October 31, 2005

Crystal Ball

No, I'm not going to quote the lyrics from that mediocre Styx song from the 1980's but Looking back, before looking forward; the past month has just raced by! Our golf tournament was four weeks ago already, amazing.

Wednesday will mark nine months since my initial biopsy and the first entry into this blog. Where has the time gone?
Time is racing by, but what am I racing towards?

This Friday I go in for my next blood test. I guess I should be apprehensive, a little scared, worried? I'm not.
I find myself in this very accepting and calm state of mind. I don’t have much to share with those close to me regarding
how I'm feeling, what I'm thinking etc. because things are somewhat normal at this point. Whatever happens, happens. As bad of a cliche as that may be, I really feel like "bring it on!". Throw the best you have at me because I'll get through it! What ever lies ahead will certainly not be easy, but I am strong mentally, spiritually and physically.

Have you started listening to Christmas Carols yet? We have….it's fun to be sitting at a stop sign bellowing "It's beginning to look a lot like Christmas" and the people around you have no idea what you are doing!

October 28, 2005

Medical News, part II

Again, some news that is encouraging but likely to have no short term effects. But it is good news none the less!

New prostate cancer clue

Fusion of genes, also seen in other types of cancer, may lead to better screening and treatment, study says


October 28, 2005

Prostate cancer may result when two genes accidentally combine within a cell, a research finding that may point to new ways to diagnose and treat the disease.

The fusion of normally separate genes in prostate cells was observed in more than half of cancer samples in a study released today in the journal Science. The combined genes cause the overproduction of proteins that spur cells to grow out of control, according to research led by Arul Chinnaiyan, a biologist at the University of Michigan in Ann Arbor.

"There is really intriguing evidence that this particular gene fusion is the causative agent of prostate cancer," Chinnaiyan, 35, said in an interview. What causes the genes to fuse isn't known, he said.

Newly diagnosed cases of prostate cancer in U.S. men will total about 232,000 this year, and deaths from the disease will top 30,000, according to the Atlanta-based American Cancer Society.

Gene rearrangements involve the movement of a gene fragment from one segment of DNA to another, often affecting whether the gene is turned on or off. Such rearrangements previously were found in leukemia, lymphoma and soft-tissue cancers.

Tests for the presence of the fused genes in blood or urine would be "far more accurate than current screening tests," according to Chinnaiyan. Doctors now test men for prostate- specific antigen, a substance released by the prostate gland.

PSA tests often are positive even when cancer isn't present, so biopsies are needed to confirm cancer. Better tests would reduce the need for biopsies.

Knowing that gene mutations can cause prostate cancer also gives drug companies targets at which to aim new medicines. The discovery that gene fusion is at the heart of chronic myelogenous leukemia, a disorder known as CML in which the body produces cancerous white blood cells, led to the development of a Novartis drug called Gleevec.

In the new study, the researchers found "overexpression" of two proteins in 95 of 167 cancer cases, and in none of 54 tissue samples with no cancer. Two genes involved, ETV1 and ERG, previously were implicated in cancer-causing genetic rearrangements in a rare bone cancer called Ewing's sarcoma, according to the National Cancer Institute in Bethesda, Md.

The gene fusion in prostate cancer "is likely to be the most common rearrangement yet identified in human malignancies," including the majority of prostate cancer cases, the researchers said in the journal.

Other gene fusions not yet identified may account for the remaining cases of prostate cancer, Chinnaiyan said.

The study provided the first evidence that "non-random, recurrent" genetic rearrangements can occur in cancers derived from so-called epithelial cells, which line the body's cavities, the National Cancer Institute said. Unlike the random scrambling of genes seen in some tumor cells, prostate cancer appears to involve a recurrent pattern that can be used to predict the disease.

Epithelial-cell diseases include breast, lung and colon cancers, Jacob Kagan, a program director at the National Cancer Institute, said in a statement today. The institute, part of the U.S. National Institutes of Health, was among sponsors of the study.

New drugs might be aimed at inactivating ERG or ETV1 or at inhibiting their expression in the first place, Chinnaiyan said. The study results must be verified in a larger number of tissue samples before new detection techniques or therapies can be developed, the National Cancer Institute said.
Copyright 2005 Newsday Inc.

October 26, 2005

Encouraging medical news

A New Approach to Chemotherapy

Doctors Try Lower Doses, Given Continuously, To Reduce Side Effects and Starve Tumors

October 25, 2005; Page D1

In the battle against cancer, doctors are finding new ways to use an old weapon: chemotherapy.
The idea behind chemotherapy has long been that more is better. In order to kill the tumor, patients are traditionally given the highest dose they can tolerate. But because the drugs are so toxic, the process must be periodically halted for several weeks to allow the body to recover. Some doctors argue that this resting period can allow a tumor to rebuild the network of blood vessels that it needs to keep growing.
Now, these doctors are experimenting with a new approach, giving very low doses of chemo drugs for extensive periods of time, with no rest. The approach represents a significant shift in thinking because the target isn't the cancer tumor itself. Rather, the aim is to halt the underlying growth process. Because the method spares patients the toxic side effects of high-dose chemo, such as vomiting and anemia, it can be given continuously for the long term -- perhaps turning the cancer into a chronic, manageable condition.
Sometimes called "chemo lite" or "metronomic chemotherapy," the method is being studied at the Dana-Farber Cancer Institute in Boston, Cedars-Sinai Medical Center in Los Angeles, the University of Toronto and other centers. Doctors are reporting promising results in a handful of clinical trials on cancers that include brain tumors, non-Hodgkin's lymphoma, and breast and ovarian cancer.

The low-dose approach isn't widely accepted, however, partly because of fears that it may result in undertreatment and jeopardize survival. There is also evidence from lab studies that even in low doses, side effects such as suppressed immune systems do eventually appear over time. So far, the approach has been used in patients with advanced cancer who have failed previous therapies. For these patients, the lack of immediate side effects has improved their quality of life. But doctors have just launched or are planning some new trials for people with breast cancer, ovarian cancer and some pediatric cancers who have less-advanced disease but are at high risk for a recurrence.

The new method comes at a time when there is increasing hope that, when cancer can't be cured, patients at least can continue to live with the disease for many years. Newer "smart" drugs such as Tarceva and Iressa are designed to target only cancer cells, not normal ones, minimizing toxic side effects that make chemotherapy so hard to tolerate and creating the prospect that they can be taken for years, not months. New attention to some of the side effects of treatment, and an increasing understanding of the biology of cancer have also helped create excitement about one day making cancer a chronic condition, much like diabetes or heart disease is today.

Low-dose, continuous chemotherapy is also part of a rising focus in oncology on the process known as angiogenesis, whereby the body develops new blood vessels that can feed tumors. A number of drugs in development, along with some current smart drugs such as Avastin, also work as so-called anti-angiogenic agents that aim to choke off a tumor's blood vessels. Instead of solely targeting tumors, which vary greatly from person to person and organ to organ, these drugs also target the blood vessels that tumors need to grow. Some researchers believe this approach could ultimately be far more widely effective.

Keeping Growth in Check
Researchers believe the low-dose chemotherapy, which is being given in combination with anti-angiogenic drugs, may work because it keeps the development of blood vessels in check. It is able to do this because the less-toxic treatment eliminates the need for rest periods, which give blood vessels a chance to start growing again. Even tumors that had become resistant to standard chemo drugs still responded to the low-dose approach in studies, these researchers say, because the treatment stemmed the growth of new blood vessels.
"So much of our current cancer treatment depends on understanding the intricacies of a specific tumor," says Mark W. Kieran, a pediatric oncologist at the Dana-Farber Cancer Institute who has led low-dose chemo trials. With this new approach, Dr. Kieran said, "we're attacking the tumor's supply line."

Many doctors are trying different ways to give chemotherapy, such as changing dose schedules, with the goal of making the regimens more bearable. A traditional chemotherapy regimen may last about six months and includes high doses -- such as 1,000 milligrams of the chemo drug cyclophosphamide every three weeks. Some doctors have experimented with how to spread out the dose, giving a little less at a time, but every two weeks. But this new low-dose method typically involves a fraction of the standard chemo amounts. In a number of anti-angiogenic trials, patients were given 50 milligrams of cyclophosphamide every day, with no breaks.

Still Responding
In one of the first published reports from the current wave of human trials, Dr. Kieran and his colleagues at Children's Hospital Boston and St. Louis Children's Hospital in St. Louis, Mo., will report next month on a trial of 20 children with various kinds of cancer. In the trial, the children received a cocktail of drugs known to interfere with the angiogenesis process, including Celebrex and thalidomide, as well as low doses of the chemotherapy drugs cyclophosphamide and etoposide. Five of the 20 patients are still responding to the treatment, according to the paper, to be published in the Journal of Pediatric Hematology/Oncology. Dr. Kieran says even just a 25% response rate is significant because these patients had no treatment alternatives left.
One of those children, Michael Shelley, age 10, was diagnosed five years ago with a brain tumor called ependymoma. He had surgery but the tumor came back. He underwent a second surgery followed by radiation, but the cancer came back again. So Diane Shelley, Michael's mother, enrolled him in Dr. Kieran's trial. At one point, she says he was up to 16 pills a day, drinking huge quantities of orange soda in order to take the regimen, which he was on for a year and a half. Mrs. Shelley says there were side effects: Michael was very tired, and because his immune system was so suppressed he got massive warts on his hands that made it hard for him to write. They ended the treatment after he needed a transfusion because his blood count got too low.
But Michael recently had a brain scan and "it was clean," said Mrs. Shelley. He just signed up to play basketball and baseball at school. "Compared to what other kids go through for chemotherapy, the side effects were minimal," says Mrs. Shelley.

Dr. Kieran is working on a new trial, which will study 160 children at hospitals that include New York University Medical Center and St. Louis Children's Hospital. He pays for these trials in large part with private donations.
There have been arguments in the medical community that perhaps the drugs are actually killing the tumor cells themselves and that is why the regimen works. But Dr. Kieran and his colleagues note in their paper that three of the patients had previously been treated with high doses of the same chemo drugs and seen their cancers grow. Now on low, sustained doses of the drugs, their cancers weren't growing or in some cases had shrunk.

Some Doubts
Not all trial results have been so promising. Ian Tannock, a medical oncologist at Princess Margaret Hospital and the University of Toronto, led a study of anti-angiogenic chemotherapy in kidney-cancer patients. He said that of the 30 patients, one saw his tumor shrink and two others were stable. Dr. Tannock, who believes anti-angiogenic drugs like Avastin are beneficial, called the low-dose chemo results "not remarkable." "I think it's a reasonable idea to test," he says, "but I don't see this as the wave of the future."
Sandra Fraley, 56, of Boston, has advanced breast cancer and has been on a low-dose daily chemotherapy regimen plus Avastin for a year as part of a current clinical trial. She says she had chemotherapy when she was first diagnosed in 2001, and "it took me a year to regain my strength."
When she started having intense back pains in 2004 and was told the cancer had come back in her bones, she was worried about the side effects of more chemo. She says with the low-dose approach, her cancer has remained stable and the main side effect has been fatigue. As part of her current regimen, she gets one of the same chemo drugs she took in the past, cyclophosphamide, but instead of 1,000 milligrams once every three weeks, she takes 50 milligrams every day. Compared with the higher doses she previously endured, she says, "this is a walk in the park."

Next Phase of Research
Harold J. Burstein, an oncologist at the Dana-Farber Cancer Institute who is the principal investigator of Ms. Fraley's trial, says he thinks the biggest benefits of anti-angiogenic chemotherapy will be in patients whose cancer isn't so advanced. He and researchers at Indiana University in Indianapolis have launched a pilot study open to women who got chemotherapy prior to surgery for breast cancer, but who had residual cancer in their breast or lymph nodes. These women are at high risk for recurrence, Dr. Burstein said.
Both this and his current trial are funded in part by grants from the National Cancer Institute and the Avon Foundation, as well as Avastin's maker, Genentech Inc.
"We need to generate more compelling clinical data if this approach is going to be useful," Dr. Burstein says.

October 19, 2005

Songs about......

Latley it seems like I have this knack for finding songs that either mention death or are primarily about death. Today for example, 3 of the 4 songs I heard on the way into work were just that. Here are parts of the lyrics for two of them:
The Calling - Wherever you will go
So lately, I've been wonderin
Who will be there to take my place
When I'm gone, you'll need love
To light the shadows on your face
If a great wave should fall
It would fall upon us all
And between the sand and stone
Could you make it on your own

If I could, then I would
I'll go wherever you will go
Way up high or down low
I'll go wherever you will go
Goo Goo Dolls - Broadway
Broadway is dark tonight
A little bit weaker than you used to be
Broadway is dark tonight
See the young man sitting
In the old man's bar
Waiting for his turn to die
So, with a mind set influenced by that, I came up with this:

Motionless in the curb, in the lawn,
succumbing to a slow death.
Your life was too short,
less than a season.
At birth you brought hope,
in death a reminder of darker times.
Your parting brings thoughts of cold,
of damp, of darkness.
And so begins the season,
that weighs most heavily on my heart.

Please don't misinterpret, I'm actually doing quite well. No I'm not depressed. My back pain is 100% gone due to a new office chair! Too think we might have considered radiation treatment!!! Many many years from now perhaps I will be "the old man sitting in the young man's bar......"?

It's Fall now, 5 months until Spring!

October 13, 2005

Why are we here?

I've been thinking a lot about this lately. Is there a purpose, a meaning to why we are here? Part of me says it is to help each other. One can see this every time there is a crisis. People want to help and they do help...sometimes in overwhelming or extraordinary ways!

However, when there is no crisis, and we meander through our day to day lives, what is it we are doing to help one another? It seems very easy (natural?) to make decisions that benefit ourselves first and foremost. When it comes to making tough choices between something that will benefit you or your family or something that will assist a total stranger, that's when it gets tough. I have no answer, I struggle with this like the rest of you. It's just something that has been on my mind.

I also wonder, was the time and effort we put into our recent golf tournament worth it? It was successful but will the money we donate "make a difference"? The direct benefit to me and my case are unlikely. The longer term benefit to others is more likely, but unknown. I'm not discouraged, that is not my intent in this message….I'm just wondering about this as well. It's not about me, my case, or me leaving a legacy. It's about some 30 year old guy that in 10 or 15 years goes through this and will have more choices, better choices and hopefully, a cure!

And for my final topic of the day...Did you know that September was 'Prostate Cancer Awareness Month'? I didn’t think so. Did you know that this month is 'Breast Cancer Awareness Month'? I thought so! Here is my concern: A man has a 33% greater chance of getting Prostate Cancer than a women does of getting breast cancer!! I feel that there is so much work to be done to expand the awareness prostate cancer. My greatest concern is that what has happened to me can happen to so many others. The people that run the Komen Foundation are very good at promoting their cause. PCF can definitely learn from their example and vision! I read a story on Tuesday that Kodak is placing a pink awareness ribbon on the NASCAR that they sponsor? (click here) Where is the blue ribbon? Where are the blue ribbons on NFL, NHL or MLB helmets? I hope that the research that is supported by the breast cancer awareness campaign will benefit cancer patients suffering from other types of cancer. (Maybe even me!) I hope and pray that the organization that supports the PCF mission will continue to evolve and become more effective in promoting an awareness of prostate cancer and continue to acquire funds that will support the research required to find a cure. Personally, we are committed to support PCF and to do our best to raise the awareness of this disease in our community.

BTW - Go Cardinals!!!

October 06, 2005

Gratitude and more opinions

I apologize for they delay but Monday was a whirlwind and things are finally winding down. It felt to both of us like a wedding reception. Old friends and new, co-workers from the past and present, family... it was all quite overwhelming. There were so many people I saw that I wanted to spend more time talking with, but we just ran out of time. In the end it appears that through the help of family, friends and complete strangers, we can accomplish almost anything!

Strangers are friends you have yet to meet.

Life is too short to go through it alone. Be thankful everyday for the friends that surround and support you.

Call it a clan, call it a network, call it a tribe, call it a family: Whatever you call it, whoever you are, you need one.

Regarding the last; I personally consider everyone who helped, sponsored, donated, played, etc. part of MY clan. You have my deepest appreciation. Your support means more to me than you will ever know.

The tournament was an incredible success, and we have received many compliments. We hope that each participant had a great day out at the course. We had almost 120 golfers and beautiful weather throughout the day (just a little warm, but definitely bearable). At this point we still have a few checks to collect and several bills to clear up, but it looks like we be able to exceed our goal of making a $10,000. donation to PCF to support research for advanced PC. It's hard to believe that all of this came together in just under four months. We owe a debt of gratitude to the FLHW Board, Rich, Mark, Steve and Chris. Additionally, special thanks goes to the many volunteers who helped keep everything running smoothly throughout the day.
…and so, with very little sleep, we had an appointment on Tuesday with a radiology oncologist, Dr. Smalley. I have been having back pain at the end of most days and wanted to check in with an expert. We got lucky again and found a great doctor. He was personable, highly intelligent and most importantly ~ HONEST. We spent almost an hour with him discussing both my case and his approach. To summarize -
1) He was supportive of the dietary and exercise regimen [and somewhat envious]
2) He was willing to administer radiation treatments to my back and was 100% sure they would help, but was cautious about playing this card to soon. He also wasn't 100% sure there is a correlation between the pain and the cancer, based on my description of the pain and a few test he administered. He suggested for now I begin taking Advil, as it has been effective in relieving the back pressure.
3) We discussed the hot flashes at length and there are a few FDA approved drugs that can address this symptom.

We are going to discuss further with Dr. Davis before moving forward. (One of the drugs is Prozac ~ it is a milder dose than what is normally prescribed and would have no effect on my mood, being that I'm a pretty happy person to begin with ~ however, just the idea of another drug leaves me a bit reluctant.) My next appointment with Dr. Davis is in 3 weeks, when I am scheduled to receive my next Lupron shot and will have another PSA test as well. We pray that the PSA # will resume to a lower level.

That's it for now…...