metastatic PC with bone mets and PSA 620.3

[nfornajam]

my father is 56 yr old and was diagnosed of PC on 23 jan 10 with a PSA of 620.3
MRI showed para-aortic lymph node enlargement and possible involvement of bladder wall ( jawets C on MRI )
TURP was done on 28 jan 10 and histology showed gleason 9/10 ( major 4 + minor 5 )
ANDROCUR ( cyproterone ) was started in a dose of 2+2+2
after 10 days PSA dropped to 177
bone scan showed multiple area of mets both axial and peripheral skeleton
done bilateral subcapsular orchidectomy on 15 feb 10
continuing ANDROCUR in a dose of 1+1
plz help me out and tell me what are the treatment options available now and what is the prognosis at this stage
i ll b very much thankful
saami

[Ash Tewari, MD, M.Ch.]

Thank you for your question. I understand that this is a challenging time for you. It would be irresponsible for me to give life-expectancy in absolute terms. There are several options for the treatment of metastatic prostate cancer. These can be stratified into two general categories, hormonal therapy and chemotherapy. It is important to clarify that no treatments can cure advanced prostate cancer. The goal of these treatments is to control the spread and related symptoms.

Hormonal therapy, in broad terms, aims to limit the effect of testosterone in driving the spread of prostate cancer.

Thank you for your question.

Sincerely,

Ashutosh (Ash) Tewari, MD

http://www.cornellroboticprostate.org

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[Ash Tewari, MD, M.Ch.]

In general terms, there are 4 types of hormonal therapy.

1. Anti-androgen (androcur, cyproterone, casodex etc.)
2. Luteinizing hormone-releasing hormone (LHRH) analogs (lupron, eligard)
3. Luteinizing hormone-releasing hormone (LHRH) antagonists (Plenaxis)
4. Castration

Anti-androgens prohibit the body's ability to use any androgens. Even after orchiectomy or during treatment with LHRH analogs, a small amount of androgens is still made by the adrenal glands.

In the course of treatment, antiandrogens are often used in two different ways. Either in combination with LHRH analogs as first-line therapy. The anti-androgen is given to prevent tumor flare, testosterone rises after administration of LHRH analogs. Anti-androgens are also given after LHRH analogs are proven ineffective.

LHRH Analogs lower the amount of testosterone made by the testicles. Treatment with these drugs is sometimes called chemical castration because they lower androgen levels just as well as orchiectomy.

LHRH Antagonists appears to reduce testosterone levels more quickly and does not cause tumor flare.

Hormonal therapy is fairly nuanced and strategies differ from patient to patient and doctor to doctor. Some patients stop responding to hormones in a short amount of time some stay on the same hormone treatment for 10 years.

These questions should be directed to your medical oncologist for a specific treatment plan and followup.

Sincerely,

Ashutosh (Ash) Tewari, MD

http://www.cornellroboticprostate.org

This forum is for information only. The contents, such as graphics, images, text, quoted information and all other materials ("Content") are provided for reference only, do not claim to be complete or exhaustive or to be applicable to any particular individual's medical condition. Users should always consult with a qualified and licensed physician or other medical care provider. Users are warned to follow the advice of their physicians without delay regardless of anything read in this forum. The Weill Cornell Prostate Cancer Institute assumes no duty to correct or update the Content nor to resolve or clarify any inconsistent information which may be a part of the Content. Reliance on any Content is solely at the User's risk. This forum may contain health or medically related materials considered sexually explicit. Users are warned that if they may be offended by such Content, an alternate source of information should be found. Publication of information or reference in forum to specific sources such as specific products, procedures, physicians, treatments, or diagnoses are for information only and are not endorsements of the Weill Cornell Prostate Cancer Institute.

[nfornajam]

thanks again
your answer absolutely clarified my mind about the course of hormonal therapy.
definitely i ll have a session  with med oncologist
i have read about monoclonal anti body treatment can you tell me about that like what is its role and at what stage of development these are.
thank you for your kind opinion.
sincerely
saami

[nfornajam]

thanks for your answer
i ll appreciate if you could elaborate more in your answer because i am a doctor too and cannot be satisfied with lay man terms...
i hope you can understand the whole situation i am undergoing
done sub capsular orchidectomy on 15 feb 10 and started Androcur in a dose of 1+0+1
thanks again for your response
saami

[nfornajam]

forgot to mention that his histology showed adenocarcinoma with 80-85 % of the gland involved