November 09, 2010

The times they are a changing, again.

 The times they are a changing

I'm a little late in getting started with the blog this month, but after today's Oncologist appointment, November is certain to be full of updates.

My PSA is up from 36 last month and now sits at 52.

This is not the news I was looking for at all. It seems that after seven months DES (estrogen) has run it's course. Though I am feeling fine, we now find ourselves at a crossroads once again. We have several options we are going to pursue and the plan is to review these with Dr. V when we meet with him next Monday.

One option is Provenge. I have written about it here before, but at a high level it is a new and emerging class of drugs called 'Immunotherapy'. Provenge is administered in three treatments over a one month time frame. With each treatment the patient spends several hours having their blood cells extracted through a process called 'Leukapheresis'. The extracted matter is sent to a laboratory where it is merged with Provenge, fermented and three days later sent back to be re-infused into the patient. There are two outstanding issues with this option: Will insurance pay for it? If so, can we find a location with supply such as Omaha or will we have to travel further? (the drug was just FDA approved in April and remains in short supply until next year)

Another option, and the one we prefer, is a drug still being evaluated in clinical tests called Abiraterone. The latest news from Johnson & Johnson is available here. Again, at a high level;  Abiraterone acetate is a novel, targeted, investigational, oral androgen biosynthesis inhibitor being developed for the treatment of metastatic advanced prostate cancer that has progressed after developing resistance to conventional hormonal therapies. This is also known as castration-resistant prostate cancer (CRPC).
There is a Phase II trial I might be eligible for but we'd have to travel to San Francisco a number of times.  Additionally, Abiraterone is also going to be made available through expanded access, as a non-blinded Phase III trial, but the timing for that approval may be longer than we are comfortable with, as it could be late December or into next year.
There is a third drug called XL 184 that I found out about through friends at the Prostate Cancer Foundation. Once again, there is a timing issue and an eligibility issue with my specific case.

All of this will be reviewed on Monday.  After we review the options with the doctor, we will make the decision we feel is best at this time.  The bad news is the test score and the increase in my PSA level. The good news, if you can call it that, is that we have a few options in front of us.  The challenge with the options is the timing and availability of the drugs.  Treading through the gray area of decision making is always a bit stressful, but we choose to remain positive and continue to have hope and faith that we will select a treatment that responds favorably.


Anonymous said...

Dr. Nick Vogelzang is a leading researcher for Provenge and it is available here in Las Vegas. I can even help out with the housing. You can contact Nick at (702) 954-3400. He has had good success with the insurance companies. Nick is a world class prostate cancer oncologist that i personally use. You might consider that call for Abiraterone as well.


Anonymous said...


I don't know your history but you might want to also investigate ProstVac ( It doesn't appear to be as widely available as Abiraterone but it looks promising.

My Father in law is has been undergoing treatment with Abiraterone since April this year with outstanding results. PSA was over 3,000 and rising quickly when he started and dropped to less than 30 by the end of Sept.

Brian - Prostate Cancer IV said...

Still praying for you David. Thanks for the updates on treatments. As I come to crossroads I look to your experience for guidance.

Anonymous said...

David ,
My thoughts and prayers are with You and Mary this weekend as you make your decision .
My thoughts are that abiraterone after keto trial in SF is an open label and it looks to me as if both arms get the drug. There is no guarentee that the other trial you want will in fact open in Jan. Besides that Provenge would be great if You could overcome the insurance and availability obstacles, especially if you could still get abiraterone either on one trial or the other afterwards.
Another thought for later would be the new chemo approved and the different combinations of chemo written about on Howards site.
Dan J

Dan said...

I second the vote for Dr V, Tony. I travel from Salt Lake City to work with him. (btw, phone number is 702-952-3400)

Another clinical trial that's less well known uses radium-233 injections that settle into bone lesions and reduce lesion size and pain. It's available in several U.S. sites even though it originated in Norway. More info at However, it is a phase III trial with a placebo arm.