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Dr. David
Dr. David, Doctor (MD)
Category: Oncology
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Hi...my father made an orchiectomy in december 2011 in a psa

Resolved Question:

Hi...my father made an orchiectomy in december 2011 in a psa level of 300.
Today psa level is 600.
Why psa level doesn't decrease?
i'm in panic
help me please
Submitted: 2 years ago.
Category: Oncology
Expert:  Dr. David replied 2 years ago.
Hello, this is Dr. David. I have read your question and am ready to help.

sometimes prostate cancers are what is called hormone refractory. which means that the cancer cells can grow despite there is no testosterone in the body. this tends to happen to advanced and poorly differentiated prostate cancers.

if he has pain in the bones, radiation therapy can help with the pain as well as pain medications.

have him talk to a chemotherapy doctor to see if he wants to try any chemotherapy for his prostate cancer.
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
Dr. David and 3 other Oncology Specialists are ready to help you
Customer: replied 2 years ago.

Hi Dr David,

My father is taking casodex 150mg (bicalutamida) during 3 weeks, to see if psa level decrease, and his doctor said that if psa doesn't decrease is necessary chemoterapy.

Have you ever had
a case similar?

How long can
my father live??


is true that with 75 years of age, the malignant cells do not reproduce so quickly?
why is this not the case with him?

thanks
Expert:  Dr. David replied 2 years ago.
95% of prostate cancers grow and feed off of testosterone, the male sex hormone. as men get older, their testosterone level naturally lowers and so a 75 year old man's testosterone is not as high as a 55 year old mans. and so the idea is that in an older man with lower testosterone, the prostate cancer should not grow as fast.

It appears that your father is in the 5% of men with prostate cancer who's cancer is not dependant on testosterone to grow. high dose bicalutamide has been used in europe before to prevent prostate cancer recurrence by going into prostate cancer cells and blocking testosterone signally inside of the cells. it also has a high chance of causing breast growth in men. that is why we radiate the breast for 5 days to prevent breast growth from 150mg of bicalutamide. make sure if your father has breast enlargement to talk to his doctors about it, or go and get radiation therapy now before his breast start to grow.

his cancer is acting very aggressively and is very unique. has he had a biopsy of the prostate or another site of metastatic disease to confirm what is going on. that is an option.

you doctor is right that he might need chemotherapy if the bicalutamide does not work. taxotere is the chemo most often used. average survival of 19 months is not great with taxotere.

another option is Provenge which is very expensive.
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 2 years ago.

Hi,

He mades, in the previous week, a CT scan that detected (only?) metastases in lymph e mades a bone scan too, but the result is not ready yet.

Taxotere can reverse the disease or psa level will always grow?

If bicalutamide results (decrease a little psa level) is
strictly necessary chemistry? My father has no appetite lately..


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Você quis dizer: o meu pai pesa 58
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Expert:  Dr. David replied 2 years ago.
taxotere can slow the growth of the prostate cancer, but can not cure the prostate cancer.

if bicalutamide works to slow the prostate cancer, taxotere chemotherapy can be delayed and used later

let me know if you have questions

thanks for the accept

please leave + feedback

you can reach me as Dr. David

Thanks for using JustAnswers.com
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 2 years ago.
Hi again, Dr David

Here is the result of the CT scan of my father:

2.4x1.6
cm nodular image in a situation subclavicular (likely adenopathy). Two paratracheal adenopathy with a larger 1.7 x1cm. Liver
without lesions. Pancreas, spleen, adrenal glands without lesions. Some minor external and common iliac adenopathy, the larger of 3.2 x2, 9 cm. Prostate gland with round morphology.bladder without lesions.

What do you think?
is very serious or we can still catch this damn disease?

thanks for all
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Expert:  Dr. David replied 2 years ago.
The prostate cancer is no longer curable because it seems to have spread to lymph nodes in the pelvis and chest

It is still treatable and he can still fight it with hormone therapy and chemotherapy
Dr. David, Doctor (MD)
Category: Oncology
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Customer: replied 2 years ago.
Hi again,

two more questions...

How long
do you think this patient will have to live?

Have you seen similar cases last longer than a few months?

No doctor tells us about it...and for family is important know that...

Thanks to tell me the truth..
Customer: replied 2 years ago.
Hi again,

two more questions...

How long
do you think this patient will have to live?

Have you seen similar cases last longer than a few months?

No doctor tells us about it...and for family is important know that...

Thanks to tell me the truth..











Expert:  Dr. David replied 2 years ago.
It depends on how he responds to the casodex and chemotherpy if needed

It could definitely be more than a few months

But how much longer I can not say
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 2 years ago.
Hi again,
My father made a blood test today and reveal urea (63 mg) and creatinine (1,6)...the doctor says that is a bit elevated but his prostate cancer can elevate a bit those values...and the values are no so elevated.
what do you think?

thanks for help
Expert:  Dr. David replied 2 years ago.
Prostate cancer would not raise those levels

Those levels are not in the dangerous range

Kidney failure or blockage of the urine by an enlarged prostate or other reason would raise them much higher
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
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Customer: replied 2 years ago.
Hi again,

Bone scan reveals some metastasis on lumbar spine, ribs and pelvis but " no serious indication that the bone can break", said the doctor. He did not recommend radiation therapy. The bones of the legs, arms and head are not affected.
what worries me is that the PSA continues to rise (884) now...the fact that in a month PSA passed from 100 to 300 (triplicate) and now in a month and a half just having duplicate may mean that the disease is slowing?
Doctor recommended chemotherapy (taxotere, i think.. for 21 in 21 days) and he already marked two treatments...what do you think?

thanks for help me
Expert:  Dr. David replied 2 years ago.
yes, I have discussed with you chemotherapy options before on 2/14. the first chemo option is taxotere.

you can't gauge the growth only on PSA because his cancer will slowly become more PSA refractory. that means fewer and fewer of his cancer cells will make PSA and so his cancer can grow, but his PSA will stay the same or go down and not make sense.
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
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Customer: replied 2 years ago.


You think that is possible stop the grow of cancer cells with taxotere?


It's a good signal not to have the bones of the legs, arms and head not affected? Or it's normal?

Thanks Dr David for your patience with me, i'm still in panic..
Expert:  Dr. David replied 2 years ago.
the taxotere can slow down the prostate cancer, but will not cure the prostate cancer.

we don't consider metastasis to certain bone and not to others as a good sign or not.

if his pain worsens in his back, he can benefit from radiation therapy to the bones.
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
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Customer: replied 2 years ago.
Hi again,

What do you think about the use of aloe vera during chemotherapy?
Do you
ever had a case where the aloe vera helps the healing of the disease?

Thanks

My father begin the chemoterapy tomorow. I will give news.
Expert:  Dr. David replied 2 years ago.
aloe vera is best used for the skin

I have not had patients use aloe vera internally

best of luck to him with the chemotherapy.

he is getting taxotere?
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
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Customer: replied 2 years ago.


Yes, taxotere.
He already has two sessions: the first tomorow and the other on April,2.
Dr. marked a new appointement only on April 17.
Expert:  Dr. David replied 2 years ago.
good luck to him

let me know if you have other questions.

please click accept if done

thanks for using JustAnswers.com
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
Dr. David and 3 other Oncology Specialists are ready to help you
Customer: replied 2 years ago.


Thanks for help me.
I read a lot about the aloe vera plant and I think we'll try to take the syrup.
I think
if
even that does not improve with it, it may also not make worse to him.

Expert:  Dr. David replied 2 years ago.
yes, I think it is very reasonable.

make sure you let his doctors know that he is trying it

Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 2 years ago.
Hi,

my father made the first session of chemotherapy yesterday.
How long it takes on average in the first symptoms appear?
he doesn´t have any symptom yet

thanks again
Expert:  Dr. David replied 2 years ago.
If chemo given once every 3 weeks he might get symptoms 1-2 weeks after chemo

He might not get any symptoms at all

He will need to get blood checks before his next cycle of chemo even if he has no symptoms
Customer: replied 2 years ago.
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Alpha
Hi again
After 1 session with taxotere my father made blood check before next cycle.. PSA increase in a month from 884 to 1400..
he had no side effect (nausea,increased lacrimation,tingling sensations,etc.)...
only hair loss..
he did not made the second cycle of taxotere because hemoglobin was low (9,5)..
What do you think of this case?

thanks
Expert:  Dr. David replied 2 years ago.
his prostate cancer could be so poorly differentiated, that the PSA does not reflect the cancer progression.

either that or the cancer is still growing dispite the first cycle of taxotere.
Customer: replied 1 year ago.
Hi Dr David,

My father made in 10/05/2012 the third cycle of taxotere.
Before this cycle he mades blood test. Here are the results (and the results of the previous blood test 21 days ago in 18/04/2012):

10/05/2012 18/04/2012

Erythrocytes(RBC) 2.95 2.97x10^6/uL

Hemoglobin 9.8g/dL 9.6

Hematocrit 28.4% 28.8%

MCV 96fL 97fL

MCH 33.3pg 32.2

MCHC 34.6g/dL 33.2

RDW 13.9 14.5

Leucocyte(WBC) 16.4x10^3/uL 13.9

Neutrophils(%) 87.3% 89.2

Lymphocytes(%) 6.9% 6.3

Monocytes(%) 4.5% 3.6

Eosinophils(%) 1.2% 0.9

Basophils(%) 0.1% 0.0

Neutrophils(absolute value) 14.3x10^3/uL 13.9

Lymphocytes(absolute value) 1.13 x10^3/dL 0.87

Monocytes(absolute value) 0.74 x10^3/dL 0.5

Eosinophils(absolute value) 0.2 x10^3/dL 0.12

Basophils(absolute value) 0.02 x10^3/dL 0.00

Platelets 348 x10^3/uL 427

MPV 8.4fL 8.3

Glucose 238mg/dL 246

Urea 37 mg/dL 76

Creatinine 1.0 mg/dL 1.0

Calcium 7.6 mg/dL 8.0

magnesium 2.1 mg/dL 1.6

total protein 6.0g/dL 6.5

albumin 3.2 g/dL 3.7

uric acid 6.7 mg/dL 8.4

TGO-AST 25U/L 35

TGP-ALT 37 U/L 45

lactate dehydrogenase (LDH) 439 U/L 1154

alkaline phosphatase 113 U/L 148

gamma glutamyl transferase(GGT) 42 U/L 64

total bilirubin 0.4mg/dl 0.4

direct bilirubin 0.2mg/dl 0.2

Na+ 133meq/L 134

k+ 4.3meq/L 4.5

chlorine 98mmol/L 100

PSA 2500 1784


PSA value is scary..but the value of lactate dehydrogenase decreased considerably. What is your opinion?
My father is good and he has no pains, only
constipation due to medication.
he is on prednisolona (5mg) twice a day, 1500mg of calcium twice a day and
Hydromorphone hydrochloride (16mg) a day for pains.
thanks for help
Expert:  Dr. David replied 1 year ago.
hopefully his PSA is coming down slightly with the taxotere.

I wouldn't worry about the LDH too much. just make sure the AST and ALT liver function enzymes stay low.
Customer: replied 1 year ago.

And Lymphocytes(%) 6.9%? It's true that in 21 days the value increase 0.6% but it's a little increase, when the normal percent are 20%-45%.

This value is due to taxotere treatment or due to the disease?
it's possible that this value goes to a normal value?

thanks

one question more: what is the maximum psa value that you ever seen? I think that PSA value doesn´t reflects the true of the story disease of my father..2500 is too high and he feels so well...
Expert:  Dr. David replied 1 year ago.
no, it is normal for the percent of lymphocytes to vary like that. that is completely normal.

the variation is not due to the cancer.

at most, it might be due to the taxotere affecting the bone marrow. the most significant affect to look for would be the total white blood cell count, not the percentages of the different types of white cells.

the PSA could be super high because the taxotere is killing some of the metastatic cancer and this can release more PSA in the short term.

I have seen PSAs the thousand range.
Customer: replied 1 year ago.
Hi again Dr. David,

Some good news, i think.
PSA values decrease from 2559 to 1818 in 3 weeks.
TGO-AST is now 17U/L

TGP-ALT is now 22 U/L

lactate dehydrogenase (LDH) is 370 U/L

alkaline phosphatase 112 U/L

gamma glutamyl transferase(GGT) 33 U/L


one question: he mades today the fourth session.
How many sessions are possible to do with taxotere? My father is very thin but doesn't have pains.

thanks for all
Expert:  Dr. David replied 1 year ago.
Usually the chemotherapy doctors will do 8 or 12 cycles of taxotere or even longer if the patient is tolerating it well
Dr. David, Doctor (MD)
Category: Oncology
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Customer: replied 1 year ago.

 

ok, my father is tolerating well, but he lost weight...

 

Is it possible that with cycles of taxotere PSA returns to a normal value?

 

how much time can the cancer respond to taxotere?

 

thanks

Expert:  Dr. David replied 1 year ago.
Most likely the PSA will never go back to normal

Taxotere usually extends survival for 6-12 months and will not be able to control the prostate cancer forever
Customer: replied 1 year ago.
hi Dr David,

The first 3 sessions of chemoterapy (taxotere) for my father did not result. He began with a PSA value of 884 and increased until 2559. The LDH value was 1154, AST 35 and ALT 45. Alkaline phosphatase was 148.

Now with more 3 sessions PSA value is 978, AST 19, ALT 13, Alkaline phosphatase 99. I'm worried first because:

PSA decrease with fourth session 750, after fifth session 500 and now in the last only 300.

second because:

LDH value was, after fifth session, 318. Now, this value incresase a little..is now 355.

What do you think? I Know that the decrease of PSA is a very good news, but i'm worried because i think that taxotere is not resulting more.

Have you ever seen a case like this?

Thanks for help
Expert:  Dr. David replied 1 year ago.
I also wish his PSA would decline more, but hormone refractory prostate cancer is a tough situation and you have to be glad that the taxotere is at least working. that is better than his PSA just continuing to go up.

his liver function enzymes look fine.
Dr. David, Doctor (MD)
Category: Oncology
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Customer: replied 1 year ago.
Ok thanks for the feedback

only one more question:

it's possible than taxotere can decrease PSA value more than 300, now? Or it's normal than the decresase will be less and less?
Expert:  Dr. David replied 1 year ago.
it is impossible to know if the PSA will go down any more or not.

there is a limit on how much benefit the taxotere can do. there are very few cases where the taxotere will bring the PSA back down into normal limits and there are no cases where taxotere results in long term like 10 year cures of the metastatic prostate cancer.

but the taxotere has been shown to improve average survival in his situation. if he is tolerating the treatments well without substantial side effects, then the treatments are worth it.
Dr. David, Doctor (MD)
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Customer: replied 1 year ago.
hi again...

After sixth cycle of taxotere PSA decrease from 978 to 859..it' s decresasing less, but decreasing again..
However LDH increase from 355 to 427. This value means that his cancer is growing again?

thanks
Expert:  Dr. David replied 1 year ago.
no, LDH increase in prostate cancer does not mean the cancer is growing.

it can mean some inflammation in the body or in the liver from the taxotere.

that is good that the PSA is slowly coming down.

any bad side effects from the taxotere?
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
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Customer: replied 1 year ago.
No bad side effects..only few and little blood-stained on hands and arms.
No pains..
i think liver function enzymes is fine because AST value is 18U/L and ALT is 21U/l and GGT is 33 U/L.. I think is good..and i'm happy magnesium increase to 1.7mg/dL and total protein increase to 6.2g/dl (this value decrease from the beginning and was 5.7 on the last cycle)
Expert:  Dr. David replied 1 year ago.
those are all good signs. hopefully he will continue to do well on the taxotere and his PSA continues to come down.
Dr. David, Doctor (MD)
Category: Oncology
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Customer: replied 1 year ago.
thanks.
I will give news after August 23..the day of next cycle.
Expert:  Dr. David replied 1 year ago.
you are welcome

thanks for the update.

thanks for using JustAnswers.com
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 1 year ago.

Hi Dr. David,


 


My father made the eighth cycle of taxotere on August 23.


the blood test results are:


AST:15u/L;ALT:19U/L;ALKALINE PHOSPHATASE:123U/L and PSA comes down from 854 to 740 (slowly comes down now).


This time many fungi appeared in his mouth and he has difficulty to eat..but it's surmountable, i think.


 


What you think of this case (PSA increase to 2559 and decrease to 740 in 8 month)?


 


Can he make a stop on taxotere one or two month or is not recommended?


 


thanks for help


 


 

Expert:  Dr. David replied 1 year ago.
I'm glad that his PSA continue to come down.

his PSA has come down to between 1/4 and 1/3 of what it was before.

his thrush fungal oral infection can be treated.

if he does not have bad neuropathy or other side effects from his taxotere, then he should continue the chemotherapy.

is that what his doctors have planned? for him to continue on with taxotere?
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 1 year ago.

His doctor recommended a CT scan in september 5, and a new chemo cycle on september 13.


 


In september 13 we have a new appointement with him to see CT scan result and decided if he continues taxotere or not.


 


I'm curious for bone metastases because alkaline phosphatase is in normal value, but doctor does not plan a bone scan yet.


 


Did you now any case where taxotere kills all bone metastases?


 


Thanks again


 


 

Expert:  Dr. David replied 1 year ago.
taxotere most likely will not kill all bone mets, but can shrink the cancer and can shrink some bone metastasis.

the bone metastasis we see on CT scan and bone scan comes from bone desctruction from the metastatic cancer. if the cancer shrinks, it can take many months for the bone destruction to heal even if all the cancer is gone from the metastasis. if the PSA is going down, hopefully he will have no other new sites of bone metastasis.

good luck with the CT scan.
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Category: Oncology
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Customer: replied 1 year ago.

Hi Dr David


 


In last chemo (September 13), blood test shows that PSA increase from 740 to 880.


AST:30u/L;ALT:30U/L;ALKALINE PHOSPHATASE:103U/L


 


Dr said me: "Don't be in panic, the rise is not significant.."


But it's obvious that i'm in panic..


 


results of CT scan reveals that the disease at the top of the trunk almost disappeared (subclavicular adenopathy and two paratracheal adenopathy), but also reveals two new sites of bone metastasis (left arms and lumbar spine) and a little increase of some iliac adenopathy.


 


liver and lungs are both free of cancer.


 


the doctor planned more 3 session of taxotere..no more..after that he said that he will take a new medicine (now introduced here in hospitals) at home..i don't now the name of this medicine but he saids that is a medicine "of first line/option" as taxotere but best tollerated.


 


I now that in last CT scan (january) the value of PSA was the same (884) and that this value increase until 2559 and now decrease to 880...that signify that taxotere did much work, and maybe the result is not so bad but...


 


What do you think?


 


Thanks for help

Expert:  Dr. David replied 1 year ago.
the taxotere you can say kept the disease in control for for the last 9-10 months when he was on it. without it the PSA would have doubled or trippled and the cancer would be much more extensive at this point.

sometimes parts of the prostate cancer can respond to the taxotere and parts of it can progress as you see with the new bone metastasis. we see this often with metastatic cancer and other cancers.

your father's response to the taxotere is as expected. his cancer is not curable, but can be held at bay for basically a period of time before the cancer figures out how to grow on the taxotere. then a new agent can be tried.

Dr. David, Doctor (MD)
Category: Oncology
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Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 1 year ago.

Hi Dr David,


 


I know that usually the chemotherapy doctors will do 8 or 12 cycles of taxotere or even longer if the patient is tolerating it well, but the question is after 12 cycles we can tried a new agent a period of time, and after this period the patient can take taxotere again if PSA increase? It's usual to do this or not?


 


 


Another question is..because PSA increase in last cycle (740 to 880), we can expect that PSA only rise now or PSA can comes down with taxotere yet?


 


 


Thanks again,


 


He has only a new appointment to his doctor to do a new cycle of taxotere on october 4, and i' m curious to know those things..

Expert:  Dr. David replied 1 year ago.
now that the PSA is coming up, it might be a good idea to try a new agent. you can always to back to taxotere in the future and see if it has effect or not.

the chances are that if he continues taxotere, the PSA will continue to rise, but you never know unless he tries it.

I hope the next cycle of taxotere goes well.
Dr. David, Doctor (MD)
Category: Oncology
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Customer: replied 1 year ago.

Hi Dr David,


 


I talked with the doctor by phone. I said me that the next agent is chemotherapy of second line and tomorrow he will begin this cycle...next week again (one time per week) and the third week he rest. I don't know the name of this agent.. but what worry me is that the new agent is yet a "second line chemo".


 


the CT scan show that iliac chain adenopathies decreased significantly (from 32x25mm to 24x17) and adenopathy of the hepatic hilum decreseaded too (from 34x29mm to 22x18).


We also see some subcarinal adenopathies and pre vascular adenopathies that were not previously present.


Last PSA was 998.


 


Do you think that chemo of second line is the best solution?


 


 


Thanks again.


 

Expert:  Dr. David replied 1 year ago.
why going to a second agent?

lymph nodes are shrinking, PSA is staying stable and is less than before. .

is the neuropathy getting worse? if so, he might have to come off of taxotere to a second line agent.
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Customer: replied 1 year ago.

No, the neuropathy is not getting worse..Yes PSA is very less (the biggest value was 2559!)


 


I think that is due to PSA value...in the last two cycle is coming up (slowly) from 740 to 880 then 998..and because the development of new adenophaties (< 1cm) and new sites of metastases bones..


Customer: replied 1 year ago.

No, the neuropathy is not getting worse..Yes PSA is very less (the biggest value was 2559!)


 


I think that is due to PSA value...in the last two cycle of taxotere is coming up (slowly) from 740 to 880 then 998..and because the development of new adenophaties (< 1cm) and new sites of metastases bones..


 


 


I'm afraid to try it (chemo of second line) now, and after that therfe will be no more chances (because chemo of third line doesn't exist) ...and i think is too early to second line...I only understand this, if the doctor thinks that we can reduce lymph nodes until 1cm or reduce PSA to 200 or 300...


 


What is your opinion?


 


 


 


Expert:  Dr. David replied 1 year ago.
I think with two rising PSAs and new areas of adenopathy, the only option now is the second line of chemotherapy.

there are other options for treatment after second line chemo, but these might only be in USA. things like provenge.
Dr. David, Doctor (MD)
Category: Oncology
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Customer: replied 1 year ago.

Hi Dr David,


 


My father made today first cycle of jevtana.In last 15 days without treatments PSA rise from 998 to 1083.


 


Today Hemoglobin was 8.6g/dL and he mades a blood transfusion.


 


How many cycles of jevtana can a man do in maximum?


 


Can jevtana decrease PSA to a normal value?


 


And after jevtana we have the option of zytiga or this drug is less eficient?


 


Thanks for help


 


 


 


 

Expert:  Dr. David replied 1 year ago.
jevtana most likely will not get the PSA to normal. it might bring it down a bit.

second line and third line drugs after taxotere are usually less effective than taxotere.
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Satisfied Customers: 27783
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Customer: replied 1 year ago.

Hi Dr David,


 


My father is now with many bone pains ..His Dr prescribed 32mg of hydromorphone daily.


While we waiting for zytiga he doesn´t prescribed other chimio..but since we are waiting (1month) alkaline phosphatase rise from 132 to 164 and PSA rise to 1400.


 


We don´t know how many time zytiga can take to get to hospital (the request has been done last month)...


 


Did you agree that my father is now only on prednisona and hydromorphone for pains? Why dr doesn't try something else while we are waiting?What is your opinion?


 


have you ever see alkaline phosphatase values so high?


 


Thanks for help


 


 

Expert:  Dr. David replied 1 year ago.
sorry for your father's situation and delay of therapy.

your doctor should refer him to a radiation oncology for consideration of some pallative radiation thearpy to areas of bone pain to help decrease bone pain as he waits for the zytiga. this might help the prednisone and hydromorphone for pain. yes, alkaline phosphatase can get very high when there is a lot of prostate cancer spread to bone. this is consistant with his PSA elevation as well.

there must be some radiation centers close to you in portugal. do you know of a cancer center with a radiation machine to treat prostate cancer spread to bone?
Dr. David, Doctor (MD)
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Customer: replied 1 year ago.

Yes,


 


In oporto and lisbon we have one.


what did you think of zytiga?..i already read much things, some goods or very goods saying that zytiga can kill bone metastases and others saying that zytiga doesn´t works for much patients..


 

Expert:  Dr. David replied 1 year ago.
your father has been through much systemic chemotherapy already.

zytiga tends to slow down the growth of the cancer somewhat, but will not cure him of his prostate cancer. the range of responses can vary as much as the responses you have read

here is more information regarding zytiga

http://www.medpagetoday.com/HematologyOncology/ProstateCancer/33048

Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 1 year ago.

Hi Dr. David,


 


PSA of my father is now 1975. We are waiting for zityga...I think only in January 2013...and PSA rise 170 in a week...However, alkaline phosphatase drop from 165 to 150 U/L...some hope...


A friend of family with head cancer was advised by 2 oncologists to eat anona (annona squamosa). She did not chimio.


What is your opinion about anona?


 


I found in magazine Nutrition and cancer (June 2011) an article that explains that anona inhibit tumor growth..


 


Did you have some experiences with patients who eats anona?


 


Thanks!

Expert:  Dr. David replied 1 year ago.
yes, he can try to eat annona fruit, but most likely it will not do too much to slow the prostate cancer down.

I have not had any patients try to eat annona fruit.

we can not get that here in USA where I live.

if your father wants to try, that is fine. let me know how it goes.
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 1 year ago.

Hi Dr. David,


 


My father started zytiga 2 weeks ago. PSA was 2200, LDH: 1000 and phospatase alkaline:215. Much pain on left femur bone.


 


Today he makes blood control.


I don' t know PSA value, because Dr, say that he request PSA only once time per month, but LDH rise to 1400 and phosphatase to 240 (the last rise was from 150 to 215).


 


Liver functions still good (AST:18;ALT:25).


 


Two weeks ago, Dr said that probably Zytiga not works imediatly.


 


Can we deduce that Zytiga is not working with this bad blood results?


 


Thanks for help


 


 


 

Expert:  Dr. David replied 1 year ago.
you have to see what the PSA is, but if the PSA is elevating, the alk phos is elevating and if the LDH is elevating, then most likely the zytiga is not working to slow the prostate cancer.
Dr. David, Doctor (MD)
Category: Oncology
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Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
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Customer: replied 1 year ago.

Hi Dr David,


 


My father mades in February 1, a new test blood: alk phos decrease from 240 to 140; LDH from 1400 to 1164 and PSA from 2200 to 2000 (since January 16 the day of last blood test).


 


Finally we can say that zityga is working? What do you think?


his doctor says that is too early and we don't say that yet.


 


Things are complicated...he is now in hospital because the last blood test of February, 1 reveals urea (80 mg) and creatinine (2,5). Today February 4, new blood test: creatinine 2,1 and urea (91mg).


 


Doctor say that the case is a Kidney failure due maybe by zityga and decide to stop zytiga.


I don't understand why creatinina decrease but urea rise. Are those levels are in dangerous range??


 


thanks for help


 


 


 


 

Expert:  Dr. David replied 1 year ago.
yes, it looks like the zytiga is at least moving the cancer in the right direction.

zytiga doesn't usually cause kidney weakness.

kidney weakness much more likely to be caused by his prior Jevtana which can cause renal failure and elevation of creatine levels.

urea is created by protein breakdown. so increased protein breakdown can cause urea increase.
Dr. David, Doctor (MD)
Category: Oncology
Satisfied Customers: 27783
Experience: Experienced Oncology Physician trained in New York City. I'm ready to help.
Dr. David and 3 other Oncology Specialists are ready to help you
Customer: replied 1 year ago.
Hi dr David,
my father has a total kidney failure since yesterday morning.

his doctor said me that is irreversible and he has a few hours of life.

is true that kidney failure are irreversible?

Thanks for all

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