=========================================
*That despite detection of Progression of disease
1. Increase in PSA
2.Radiologic Means of progression detection (bone scan, PET, CT)
3.symptomatic deterioration (mostly Pain, and decrease of performance)
Most Oncologists and Urologists at the meeting are still driven by Increase in PSA to make therapeutic decisions.
*That 30% of Men not thought to have Metastatic disease, were found to have positive bone scan
750/2516 pushing for an early proper radiologic staging particularly when PSA is greater than 10.
*That Lupron +Casodex or flutamide are still the first intervention for primary intervention
followed by initiation of Provenge. We heard about this brave urologist who has given already 0ver 30 times Spileucel-T (provenge) insisting it is category 1 NCCN recommendation. Most Oncologists agree but cost and practicality of doing Apharesis and infusions by dedicated locations make this drug still a difficult option. Provenge may be more effective given early when the Cancer or tumor burden is lower (of note some patient in the trial had received chemotherapy, so this remain an option even after chemotherapy had been given! That Provenge had shown 22.5% decrease of risk of death from Prostate cancer (Improving survival by 4 months!
*Abiraterone (Zytiga) came 3rd after progreesion on Sipuleucel-T (Provenge) should the disease progresses
- The most common side effects of ZYTIGA® include:
- Weakness
- Joint swelling or pain
- Swelling in your legs or feet
- Hot flushes
- Diarrhea
- Vomiting
- Cough
- High blood pressure
- Shortness of breath
- Urinary tract infection
- Bruising
- Low red blood cells (anemia) and low blood potassium levels
- High blood sugar levels, high blood cholesterol and triglycerides
- Certain other abnormal blood tests (from the manufacturer)
================================================== After Zytiga came chemotherapy with Docetaxel+Prednisone (option that has given up competing as everyone is fighting to come before it. Even Enzalutamide (THE BETTER ANDROGEN RECEPTOR BLOCKER) IS TRYING TO COME FIRST TO CHEMOTHERAPY.- ========================================Docetaxel is now coming after Zytiga failures and Enzalutamide is coming before Cabazitaxel in those who are asymptomatic with increase of PSA only whereas symptomatic patients are going to Cabazitaxel more often
- BUT WHATEVER YOU DO CONTINUE LUPRON BECAUSE THE STUDIES DID!
- ALSO START ZOMETA OR BETTER YET DENOSUMAB AS SOON AS BONE METASTASIS ARE DOCUMENTED
- ===============================WATCH OUT NOW ONCOLOGISTS ARE BEING SUED FOR NOT OBTAINING DEXA SCAN AND NOT GIVING CALCIUM AND VITAMIN D TO THEIR CASTRATE REFRACTORY PROSTATE CANCER PATIENTS
- SO ON EVERY ONE ON TREATMENT KEEP
- -Calcium and Vit D
- -weight bearing exercice
- -Cardiovascular risk record (controlled DM, HTN and Cholesterol level)
- -avoidance of Alcohol/Tobacco documentation
- -FRAX score
- -DEXA Scan
- or be sued!
- other alternative treatments discussed, Radium 223 (Alpharadin)
- Still open!
A Study of Alpharadin® With Docetaxel in Patients With Bone Metastasis From Castration-Resistant Prostate Cancer (CRPC)
NCT01106352
register your patients!
biggest concern with Enzalutamide, fatigue and seizures in 8% of treated patients. check Brain MRI since rare brain mets seems to contribute to their occurrence!
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