Tuesday, May 28, 2013

Degaralex, Zometa, Prolia, Cassodex, and Lupron

These sinister sounding words are the gobbledygook of cancer. Here is the study, the experience, and the decision to be made.  When does one stop?

Make me know יהוה my end
and the measure such as it is, of my days
let me know how finite I am! (Psalm 39)

For the past 21 months I have been contending with cancer. (For contention - see Psalm 35 - Contend יהוה with my contenders, and watch out for the negative aspects of one's own inner contention - Meribah, see Psalm 95).

I had a Gleason scale 10 cancer of the prostate, a thoroughly deserving tumor.  I see the doctors as the hands of God on my body. They act and learn as we all do - with the best of intentions.  My oncologist, saying that I have done very well, has now put me back into the hands of my urologist.

My tumor got the full treatment. Above a PSA of 10 (Prostate Specific Antigen) the cliff begins, a cliff that leads to bone metastases (and that's not Hebrew grammar where worship has a  metastasized taf - a meso-fix.)  I had a PSA of 30 - so I began hormone therapy or androgen deprivation therapy - and the PSA dropped rapidly at first then slowly to 0.1 at which point, radiation therapy was applied. I have written about this elsewhere. I had 37 days of laser light therapy in February to March.

Before starting, scans were done and no spread of the cancer was detected. The deprivation therapy is a whole body treatment, so if there were bits undetected, they were probably also starved in the process.

It takes some time to recover, but my recovery is well under way. We have managed a 7100 km road trip and several games of golf. I am back on my bicycle and we walk lots. I have even played a set of tennis. Now the PSA is down to 0.01.  And will undoubtedly stay there for the next 6 weeks. The Degaralex 'suppression' therapy was applied monthly for 17 months. In the last few months it was supplemented by Cassodex. The final injection of the Degaralex disagreed with me thoroughly - fever, asthma, increased heart rate etc.  So we switched to Lupron (on a three month dosage - allowing us more freedom to travel). These therapies make one liable to 'catch' osteoporosis, so along with the suppression therapy, other drugs like Zometa or Prolia are prescribed to prevent bone loss. One must take calcium supplements and vitamin D as well.

I will never stop taking the vitamin D - it seems to prevent colds.  I have had zero other health problems during this treatment period.

Now here's the question - theological, scientific, and practical.  There were tests done on the protocols for treatment of prostate.  They are really primitive as far as data collection is concerned.  There were two groups - those that intended to do what I have done - androgen suppression therapy for three years and radiation and those who did radiation only.  Notice that word 'intended'.  If someone in the suppression therapy group said after 0 treatments - phooey - I won't do this and did radiation only, he (yes it is he) was not moved to the other group but stayed in the initial group he was placed in.  The suppression/radiation group had a 20% improvement in survival rate over the radiation only group after 5 years.

So if 80% of the rad only group was alive after 5 years, then 96% of the sup/rad group was alive after 5 years.  And many of them dropped out of the sup therapy after 0, 1, or 2 years - i.e. before the 3 year target. What is the optimum trade-off between the risk of recurrence and the risk of long term disability due to energy loss?  My own opinion is that the less medicine, the better.

Also note that it takes 6 months after the last injection (in a three month injection cycle, there's up to a 4 month dosage) to recover from the side effects. The first side effect is lack of desire (useful actually) and the second is lack of energy (debilitating actually). My next scheduled injection is July (some retention of the suppression component will continue until August even without an injection).

So when should I quit?  My next injection of Prolia will be in Sept if I don't quit. And it - well they all - cost money, but Prolia I have to pay for (granted that extended health coverage kicks in also).

I will ask my urologist and my regular doctor as well - wonder what they will advise if anything...