Happy Christmas everyone

Happy Christmas and a very Happy New Year

Let's try and make 2018 another year where we reach out and help people everywhere

The State of Cancer

I received this e-mail from Healthline (USA) who have been tremendously supportive of my blog over the past 3 years.

I am happy to share their recently published report on 'the state of cancer' and I'm sure you'll find it very beneficial reading, whether for yourself, a friend or family member.....

Dear Daniel,

As a major source of inspiration, information, and support for cancer patients and those who love them, Prostate Cancer - Our Journey is changing the way individuals relate to their cancer. 

Healthline understands this because we recently published a report on the State of Cancer, an in-depth research report and thorough survey complete with clear statistics and infographics. Prostate Cancer - Our Journey helps by:

• Providing answers and support: 74% of newly diagnosed individuals went online to find answers within one week of diagnosis. Many of those people searching for answers and support found you.

• Breaking through the “doctor speak”: several patients interviewed noted that they felt more anxious about their condition after talking to their doctors, and turned to the internet to find understanding.

• Building long-term community: 59% of millennials & 51% of Gen Xers stay engaged in groups after remission.

When individuals get diagnosed, they turn to you for information. The more information you can provide, the stronger a resource you can be for those who look to you. With this end in mind, would you consider sharing our State of Cancer report with your readers?

Healthline wants to thank you for participating in the sharing of information and empathy. We hope we can continue to work together to make the world a stronger, healthier place. 

In health,

Shelby Drabot

Outreach Coordinator
HEALTHLINE

My wonderful Christmases in the 60s

Christmas back then didn't start in September, as it does now; it started just a few weeks before, which made it oh so much more special. Can you imagine, Christmas when only one person in the street owned a car, everybody was employed, and nobody had a telephone? Writing letters was the way to keep in touch, and if you had to call, there was the big red phone-box at the end of the street; and I was still trying to work out buttons A and B because now I could reach them.

The TV was becoming affordable, but even so, very few had one where we lived. It would soon arrive though, firstly in black and white, with blissfully just two channels, and we'd all pack into Daphne's house when she shouted, "Lone Ranger's on!" Her husband, Dobin, worked in the Army stores, so they were almost middle class! She also predicted that TV was an evil that would destroy future generations of children, but it also brought me Robin Hood and William Tell, so I wasn't listening.

My Grandmother would send a chicken (dead), all the way from Ireland! Yes, it smelt pretty bad when it arrived, the postman would always hold his handkerchief over his nose and mouth, but it tasted delicious once cooked. You had to use the vegetables from your own garden, everybody did, and being Irish we were good at growing potatoes, which we swapped with the neighbors who were good at sprouts, making everyone happy. My parents were very poor, but I have to say they always made Christmas feel like a magical time. Along with my teachers, they planted and cultivated an imagination that lived and grew with me to this day. In fact, only Disney films could compare with what went on in my mind back then and often still does!

Christmas Cards were essential and not getting a card was like being 'unfriended' on Facebook. You sent and received cards from everyone you knew and cared about, and they often had their latest address on so you could be sure to know where to send their card. If you were lucky, there would be a 10/- note or even a £1, but as soon as my Grandmother's card arrived, it would always contain a British £5 note; which wasn't that easy for an old lady living on a small farm in the Republic of Ireland.  

Putting things into perspective, my father was earning £15 a week; my pocket money was one shilling (there were 20 in a pound), and a new car cost around £950. We never did afford one, but it didn't seem to matter, our legs, a bicycle or the bus would take us everywhere.

There was always loads of snow from around December to February and no better site than looking out the window on a cold winter evening, with the coal fire at your back, and seeing giant snowflakes starting to fall gently in front of the yellow street lights. The following morning we would go out to a carpet of new crunchy white snow, often up to my waist, then we'd build massive snowmen and have snowball fights until our hands went blue. Some of the ice slides we made must have been the length of the street, and we'd play for hours, regardless of falls, cuts and bruises.

It usually ended with some miserable old person pouring boiling water and throwing sand over our ‘work of art', and as that older person now, I can, at last, understand why!

Just as well I had all those outdoor activities because when it came to Christmas presents, there were very few. I had a clockwork fireman, I'd wind him up, and he'd climb to the top of the ladder and slide down again. How could that keep me occupied for hours? It did! Jigsaw puzzles were all the rage, and the more complex, the better; I even had one with just a cloudy sky! The only Christmas decorations were paper chains that you'd lick the ends and make yourself. I wish I'd thought of the wet sponge sooner as I found out the glue was made from old dead horses. I could never understand that, because when you touch a horse, it's not that sticky, is it?

Meccano was to change my life forever; I could now build machines, but my attempt to make my very own electric motor was a bridge too far resulting in my first electric shock; such a scary feeling. I engaged my younger brother in switching on future experiments; he was a willing victim.

As the 60s wore on we became a bit better off and Christmas saw my Mum switching from Emva Cream sherry to Harvey's Bristol Cream and my Dad choosing Castella cigars over his pipe. Soon, Blue Nun and Mateus Rose started washing down Vesta Chow Mein and spaghetti bolognaise as immigration, thankfully, began to change our diet in a way we couldn't have imagined.     

The postman delivered on Christmas Eve, right up to 4 pm and though he had the next day off, he was there bright and early on Boxing Day. But, even the milkman delivered on Christmas Day morning, and after a sherry at every house, I often wonder what his evenings were like!

My favourite Christmas hits of the 60's?

1962 Elvis Presley – Return to Sender

1963 The Beatles – I Want to Hold Your Hand

1966 Tom Jones – The Green Grass of Home

1967 The Beatles – Hello Goodbye

1968 Scaffold – Lily the Pink

Did Father Christmas exist? That was the terrible question I had to deliberate one day and though I had no doubts, it did lead me onto the shameful path of trying to prove to other less faithful followers, that he was as real as them. I thought very logically about how this obese man could fit down our chimney, even though the coal fire was in full blaze, and carrying all those presents. Surely at the very least, he'd get utterly filthy? There had to be another explanation, and that could only be ‘magic.'

So having accepted that it was possible for this guy to park a sled and team of reindeer on our council house roof, and drop in with all those goodies, I'd have to catch him in the act. I'd tried all the usual stuff, leaving out the mince pies and the sherry, and sure enough, they had all gone in the morning, which proved what?  My parents filled the sherry glass, as usual, that night and along with the mince pies, left them by the fireplace. My mother was very ill that Christmas and my mind did not link that to the sherry I'd half emptied and topped up with bleach. Father Christmas was indeed a superman; even poison couldn't slow him down, he had proved himself beyond doubt.

That someone ate them? I wanted conclusive proof but was told that if Father Christmas heard me, he might vanish so quickly, perhaps even forgetting to leave presents. After years of failed attempts, in 1966, I came up with the perfect plan – I would make him sick enough to slow him down and that way I'd at least see him as he struggled onto the roof.

I was told that if I stopped believing in Father Christmas, he would stop coming, and that was a risk I wasn't prepared to take. Aged 12, I was still shouting down the doubters, like a preacher trying to uphold the word of God; nobody was going to convince me otherwise.

2017 – My year without alcohol!

That was the target I set myself back in December 2016. Why? Because I'd been drinking regularly since the age of 15, probably earlier, and at 65 I wanted to tweak a few things in my life, to see if things could be done differently. I guess the driving force was sort of a ‘bucket list’ item: I wanted to see what it felt like to be a non-drinker again, just one more time.

So, why not give up for a week, even a month, wouldn't that do it? Well, I tried that last year when I gave up for 90 days, and here's what happened. After 30 days you realise that you're starting to come out of a mental haze, a numbing cloud that's always there with you, but you’re never aware of when you're a regular drinker.

I had no idea how thick that cloud was, after all, I'd never tried walking out of it before!

After 60 days, the cloud was getting noticeably thinner, but I was still moving through it and felt that I hadn't yet reached the edge. This was even the case at 90 days, and because I'd reached my target, I had a bottle of wine that night to celebrate, and a few beers. If only I'd continued, would I have found the edge of that cloud? Would I have one day been able to look back at that fog, see it from a distance and say, "hell, I was trapped in there once." I concluded that 3 months was probably not enough time to know what it felt like to be a non-drinker. The answer lay further into the future, and I was determined to find it, but the time had to be right and I had to be ready.

My top tip: Don't try and stop drinking with willpower alone; it simply doesn't work.  

You'll be forever walking past bars full of ‘happy' people and couples sharing bottles of wine, and you'll be wishing you were sat right in there with them. That's not the way! You need to do what I did first and change the way you see alcohol and the role it plays in the lives of all who allow it to run their agenda. See how we are brainwashed almost from birth into thinking that this substance is our friend, used at every celebration, a reward for a hard days work and such a cool thing to do.

No better book taught me this than one written by Annie Grace, 'This Naked Mind.'

You need to turn that switch in your mind before embarking on this adventure; you have to change what you have always believed about this ‘nectar' and start to question the benefits that you get for the money you spend.

When you reach the 90-day mark, yes, it's a significant achievement and probably the hardest point to reach. Friends will try and steer you the other way, and there will be many, many times when you question your judgment. You'll be continuously reminded of what fun it is to drink, on films, advertising, almost everywhere you look. This is also the time when many people fail, but if you can crack the 90 days, there are huge rewards ahead.

It's somewhere after the six months point that you suddenly realise that you've ‘broken the habit.' You don't want a drink of alcohol anymore; you've replaced that habit with other types of drinks and activities. Maybe we’re all creatures of habit, rabbits that stick to the same runs, day in, day out, so if we do choose a habit, better to try and pick some good ones. There were physical and mental changes for me, some very unexpected. I lost over 10kg, which meant I had to buy more shirts and trousers, but hey, I was feeling healthier than I had for years. I'd started to dream again, that surprised me! I'm told it's because you sleep far deeper when there's no alcohol involved, even though it may take you slightly longer to get to sleep, and you sure do wake up feeling a hell of a lot better than after a skin-full the night before.

You can ignore the restraints that alcohol used to put on your life, such as what time you go shopping because it has to coincide with licensing hours, and when you can and can't take the car because now you can drive at any time. The money I save, although not the driving force was a massive bonus and I can now treat myself to things I used to view as extravagant. I drink more coffee than I used to and certainly eat a bit more chocolate, even the occasional cake, but on balance, I'm happy with my diet.

Did I ever like the taste of alcohol? I remember the first time a tasted whiskey, it was probably the worst thing I'd ever tasted and couldn't spit it out fast enough. Years later though, after absorbing enough adverts and cowboy films, I wanted to be that ‘wild west hero' who shot all the bad guys, pulled all the chicks and then hit the local saloon for a large Jack Daniels. I was hooked! I grew up with Guinness in Ireland, as much part of the culture as the Catholic Church and the second word I learned to spell.

The Guinness brewery in Dublin draws its water from the bogs that feed the River Liffey. As is tradition, my Grandfather and I stood at the edge one day and sent our joint waters into those marshes, knowing that we would both unite and become part of the Guinness forever; such is the tragic magic that weaves Irish folklore into the shareholder's dividends of this national brewery.

 Yes, I can look back now and see that cloud, and wow, it was far bigger than I could ever have imagined. I walked out of that mass without really knowing how far from the edge I was, or even if there was an edge. Was I an alcoholic? I don't think so. I didn't get the sweats or shakes when I stopped, or contract any mental health problems. Did I have a bad habit? That more fits the bill. Yes, I had a bad habit!

Will I drink alcohol again? I'm not setting any more targets, that’s a sure way to fail, but right now, I can't imagine going back into that cloud, not now that I can see the world again as it really is.

 

For support: Take a look at https://www.oneyearnobeer.com/ a fantastic UK based organisation run by Andy Ramage and Ruari Fairbairns. 

New today (5th December) in Thailand. Big advance in detection of prostate cancer announced!

This sounds like an amazing advance in prostate cancer detection and the possibilities for its application across all cancers is mind-boggling.

This test is more accurate than anything ever imaginable a few years ago. But- I feel that I am 'cancer free' 7 years after surgery and I'm delighted with that. 
Having had a quick read I see only one drawback. If this test can detect tiny microscopic metastatic prostate cancer cells in my bones, that might never bother me in my lifetime, would I really want to know about that; also knowing that nothing could be done?

Bangkok, Thailand –  X-ZELL, a global biotech firm specialising in rare cell detection technology, is launching a revolutionary new prostate cancer test in the Kingdom of Thailand.

The test – aptly named X-ZELL Prostate™ – will be available FROM TODAY via Chularat 9 Hospital in Bangkok, conveniently located near Bangkok’s Suvarnabhumi International Airport.

According to X-ZELL CEO, Dr Sebastian Chakrit Punyaratabandhu Bhakdi (pictured above), the launch on Thai Father’s Day not only demonstrates the company’s commitment to protecting men’s health, but also marks a historic milestone for the start-up, with Thailand becoming the first country worldwide to have access to the game-changing test, which is able to find a new type of cancer cell that has been considered undetectable until now.

Read the full story here

They will never forget how you made them feel....

When I was diagnosed with cancer, some seven years ago, I thought I was about to say goodbye to a life I had, in the main, really enjoyed. At the time, my friend Charlie became a great support, sending many an encouraging mail. We joined the Army together as 14-year-old boys on 9^th May 1967; hard to believe when I look at kids that age now! We were both top of our tree when it came to athletics and a guaranteed gold medal for our unit every time we competed. We both went on to gain Regimental and British Army colours! I guess that’s why we both look at our bodies now, and think, what went wrong?

Charlie Dowie

How sad I was then, a few years back, to hear that Charlie had been diagnosed with Motor Neuron Disease (MND), putting him now ahead of me in the river of life, but still not far enough ahead to hear the falls! Of course, none of us really know where we are on that river; the falls can come at a seconds notice. I may yet overtake my friend, life’s like that, and all that Charlie and I can do for now, is the same as anyone else - enjoy the river. 

When we are gone, all we really leave is our reputation and how we made others feel. Charlie’s reputation is very much embedded in this letter he wrote to me recently and has given permission to publish. At a time when you might think he would be caving in, he’s thinking of those around him and making it as easy for them as possible; that’s the mark of the man!

Swim on my friend, there's many a bend yet, and I'm right behind you...

Daniel Sencier

 Hi Dan,

Many apologies Dan – like you I got caught up in things to do – not least building up a presentation and preparing for a Q&A session with my local Hospice – and the local CCG (Clinical Commissioning Group). I attend the Hospice once week – daycare – for a bit of light relief and a chat with a few other MND affected people as well as a few cancer patients. It is quite humorous talking about what will, in all likelihood, kill us. It is a no holds barred discussion about what is affected, the cures, the care system and end-of-life stuff – quite uplifting too. The hospice staff are a great bunch of people and it was they who wanted to know more about MND and in particular how it is affecting me. The CCG are coming along too because they also want to know more about my experiences with the care system and how they might improve things – they want to give a presentation to the CCG Board of Directors so I took the opportunity to double up on the day. Quite looking forward to the day.

I was recently rather perplexed by the host of questions the hospice staff were asking about my mental state – they have a set of standard questions that give them a ‘score’ indicating ‘state of mind’. I had scored a ‘zero’ in all their graphic scores – not heard of before – and they thought I was maybe hiding some issues from them – but I have been tested many times and always come up with zero issues. My explanation is simple:

                ‘…you can sit on your RS and tune into black box of bad news (BBC etc) and rant at the perceived injustices in the world – OR – take a hold of the ‘black dog’ and screw it up tight and stuff it in the waste bin – and get on with living my life and not someone else’s…’

Seem to have done the trick. The neurologist suggested that it was OK to get angry at the way this disease gets to you – but I replied that ‘I could’ but it doesn’t help Mags – the main carer – to see me getting angry with myself or feeling sorry for myself. It is a fine line between sharing and caring. I tread that line with great care – but err on the side of humour and positivity. I think it helps her a great deal to know that I am OK with MND and whatever it will bring.

About that ‘ hereafter’ stuff: science would have us believe that matter (in whatever shape or from) remains constant – just gets changed – so I can see how those Roman soldiers are still ‘with us’. But thinking about that – if we are just a collection of atoms arranged in a particular way for a period of time then why not believe in ‘re-incarnation’ of atoms – so with that logic we must all have something of the past within us – and something of the universe too – star child springs to mind (Arthur C Clarke). What if we could find those ‘particular atoms’ and recreate them – hey – Frankenstein!. 

Thanks for thinking about stopping or reversing MND – one day I’m sure – but just maybe not today – but I live in hope. 

I still don’t hear the crash of the waterfall – but like you – I know it’s there.

Take care Dan  

CD

Emergency? Do you know what to do?

Of course, while we are all busy thinking of cancer, which is relatively long-term, we can find ourselves faced with sudden emergencies that can end life even sooner, if not dealt with immediately.

Would you know what to do if the person in front of you collapsed at your feet?

I recently organised a 1st Aid and CPR training course kindly provided by BNH Hospital in Bangkok. Everyone left feeling far more confident that they now had some valuable skills.
Ask at your local hospital to see if you can do the same.

Slowed the progression of prostate cancer in 80% of men

Six injections of OncBioMune Pharmaceuticals‘ prostate cancer vaccine ProscaVax stopped the progression of the disease in 80 percent of patients in a Phase 1 clinical trial, the company announced.

The results applied to patients who had been treated for 19 weeks. All the participants had cancer that had returned after other treatment regimens.

“All the data to date is consistent with previous study data showing ProscaVax elicits immune responses to fight tumor growth in prostate cancer,” Dr. Jonathan Head, chief executive officer of OncBioMune, said in a press release. “We are impressed that 80 percent of the patients treated with ProscaVax demonstrated stable disease” — that is, no progression.

ProscaVax immunizes patients against the protein prostate specific antigen, or PSA, high levels of which are associated with cancer. The vaccine includes PSA plus two immune system activators, interleukin-2, or IL-2, and granulocyte-macrophage colony-stimulating factor, or GM-CSF. It is designed to boost the immune response against prostate cancer cells.

The ongoing Phase 1 trial (NCT02058680) is evaluating the vaccine’s effectiveness against recurrent  prostate cancer in patients whose PSA levels had increased for more than six months before the trial started. The study is also assessing the vaccine’s safety.

In the Phase 1a part of the trial, the 20 participants received vaccine shots at weeks 1, 2, 3, 7, 11, and 15.

At 19 weeks, in the first patient follow-up, researchers discovered that the cancer of 16 of the 19 patients had failed to progress. Among the four patients whose disease progressed, three had higher PSA levels. Imaging indicated that the cancer of the other had spread to the brain.

Researchers also found the vaccine to be safe. They observed no serious adverse events or dose-limiting adverse events in the 30 days after vaccination began.

OncBioMune is conducting additional analysis to determine whether the vaccine can increase patients’ immune response against PSA and decrease PSA doubling times — a measure of cancer progression.

“We look forward to continuing to follow the patients in this study to collect additional data and also to conducting a larger study to further validate the therapeutic benefit of our vaccine platform technology,” Head said.

The Phase 1b part of the trial will involve patients receiving booster shots at weeks 27, 35, and 43, along with IL-2 injections at weeks 23, 31, and 39.

The Phase 1 trial is being conducted at the University of California San Diego Medical School, with support from the U.S. Navy Cancer Vaccine Program.

Your PSA doesn't matter when you're dead!

Do you know how many men have died while deciding whether or not to have a PSA test? No, I don't either, but I'd be dead now if I'd listened to the 'Prostate Press'.

Have a PSA test today! That's the easy bit! They take some blood and test it for PSA.

Then, and this is the part where almost everyone goes wrong....

Your doctor/nurse says to you with a smile, "Yes, that's fine, everything's OK" and you walk away thinking, everything's OK! But is it? They're professionals, aren't they? They care about me, don't they?

If your result is between 0 and 4 and the medical professionals say you are within limits, and thus OK... No, no, no, no and NO! All my tests were within these limits, but my doctor spotted that there had been a doubling of PSA in about 18 months, which is a warning sign that all is not well. It doesn't mean you have cancer, but it OFTEN does!

If you're a man over 50 and you do not know your actual PSA test number (not just..." the doctor said it was ok") and have not written that down so you can compare it to the previous year, next year, then you are dicing with death!

Prostate Cancer relapse after surgery...

Today, again, I was lucky! My 16th PSA test after surgery 7 years ago, and still, all clear of cancer. 

For 10 years after surgery, it's like drawing a ticket every 6 months, knowing that around 30% of us will be unlucky. But 70% will be lucky, and I'm still in that group, so all I have to do is go again in May 2018, and every 6 months after that. If you make it to 10 years, the cancer rarely returns. 

BUT, what if I had been in the 30% this time; the unlucky ones? How bad is it to be in that group and what should they expect now?

What is the most frightening thing about cancer? For many, it’s the chance the cancer might return after surgery. With most common cancers—colon, breast, brain, melanoma, or lung, for example—these recurrences are almost universally fatal. Prostate cancer, however, is different. You might find it hard to believe, but men with relapsed disease are more likely to die from old age than from prostate cancer.

Prostate Cancer Is Different

Why is prostate cancer relapse so different? Several reasons. First, it grows and spreads far more slowly than other types of cancer. Second, medications that inactivate testosterone (hormonal blockade) are shockingly effective. Men go into remission for an average of 10 years! But what makes prostate cancer most unique is a particular type of protein produced in the prostate gland called prostate specific antigen, otherwise known as PSA.

PSA Is Amazing

Even though measuring the amount of PSA in one’s blood to screen for cancer has been seriously questioned, PSA is the gold standard for detecting relapsed disease. In fact, other types of cancer have nothing that even approaches the accuracy of PSA. PSA detects microscopic cancer. Unfortunately, other cancers can only be detected with scans, after the recurrent tumors become large enough to be seen with the naked eye.

For tumors to be visualized on a scan, they must be over a half-inch in diameter and contain at least one billion cancer cells. The PSA blood test, on the other hand, detects recurrences with as few as 100,000 cells.

PSA Doubling Time Is More Accurate Than Gleason Score

Detecting recurrence with PSA at the earliest possible stage creates an opportunity to determine the seriousness of the relapse.

With repeated, sequential testing of PSA—say with monthly blood draws—the rate of PSA increase can be accurately determined. How quickly the PSA doubles reveals the grade of relapse. This information is very important because low-grade relapses are treated very differently than high-grade relapses. Most people are familiar with the Gleason grading system, the most popular methodology for cancer grading in newly diagnosed men, that is, prior to relapse. With the Gleason system, the cancer cells are graded by a special doctor called a pathologist. The pathologist views the biopsyspecimen under a microscope and assigns a grade to the cancer. The Gleason system is the most powerful prognostic indicator for grading newly-diagnosed prostate cancer and has a very important role in determining optimal treatment for newly diagnosed men. However, in relapsed prostate cancer, the PSA doubling time easily supersedes the accuracy of the Gleason score. Knowledge of the cancer’s growth rate is the most accurate way to grade the cancer’s aggressiveness, and, luckily, the PSA determines this with unparalleled exactitude.

Once the PSA doubling time reveals the severity of the relapse, a treatment strategy is implemented.

Treatment varies drastically depending on the grade of relapse, so the optimal type of treatments for each grade of relapse is discussed below.

Low-Grade Relapse

For descriptive purposes, three different grades of relapses can be described: low, intermediate, and high. Knowing the grade of relapse is the basis for treatment selection. Some relapses, for example, are so low-grade that no treatment at all will be required. This occurs when PSA requires more than a year to double. When the doubling time is this slow, the best approach is to withhold treatment and continue monitoring the PSA every three to six months.

Many of these patients remain off treatment indefinitely.   

Intermediate-Grade Relapse

When men have PSA doubling times that are somewhat brisker, say in the six to 12-month range, they will usually be candidates for some form of therapy. Historically, treatment has consisted of a blind shot of radiation to the area of the body where the prostate was located prior to its removal. The area that is targeted is called the prostate fossa. Sometimes radiation used in this fashion will be curative. Studies show that cure rates are best if the radiation is initiated before the PSA rises above 0.5. Like so many types of cancer therapy, the earlier treatment is started the better it works. 

Hormonal Therapy

If the radiation is unsuccessful, hormonal therapy is the next line of defense. The most common approach is to select an agent from a long list of active hormonal agents of more or less equal effectiveness—Lupron, Trelstar, Eligard, Firmagon, or Zoladex. These injectable medications are typically implemented as a backup if the radiation fails to control the rising PSA. Prostate cancer cells require testosterone to survive, and these medications work by lowering testosterone. Depriving the cancer cells of testosterone causes them to die. Hormonal blockade induces a sustained anticancer effect that is maintained for an average of 10 years, assuming that treatment is initiated early, that is, before the onset of bone metastases. The duration of disease control is much shorter if prostate cancer is allowed to progress into the bones before treatment is started.   

Intermittent Therapy

To reduce the side effects from having low testosterone, periodic treatment holidays are often recommended. The usual approach is to administer Lupron for six to eight months and then take a holiday. Usually the PSA drops to less than 0.1 within six months of starting therapy. After the medication is stopped and its effects wear off, testosterone slowly recovers and the PSA begins to rise. A second cycle of Lupron is started when the PSA rises to a prespecified threshold, say between three and six. Studies prove that this intermittent approach effectively controls the cancer just as well as if the Lupron is given continuously.  

A Milder Type of Hormone Therapy

Sometimes milder, oral forms of hormone therapy such as Casodex (bicalutamide), with or without Avodart (dutesteride), can be substituted for Lupron to reduce side effects. This type of approach might be preferred, for example, in patients who are older or frailer. The most common side effects associated with the standard injectable types of hormonal therapy—fatigue, weakness, and weight gain—tend to be less severe. However, there is one side effect that is more common with Casodex—breast growth.  This problem, however, can be counteracted with an estrogen blocking pill called Femara. Alternatively, a moderate dose of radiation administered to the breast area before Casodex is initiated usually prevents breast enlargement.

Treating a High-Grade Relapse

Men with relapsing prostate cancer whose PSA doubling time is less than six months face a more daunting situation. If the disease is not kept in check with effective therapy, the cancer is likely to spread quickly and become life-threatening. Here, the most prudent therapeutic approach is to adopt an aggressive plan that relies on a combination of treatments given simultaneously, aka a multi-modality approach. The remainder of this article will address the treatment of high-grade relapses.

State-of-the-Art Scans

The first step is to use optimal scanning technology to determine where in the body the cancer is located. Presently, the best available lymph node scans (lymph nodes are usually the first site of metastases) are C¹¹ Acetate or C¹¹ Choline PET scans. Unfortunately, in the United States these scans are only available at Phoenix Molecular or at the Mayo Clinic. Recently, a new type of PET scan called Axumin has become more widely available. Studies comparing the relative accuracy of Axumin with C¹¹ PET are in process. Another, newer type of PET scan called Gallium⁶⁸ PSMA is now entering into clinical trials at various centers around the US.

In addition to lymph nodes, advancing prostate cancer often spreads to the bones. The importance of accurate scans to detect early disease cannot be overemphasized. Recently, bone scan technology has been greatly improved with the use of new F¹⁸PET technology. Whenever possible, F¹⁸ PET bone scans should be used rather than the older Technisium⁹⁹ methodology. PET scans for prostate cancer are a revolutionary new development, enabling doctors to apply potentially curative radiation in a far more intelligent manner.

Radiation Plus Lupron Plus Casodex

Once the extent of disease has been determined by accurate scanning, assuming the number of metastases is relatively limited, (say no more than five), the first step it to initiate treatment with Lupron plus Casodex with the plan of continuing it for at least a year. Generally, a couple of months after starting Lupron, radiation is administered to the known metastatic sites (the ones that were detected by scanning) along with further “blind” radiation treatment to the prostate fossa and to the “normal” pelvic lymph nodes. These areas of the body are treated because they are the most common location for microscopic disease, and even the modern PET scans may fail to detect cancer here.

Microscopic Disease Outside the Radiation Field

Studies clearly show that when radiation is directed at known sites of disease, sterilization of the cancer at those sites is usually achieved. So, treatment failures are usually related to small amounts of microscopic disease in other parts of the body that were undetected, despite the best available scanning technology. Therefore, when dealing with these more dangerous types of prostate cancer that have very fast doubling times, using an aggressive strategy that employs systemic medications that have anticancer activity  throughout the entire body makes a whole lot of sense. As was already noted above, anticancer therapy is most effective when starting treatment at an earlier stage, while the disease is still microscopic. 

Multiple Medications to Eradicate Microscopic Disease

Since Lupron and Casodex can be such integral players in the treatment game, some might wonder if other types of effective anticancer therapies exist. When the question is framed this way, two medications immediately come to mind, Zytiga and Xtandi. These powerful agents have demonstrated anticancer efficacy even when treating men whose cancer has developed resistance to Lupron!  Considering that they are convenient oral agents with a manageable side effect profile, it is logical to consider substituting Zytiga or Xtandi for Casodex.     

What About Chemotherapy?

In addition to using a combination of medications, as was the approach outlined in the previous paragraph, reports also indicate that the addition of chemotherapy with a medication called Taxotere has the potential to further improve survival. While such conclusions are preliminary, studies evaluating the combination of Taxotere with Xtandi or Zytiga indicate that this approach may be feasible.

Conclusion

Men whose prostate cancer recurs after surgery cannot adopt a one-size-fits-all treatment approach.  When the PSA doubling time is very slow, men can be safely watched. When the PSA doubling time is somewhat faster, radiation, Lupron, or both can effectively forestall disease progression for over a decade. Men with aggressive relapses signaled by a very fast PSA doubling time should strongly consider the prompt initiation of multiple therapies in combination.