Becoming immune to Zoladex

[Simon Brentford]

Hello,

I have been advised to come here cancerforums.net. I am writing here for the first time on behalf of my father (age 72). The long and short of it is that I think he is becoming immune to his Zoladex injections.

I am looking for other peoples opinions to the stated facts below and also some other treatment ideas.

1. The PSA test has been a good predictor of cancer activity in his case.
2. There has been no evidence of secondary disease.
3. He has a cryo-ablation procedure of the prostate 22.04.04. The PSA then fell to 0.1 subsequently and has remained low for 15 months until the beginning of this year.
4. MRI scan 13.03.07 showed no sign of a tumour, so any rise in PSA indicated activity at micorscopic level.
5. PSA values:
13.03.07 0.5
22.01.08 0.8
20.01.09 2.0 Zoladex injection triggered by this value
05.05.09 1.9 Another 3-monthly Zoladex injection
11.06.09 2.5 another PSA test in 5 weeks to check if the trend continues and whether this indicates resistance to the drug.

So any opinions or ideas on other treatments?
Kind regards,
Simon

[E. Michael D. ("Mike") Scott]

Dear Simon:

Patients like your father, who are treated with LHRH agonists like Zoladex, will, after variable periods of time, often stop responding to these agents. It's not so much that they become "immune" to them as that the proportion of hormone-sensitive prostate cancer cells in the patient's body gets smaller compared to the proportion of hormone-resistant cells.

Your father appears to be early in this process (at least based on the information you have provided above) but his PSA doubling time is a little worrisome because it seems to be relatively fast at somewhere between 3 and 6 months. I think there is little doubt that he is no longer responding as well to the Zoladex alone.

There is a wide range of potential opportunities still available for him, however, many of which will depend on other health factors and his personal wishes. Here's a preliminary list of possibilities:

-- Try switching to a different LHRH agonist, i.e., leuprolide acetate or histrelin
-- Try adding an antiandrogen (e.g., bicalutamide) to the Zoladex
-- Try adding a 5-alpha-reductase (e.g., dutasteride) to the Zoladex
-- Try adding both an antiandrogen AND a 5-alpha-reductase to the Zoladex
-- Think about the possibility of early chemotherapy with Taxotere + prednisone (while still staying on the Zoladex)
-- Ask about trying a completely different type of hormone therapy, such as estramustine (Estracyt) --
-- Ask about clinical trials of investigational agents such as abiraterone acetate (a new trial has just started for which your Dad is likely to be eligible) -- contact the Royal Marsden Hospital in Surrey to find out about these trials, which are being supervised by Dr. de Bono.
-- Ask about ketoconazole therapy, but you don't want your Dad to do this if you want to get him into the abiraterone trials because prior ketoconazole therapy is an exclusion factor for those trials

That list should give you a good start. Others will probably add information here from their personal experiences.

[Simon Brentford]

Many thanks for your prompt reply. This gives me some new places to research.

Anyone else with some ideas / opinion?

Regards, Simon

[E. Michael D. ("Mike") Scott]

Simon: It's still early here in the USA, and the west coast hasn't even thought about today yet. You'll get lots more replies over the next 24 hours. I'm just one of the world's early risers! :O)

[Steve J]

I'll just add this:

The purpose of the LHRH agonists Zoladex (goserelin acetate), Lupron (leuprolide acetate) in its various guises, and Trelstar (triptorelin pamoate), is to suppress production of testosterone in the testes.

Seems to me that, in order to confirm whether the Zoladex is no longer effective, it would be wise to have a simple blood test for total testosterone performed.

[Simon Brentford]

Thanks for the info Steve. He is having this test done next week and thanks Mike this drug was also suggested. So fingers crossed, my father is making a good step in the right direction.

[Mike Simmons]

After my PSA rose to 15 after having my prostate gland removed, I started using a product called Prostasol. After two months my PSA was 0.2. That was almost four years ago. My last reading taken last month was 0.1. You can buy it from several sites on the internet.

Here is a site that will offer you some hope from a Dr. Pfeifer,

http://www.clearfeed.com/pfeifer/05excel-transcript.html

You can also get in contact with a great number of prostate cancer survivirs on the Yahoo forum,
'Natural Prostate Treatments" at

http://health.groups.yahoo.com/group/natural_prostate_treatments/

Mike S

[Steve J]

Mike S wrote enthusiastically about Prostasol.

The decline in PSA, if attributable to nothing else, was likely the result of the undisclosed diethylstilbestrol (synthestic estrogen) in the stuff. This was reported by Danish medical authorities in November, 2008. See,
http://www.dkma.dk/1024/visUKLSArtikel.asp?artikelID=10577
or
http://tinyurl.com/l9vde6

Estrogen can cause, among other conditions, DVT (deep vein thrombosis), pulmonary embolism, and myocardial infarction.

See the entries for various estrogen compounds on www.rxlist.com