Just When You Thought it was all Under Control…

If you have been on hormone therapy for a while, read this

 

I usually don’t get too excited about any study that talks in terms of “associated with” rather than quoting actual statistical support or even actual numbers, but… This report was published in The Journal of Clinical Oncology.

According to the Journal article there is an “association” between men being treated with hormone therapy (androgen deprivation therapy) and an increased incidence of diagnosed Alzheimer’s disease.

16,888 men with prostate cancer (2,297 being treated with a hormone therapy) were followed for 2.7 years. In this group there were 125 new diagnoses of Alzheimer’s disease. Overall, those treated with hormone therapy had an 88% higher risk of being diagnosed with Alzheimer’s than those men not on hormone therapy. The longer men had been on hormone treatment, the higher the risk.

There will be further studies, of course and more definitive information will be available. In the meantime, researchers and doctors do not have any recommendations for us. Don’t stop your hormone therapy just yet.

I have been on hormone therapy for quite a few years so I will be watching this drama unfold very carefully. Maybe I’d have been better off if I had never read this. Naaaaaaa.

axman

Miracle Cures, Breakthrough Drugs, Game Changers, Cancer Cure Diet, etc…..

In addition to the terms and phrases in the title, you might recognize these additional phrases:

• Now I’m cancer free: you can be, too
• A miracle diet cured my cancer
• Your doctor doesn’t want to cure you, but WE do
• Drug companies don’t want a cure for cancer (hmmmm, that one may need further research)
• I smoked my way to being cancer free
• Our injection was 100% effective in curing cancer in mice

 It must be true; it’s on the Internet

I spend a lot of time (probably too much) browsing the Internet for new and interesting information about cancer. Some of the terms and phrases above are from actual advertisements for FDA approved medications. 

It seems, from my less than comprehensive searches, that there are thousands of absolutely true, guaranteed, time tested, and anecdotally proven cures for cancer available for direct order on the Internet. So why do I still have cancer?

Equal Opportunity Internet

Anybody can advertise whatever they want about anything (mostly) on the Internet and then ask for your money so you, too, can be cured (or conned). There are many who are willing to pay to find out if these claims are true. Maybe those herbs, special mixtures, supplements, diets, and magic beans will actually cure me. But then I also know that truth in advertising is not the norm on the Internet. What we do know is that by buying these products online we are helping to improve the seller’s bank account, wherever it might be.

Why would we even look at these dubious, not very scientific, and highly hyped “cures?” Maybe because many of the very official, very expensive, scientifically tested, and approved meds we now take don’t keep us alive much longer than if we didn’t take anything. Obviously there’s a living to be made in the alternative treatment buy online world. But beware my friends. Anything that sounds too good to be true….you know the rest.

Bottom Line

It’s hard to know who or what to trust in the high profile cancer treatment world. I am sticking with my medical team for now. If something on the Internet looks promising, I’ll ask my medical team first. 

And I know there are some things I can do for myself. I have been doing most of these things, actually, and I’m still alive so they must work.

• Eat a healthy diet (you know what that means for you)
• Exercise moderately and often
• Manage your weight (get medical help if necessary)
• Manage your cholesterol and blood pressure (get medical help if necessary)
• Don’t smoke at all, period
• Don’t abuse alcohol (define abuse for yourself)
• Talk to your doctors and also listen to them. They probably have your best interests at heart. If they don’t, fire them.

 Doing these things will very likely NOT cure your cancer, grow hair, or help you win the lottery but you might feel a little stronger in your battle. 

axman

So Chemo is Good for You Again?

You men with incurable prostate cancer have probably heard at least some of this. In recent years men with advanced prostate cancer were usually given chemotherapy only when everything else failed. When your Dr. said, “Let’s try Chemo,” you (or at least me) figured you were almost dead. In a world where cancer drugs showing ‘significant survival benefit’ keep you alive 3.7 extra months, it’s easy to be skeptical of new claims. 

But wait, things are changing…

A recent article published by Medscape reports changes in the use of chemotherapy. Several recent studies have shown that adding chemo BEFORE the hormone blockers (such as abiraterone and enzalutamide) have failed can lead to ‘significant survival benefit’ for many men—in the 17 to 22

month range (on average). That’s good. Docetaxel, a plant based chemotherapy agent, was used in the studies. It has been around nearly 20 years but just recently used earlier in the prostate cancer treatment cycle. 

Men using hormone blockers and who also have metastatic prostate cancer have been treated with docetaxel infusions while the hormone blockers have still been effective. Those men lived significantly longer than men who did not start chemo treatment until the hormone blockers became much less effective.

But there can be side effects…

Side effects are common. Most cancer meds come with some unpleasant side effects. Docetaxel (like other chemotherapies) has side effects that can be serious enough that some men can’t tolerate it. 

Side effects can include:

•         Being allergic to docetaxel
•         Increased risk of infection, red and white cell blood counts low
•         Nausea 
•         Diarrhea 
•         Mouth sores 
•         Weight gain
•         Hair loss (for those who still have hair)
•         ….and more

So when your doctor brings up the subject of chemo—don’t panic, it just might be worth your while (and a few extra months) to consider the possibilities.

axman

All Those Other Diseases of Old Age

This BLOG has almost always been about prostate cancer, things related to prostate cancer, or coping with prostate cancer. I have written about diagnosis, surgery, no surgery, radiation therapy, clinical trials, hormones, chemo, psychological factors, support groups, family, stages, and more. 

But to put life and diseases into some sort of perspective there are a lot of things other than prostate cancer, that can make old men sick. Really. Prostate cancer has long been the center of my world, but it is not the major cause of illness and death in old men. It’s not even the most dangerous cancer!

Heart disease is the most dangerous condition for older people, both men and women. About 25% of older men die from heart disease. So take care of your heart!

Cancer in general is the second leading cause of death in older men—23%. A majority of those deaths are from lung cancer with prostate cancer and colorectal cancer trailing behind.

After those two major categories there is a long list of life threatening things that can happen. The list includes injuries, COPD, stroke, diabetes, suicide, pneumonia, Alzheimer’s, and liver disease. None of those conditions account for more than 6% of all deaths, but we all know somebody who has had to cope with them. 

I’m not trying to preach doom and gloom; just the opposite. Most of us are living long lives and managing all those diseases and conditions pretty well. Nobody lives forever, but ‘almost forever’ is probably good enough. And having prostate cancer doesn’t mean you can ignore all those other things that could go wrong. We all need to pay attention, take care of ourselves, and have lots of fun.

axman

A Small Dose of Good Medicine

A week in the woods with kids and grandkids…

 

Good medicine can take many forms—it doesn’t always have to be pills, injections, drips, X-Rays, etc. It’s easy to focus on diseases, side effects, pain, and whatever can go wrong—so we decided to focus on the ‘good’ stuff for a while. 

We organized a week-long get-together and invited all our kids (5), spouses, and available grandkids to come and stay in a large six-bedroom rental in the woods. It all came to be and we had our week in Sunriver, Oregon. All five kids appeared on cue, spouses, some grandkids, and even friends and relatives in the general area dropped by. 

No cartoon for this article—can’t improve on the real thing!

The age range was five-and-a-half (youngest grandson) to 75 (oldest geezer: me); some people came several hundred miles, others several thousand miles. After each day of hiking, jogging, swimming, museums, and eating too much, the clan gathered to talk and laugh into the night (actually 9:30 or 10:00 seemed to be our limit). At the risk of sounding too sentimental, it was a good time to soak up good feelings. I’m sure we’ll do it again. Thank you to everybody for the gift of being together.

axman

Drug Costs Revisited

And the costs go onward and upward…..

 

I have written a blog or two (or more) about the high and still rising costs of prostate cancer (and other cancers, too) treatment drugs.Here is another one!

The list of current FDA approved treatments for prostate cancer is rather long. Some of the approved drugs have been around long enough to be generic and not nearly as expensive as the new drugs.

I googled the drug names and drug costs of a selected few of the newer ‘miracle’ drugs. I use the term ‘miracle’ advisedly here. In clinical trials some of the drugs provided an extended lifespan or symptom free time of only a few months. So I consider these drugs to be ‘small miracle’ drugs. We are still in an era of “one size fits all,” and all patients do not receive the same benefit from a particular drug.

Personal disclosure: I worked my way through the generic drugs and graduated to one of those zillion dollar miracle drugs. For the past several years my PSA and my side effects have been more or less under control—thanks to the new medication. I discovered in my searches it is sometimes hard to pin down the actual retail cost of these drugs. Numbers seem to vary slightly depending on what site you look at and what day it was updated, so the sample list I have compiled is more or less accurate. I have included the ball park average cost. These are the basic full price costs for a few selected drugs.

A few spendy drugs

1.      Abiraterone (Zytiga): Pills taken daily. Approximately $8,500 per month.

2.      Cabazitaxel (Jevtana): Injection every three weeks. Approximately $48,000 for one course of treatment—ten injections.

3.      Enzalutamide (Xtandi): Pills taken daily. Approximately $9,000 per month.

4.      Leuprolide Acetate (Lupron): Injection. Approximate cost of three month 11.25 mg injection is $6,800.

5.      Radium 223 Dichloride (Xofigo): injection (six treatments at four week intervals) $69,000 for six injections.

6.      Sipuleucel-T (Provenge): Injection, three infusions in one month. $93,000.

Paying the Piper

Most of us don’t (and couldn’t) pay that amount, of course. The average age for prostate cancer diagnosis is 66, so most of us have Medicare, most likely Part D, and often a supplemental or med advantage program. So our yearly copays are more likely in the $5,000 to $10,000 range. Substantial but still possible for us lucky ones. Some older patients are forced to choose between meds and food and rent.

A man with no insurance would have to be rather well-to-do to afford any of these treatments. In reality, men with no health insurance just don’t take these meds. Cancer patients are at the bottom of the food chain and pay what the traffic will bear. We know it is very expensive to develop these drugs. But the cost of many drugs has increased each year since they were approved by the FDA, even after research costs have been met.

There are Co-Pay Assistance programs to help those who can’t afford the high co-pay costs. My experience several years ago was not good—I applied, filled out forms, waited, there were delays, letters, personal information, more delays, etc. I finally gave up because I needed to get started on the prescription. If you have experiences with the copay assistance programs (good or bad) please share that with me and the blog readers.

If you were to buy these same drugs in Canada, India, Japan, or many other countries, the cost would be substantially less because other countries negotiate prices with the drug companies.

Factoid: The most common cause of bankruptcy in older Americans is massive medical bills they can’t pay. 

Final Note 
Growing old ain’t for sissies—especially if you have cancer.
 

axman