James (not real name) is a 58-year-old Indonesian. His problem started in early 2016 when he lost his appetite, felt fatigue and lost weight. Blood test showed his PSA was more than 500 and his alkaline phosphatase was 200 plus.

James went to Singapore to consult an urologist at a private hospital. A bone scan showed his prostate cancer had spread to his bones.

James was given Lucrin injection (three months once) and an oral drug, Casodex.

Three months later, the doctor increased the Casodex dosage because his PSA was rising.

With the treatment, James PSA dropped to 0.03, his alkaline phosphatase was at 270 (table below).

Eight months later, (December 2016) his PSA started to increase again from 1.6 to 6.0 and by June 2017 it was at 89.4. The treatment failed (Table 1).

Table 1: The fall and rise of PSA after hormonal treatment

Date	PSA	Alkaline phosphatase
12 Apr 2016	0.03	270
12 July 16	0.04	102
29 Sept 16	0.19	84
13 Dec 16	1.63	82
7 March 17	6.07	72
5 June 17	89.4	87

Disappointed with the results, James consulted another doctor in The Singapore General Hospital. A PET scan results showed evidence that the cancer had spread to his bones.

James continued to receive his Lucrin injection but Casodex was discontinued. He was asked to take a new oral drug Enzalutamide (or Xtandi). This cost SGD 5,600 per month.

James was also told that if the above treatment is not effective, then there is no other option but to go for chemotherapy.

James found us in the internet and decided to seek our help. During his first visit we prescribed herbs for his problems.

Three months later, September 2017, James came back to see us again. James told us that after seeing us, he went back to his doctor in Singapore and was started on the new oral drug Xtandi. He took 4 tablets of Xtandi per day for the three months while at the same time half-heartedly following our therapy.

Let’s look at his blood test results done in Singapore (Table 2)

Table 2: Blood test results done in Singapore

	5 June 2017	11 Sept 2017
PSA	89.4 High	19.8 High
Liver Function
Alkaline phosphatase	87	110 High
Alanine transaminase – ALT	16	23
Aspartate transaminase – AST	35	49 High

When James showed me the two blood test results done in Singapore, my immediate remark was, Good – what else do you expect? Cannot ask for more! His PSA in June was 89.4 and with Xtandi and herbs the PSA dropped to 19.8. Great result! But hang on, James had not finished his explanation yet. Actually I am being fooled by these numbers.

James said, he monitored this PSA level often (Table 3). And if you study the numbers below properly you will note that James is heading for another disaster. That SGD 5,600/month drug and our herbs did not work!

	28 June 2017	12  July 2017	2 Aug 2017	30 Aug 2017	6 Sept 2017
PSA	101 High	55.5 H	8.85 H	14.29 H	16.6 H
Liver Function
Alkaline phosphatase	77	n/a	197 H	105	102
Alanine transaminase – ALT	15	n/a	22	41	31
Aspartate transaminase – AST	24	n/a	29	52 H	48 H
GGT	31	n/a	35	52	n/a

After James took Xtandi (+herbs) for about 2 weeks, the result was dramatic fall of PSA from 101 to 55.5. That’s a 50% reduction. You cannot ask for more. Then for another 2 weeks, the PSA dropped further to 8.5. Fantastic results — PSA dropped from 101 to 8.5 after one month on Xtandi.

Hang on! Barely a month later, the PSA on 30 August showed the PSA had gone up to 14.9 from 8.85. That the beginning of disaster. Within a month, between 2 August and 6 September the PSA had doubled from 8.85 to 16.6. This is a clear sign of failure.

Besides the PSA what could be another possible problem is James’ liver function is deteriorating as shown by the increase in AST and GGT. James has to watch out  for this too.

Some notes from the internet

1. Xtandi: Expensive drug and price merry-go-round

Xtandi is a drug used to treat hormone-resistant prostate cancer that has metastasized, or spread to other areas of the body. Xtandi costs $7,450 per month. The average treatment course is eight months, so the cost of Xtandi is usually about $60,000 for a full course of treatment.

Xtandi (enzalutamide) is an expensive prostate cancer drug market by Astellas Pharma, a Japanese pharmaceutical company. The total cost for a one-month supply of Xtandi (120 pills) comes to $8,839.49, or around $73.66 per pill, $294.64 per day, and $107,617.26 per year.

The drug costs much more in America than it does elsewhere, with a U.S. list price of about $129,000 per treatment course, compared with $39,000 in Sweden and in Astellas’ native Japan.

In Singapore, James paid SGD 5,600 for a month supply.

2. Xtandi increased survival by 4 to 4.8 months

Xtandi is an oral medication that inhibits the androgen receptor, which drives prostate cancer progression.

In a phase III clinical study of patients previously treated with chemotherapy, Xtandi reduced the risk of death by 37 percent and increased median survival by 4.8 months, compared to instances where subjects took a placebo.

In a separate phase III clinical study of patients not previously treated with chemotherapy, Xtandi reduced the risk of death by 23 percent and increased median survival by 4 months.

3. Side effects of Xtandi include:

• seizures,
• back pain,
• diarrhea,
• joint or muscle pain,
• hot flashes,
• flushing (warmth, redness, or hot feeling),
• headache,
• muscle weakness or stiffness,
• anxiety,
• dizziness,
• sleep problems (insomnia),
• feeling tired,
• numbness/burning pain/tingling/prickly feeling under your skin,
• swelling in your hands or feet,
• cold symptoms (such as stuffy nose, sneezing, and sore throat),
• high blood pressure,
• upper respiratory tract infection,
• blood in the urine,
• urinary frequency,
• dry skin,
• itching, or
• nosebleeds.

4. Can Xtandi cure prostate cancer? Try google this question and see what you get. There is NO mention of cure, only delayed deterioration.

In the case of James he is still fine and he is not dying yet. HIs main concern is his PSA is rising in spite of all the drugs taken.

Comments

From our conversation with James and his wife, it appeared that we are wasting our time. I told James and his wife our herbs are not magic bullets and I do not expect his PSA will drop like when he was medical drugs. Healing needs full commitment. James did not show that he has that commitment. He did not take care of his diet. Once a while he ate things that he is not supposed to eat. Did he really take his herbs properly? I am not sure either and I did not ask him about this.

In fact I told James and his wife. If I was told earlier that he wanted to take Xtandi, I would not have prescribed him the herbs. It would be better that he takes the Xtandi first and see what happened. If and  when the doctor’s drugs cannot work anymore then he can come and see us for help.

Although James said he benefited from taking our herbs, I am not sure if this is true or not.

Listen to our conversation that morning.

1. Lucrin & Casodex

2. Xtandi & Herbs