During the past month, many prostate cancer patients came to CA Care. Let us highlight three cases.

Patient 1

PS is a 73-year-old man from Indonesia. His problem started in 2011 when his urine flow was not good. His urination was also frequent. A check with the doctor in July 2011, indicated prostate cancer — PSA = 41.9 and Gleason’s score 9 (5+4). PS underwent TURPT.  In addition he was started on Tapros injection – once every three months. PS continued to receive this injection, a total of 15 injections, until January 2015.

His PSA initially decreased from 41.9 (June 2011)  to 0.47 (in October 2013). But after that it started to increase again. Within one and half year, January 2014, the PSA started to increase to 4.4 (see Table below).

Note:  1. TURPT or Transurethral Resection of Prostate Tumor is a surgical procedure used to remove part of an enlarged prostate. This procedure is a less invasive option to an open prostatectomy and is used in cases where the prostate is not large enough to necessitate complete removal. During TURPT, an instrument is inserted up the urethra to remove a section of the prostate.

2. Tapros (leuprolide acetate) injection is used to treat advanced prostate cancer. It is not a cure but to slow or stop the growth of cancer cells and helps relieve symptoms such as painful/difficult urination. Most types of prostate cancer need the male hormone testosterone to grow and spread. Tapros works by reducing the amount of testosterone that the body makes.

In February 2014, a bone scan showed the cancer had spread to his bone. PS was given Zometa injection. The doctor stopped Tapros injection for a while, and replaced it with Casodex 50 — an oral drug.

PS continue to received Zometa injection (total of 12 injections) and Casodex until September 2015.

Even with these treatments the PSA from 4.4 (January 2014) started to increase to 32.3 in February 2015.

Since the drugs were not effective, PS underwent an orchidectomy (surgery to remove the testes). After the surgery, his PSA dropped from 32.3 to 11.3 (June 2015). But again, the PSA started to increase. By September 2015, his PSA was 28.7

The doctor recognised that the treatments were not effective. PS was asked to undergo chemotherapy — 6 cycles. The family declined chemo and PS’s son came to Penang to seek our help. About a month on the herbs, his PSA continued to increase to 39.7 in October 2015.

Patient 2

PL is a 62-year-old Malaysian. His problem started in May 2012 when a routine health check showed an elevated PSA of 33 plus.

In June 2012, PL was started on a three monthly Zoladex injection (received a total of 10 injections). Initially the PSA started to decrease from 33 to 3.9 (on 14 January 2013). After that it started to increase to 10.9 (3 September 2013).

Casodex caused a temporary drop of PSA from 10.9 to 1.5 within a month. But after that the PSA started to rise again. In April 2014, the PSA was 15 plus. The doctor stopped Casodex and replaced it with Diethylistilberstrol 1 mg.  This replacement drug was not effective. The PSA rose to 22 plus.

The doctor again changed to another drug, Ketoconazole 200 mg. It was also not effective. The PSA shot up to 41 plus (14 August 2014).

A bone scan on 4 September 2015, confirmed bone metastases involving both iliac crests and left sacro-iliac joint.

From 24 September 2014 to 5 March 2015, PL underwent 8 cycles of chemotherapy using Docetaxel.  After 3 cycles of chemotherapy, the PSA decreased from 41 plus to 20 plus (3 December 2014). After the completion of the 8th chemo, the PSA decreased to 6 plus (31 March 2015).

PL was again started on Casodex and Lupron injection. But it was not to be. From 14 April 2015 to 25 August 2015, PL received a total of  five  Lupron injections while still taking Casodex. His PSA shot up from 6 plus to 400 plus.

The doctor suggested that PL undergo chemotherapy again. He declined and started to find alternative therapy.

PL went for ozone therapy. Before the treatment his PSA was 499.8. After 6 ozone treatments his PSA went up to 617. The treatment costs RM3,800.

It was at this stage that PL and his family came to seek our help and PL was started on herbs.

Note: 1. Zoladex or Goserelin acetate is a man-made hormone used to suppress production of the sex hormones (testo sterone and estrogen), particularly in the treatment of breast and prostate cancer.

2. Diethylstilbestrol(DES) is a syntheticestrogen, first synthesized in 1938. DES was given to pregnant women in the mistaken belief it would reduce the risk of pregnancy complications and losses. In 1971, DES was shown to cause clear cell carcinoma, a rare vaginal tumor in girls and women.
3. Ketoconazole. This is a broad spectrum antifungal agent but is used for patients with advanced prostate cancer.
4. Lucrin or Lupron (leuprorelin acetate) reduces the amount of testosterone in men or estrogen in women. It treats only the symptoms of prostate cancer and does not treat the cancer itself.

Patient 3

RS is a 67-year-old Malaysian.  A routine screening procedure in September 2012 detected his PSA was elevated at 14.7. A biopsy done confirmed cancer of the prostate, Gleason’s score 3+4. Bone scan did not show any bony metastasis.

RS went to Singapore and underwent a robot assisted radical prostatectomy in January 2013. After this surgery, RS did not receive any further treatment or medication. He only monitored this PSA over the years.

After the prostate surgery, his PSA dropped from 14.7 to less than 0.03 and remained around that level for about a year. In February 2014, his PSA started to increase to 0.07. Later that year in June / September the PSA increased further to 0.18 / 0.23. This results showed that the cancer is coming back and RS felt that he should do something about this.

Comments

What can we learn from the above cases?

1. It is obvious that chemotherapy or surgery did not cure them. The cancer comes back sooner or later.
2. For Patient 1 — the hormonal injection kept the PSA down for about two years. Removal of testes caused a drop of PSA for about 4 months. After four years of hormonal injection and oral drug, Patient 1 decided to find an alternative path, turning down chemotherapy.
3. For Patient 2 — hormonal injection and various oral drugs kept him happy for about two years. Then bone scan showed the cancer spread to his bone. Eight cycles of chemotherapy with Docetaxel kept his PSA down for a few months, then the PSA started to increase aggressively. From September 2012 to September 2015 — within three years, his PSA at 33 plus shot up to 617, in spite of 15 hormonal injections, 8 cycles of chemo and taking of oral drugs — Casodex, etc.

It appears that for Patient 2, the more aggressive the treatment, the more aggressive the cancer become!

3. Patient 3 — opted for surgery instead of Watchful Waiting (i.e. wait and see and do nothing) or Hormonal therapy. From September 2012 to September 2015 — three years, his PSA was kept down from 14.7 to 0.23. There is no immediate danger yet, so there is no reason to panic. Nevertheless, the sign is not good. Surgery did not remove his cancer totally. The gradual rise of PSA is telling us that the cancer is coming back slowly NOT as aggressive as the two other cases above.

Surgery or removal of the prostate is only indicated when the cancer is still confined and not spread anywhere else. However, the long term side effects of surgery are: 1 — Erection problems. Seven out of 10 men become impotent. 2 — Urine leakage or problem controlling the flow of urine (incontinence) because of swelling or damage to the muscle that holds urine in your bladder.

The question in this case is, What if you do nothing — wait and see? Or find an alternative healing path instead of surgery? Patients have a choice!

Prostate Cancer Statistics

• Prostate cancer is the most common cancer in American men.
• It is the second leading cause of cancer death in American men, just behind lung cancer.
• About 1 man in 38 will die of prostate cancer.
• About 1 man in 7 will be diagnosed with prostate cancer during his lifetime.
• Prostate cancer occurs mainly in older men. About 6 cases in 10 are diagnosed in men aged 65 or older, and it is rare before age 40.

Source: http://www.cancer.org/cancer/prostatecancer/detailedguide/prostate-cancer-key-statistics

Do you have money to buy time?

Lately, many new drugs are being released to treat advanced prostate cancer.  The rich may want to try! But make no mistake, like the chemos and drugs used by the two patients above, these new, expensive drugs don’t cure you either! They are said to prolong your life for a few weeks or months.

1. Provenge — approved by the FDA in April 2010 costs US $93,000 or RM 406,251 for a standard course of three treatments. In a study involving 512 patients with advanced prostate cancer, Provenge increased median survival from 21.7 months to 25.8 months.

“To charge $90,000 for four months, which comes out to $270,00 for a year of life, I think that’s too expensive,” said Tito Fojo of the National Cancer Institute. “A lot of people will say, ‘It’s my $100,000, and it’s my four months.’ Absolutely: A day is worth $1 million to some people. Unfortunately, we can’t afford it as a society.” http://www.washingtonpost.com/wp-dyn/content/article/2010/11/07/AR2010110705205.html

3. Enzalutamide — approved in August 2012, sold under the name Xtandi. A typical eight-month treatment costs nearly US$60,000 or RM 262,098. Enzalutamide was assessed in 1,199 patients with advanced prostate cancer who had previously received chemotherapy. Survival with enzalutamide was 18.4 months on average, compared with 13.6 months for men receiving a placebo. This means Enzalutamide extends life by just five months. http://www.dailymail.co.uk/health/article-2465570/New-prostate-cancer-drug-approved-use-NHS-offers-month-lifeline.html#ixzz3nlnYiWGw
4. Cabazitaxel — a new form of chemotherapy, approved in June 2010, and sold under the name Jevtana. The typical six cycles cost about US$50,000 or RM 218,415.

5. Abiraterone — approved in April 2011, and sold under the brand name Zytiga. An    eight-month course of treatments costs about US$47,000 or RM 205,310.