Treatment for hormone refractive prostate cancer

[mick308]

I am currently doing antiandrogen monotherapy with casodex with a rising PSA. 0.17 to 2.8 in one year. How long does one stay on such treament,and what are the best treatments for hormone refractive prostate cancer. No prostate cells or metastatis has been detected,however possible micrometastasis.
                             Taxatere only has a survival rate of 2 months.I am more interested in QOL and no chemo for me.Am seriously considering dropping all treatments when I become hormone refractive while continuing Vipassana meditation,calorie restriction and exercise as long as possibe and if the pain becomes too intense,assisted dying.I am not trying to be morbid.Intense pain and being bed bound is not my idea of QOL.Please help me with these issues as my search for answers is pretty much exhausted.Thank you so much,Mark

[Ash Tewari, MD, M.Ch.]

Thank you for your question. To help me better answer your question, please respond with response to the following:

1) Is this your first line of anti-androgen therapy, have you been on a LHRH agonist 2) what are your testosterone levels 3) what is your age 4) did you have surgery or radiation or any other interventions?

Ashutosh (Ash) K. Tewari, MD
www.cornellroboticprostate.org

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[Ash Tewari, MD, M.Ch.]

Thank you for your question. Nearly all prostate cancers become resistant to hormone therapy after a few months or years of treatment. In short, hormone therapies should be reevaluated after the PSA starts to rise. If you are currently taking bicalutamide you could switch to flutamide or nilutamide. The next step may be to move to secondary therapy ketoconazole.

It is important to continue to watch the PSA along with imagining to monitor bone activity.