of the enormity of the universe. I don’t know about you, but the distances and objects visible in the night sky make me dizzy; they confront me with the realization of how little I seem to matter by comparison… which is exactly the reaction God wanted us to have. Our own wonder ought to echo the Psalmist, who sung: “When I look at your heavens, the work of your fingers, the moon and the stars, which you have set in place, what is man that you are mindful of him, and the son of man that you care for him?”
God—the Creator of VY Canis Majoris—answered that question, but not ultimately in words. Instead, He came to dwell with His people, first through the Ark in the Tabernacle in the Old Testament, and ultimately in the Incarnation of Jesus Christ, whose name means “Immanuel, God with us.” Though it boggles the mind, the maker of the Milky Way chose this little planet to reveal Himself most fully and personally. By doing this, He bridged a gulf that makes the space between our stars seem small—the separation between an infinitely holy God and sinners like us who are doomed to death.
Against this backdrop of our cosmic insignificance, we can better appreciate God’s love—which He demonstrated by ‘coming to our neighborhood.’ Thank God, since we can’t even build a probe able to leave our interstellar neighborhood.”
As stated above, this enormous Creator God can be known in an intimate personal way through Jesus Christ, appropriately named Immanuel, meaning God with us. He is interested in every aspect of our lives including our medical situations. To substantiate this, God gave us hundreds of specific promises in writing, His Word. For example, Deuteronomy 31:8 states “And the Lord is the one who goes ahead of you; He will be with you. He will not fail you or forsake you. Do not fear or be dismayed.” For many others, see this website section entitled Scriptural Medicines. To enter into such a personal relationship with God, see the following.
The Voyager 2 essay was published online from “Breakpoint Daily from the Colson Center“, January 8th, 2019 to which I enthusiastically suggest a subscription.