As most know, every three months I go in for a checkup which necessarily includes a PSA measurement.  The interesting thing with the last few checkups is, based on bone and CT scans done in early February, no longer reflects my disease burden.  Another way of saying this is that I have much more disease than one would expect with the most recent PSA of 9.8 (February), slightly less than the 4.6 measured in November.  This checkup will also come after having been on a new drug, approved in August 2012, called Zytiga.  While it is still early in the treatment, by all accounts, as described in my last post, the drug is not even slowing progression of the disease. Certainly the PSA will be the determining factor, but if rising at the same rate, or faster, than the last measurement, it will be the end of the Zytiga trial, at least in my view.  That said, early indications from Paul are that he will want to continue with the drug under the pretext it has not had sufficient time to ‘do its magic’.  I am guessing he will lack the data to defend that position and thus it will be time to move to the next option.

When thinking about options, they are few and far between.  The current dialog resides around the idea of trying a protocol called ‘desensitization’.  The idea is to facilitate the administration of chemotherapy, in my case Taxotere, to individuals like me who previously exhibited profound allergic reactions.  According to Ron the procedure is “worth a try”, but very risky.  I guess I will learn just how risky soon enough.  The good thing is if successful, my disease ‘responds’ very well to Taxotere and so a number of successful cycles could be meaningful in terms of longevity.  The down side, as Ron points out, is I come home in a box, a little sooner than I feel to be the case.  I think the other benefit to desensitization is scientific contribution, principally because as one with ‘castrate resistant metastatic prostate cancer’ with a still very active immune system, I am something of a rare bird.

The other remaining alternative is one which I felt to be something I would never consider, that being Provenge.  Provenge is an immune based therapy with a hefty price tag, $93,000 for the one and only one series of treatments.  Based on the data submitted for its FDA approval, Provenge, on average, extends lives four months, not a great deal in my view.  However, and again since I offer a very active immune system, there may be basis to believe my response will exceed the average.  Additionally, should I use Provenge, I may contribute to the body of science, that being a data point from a subject with  an active immune system.  My inclination is t not follow that path since I find the cost offensive and the outcome negligible.

In the end, the question comes down to the value of life, the value of my life and the extent to which I will go to cheat death.  In one way, I continue to entertain the alternatives, including some holistic approaches, just because it is not in my nature to loose and dying is the ultimate loss.  In other ways I reflect back on the ideas of what comprises the ‘good fight’ and the question of when the fight is futile.  Time will tell, as will the upcoming discussion with Paul.  Perhaps I will offer additional resistance, to offer additional fight.

Happy reading, happy thoughts and happy trails.

As always, feel free to comment or you may email me at lifeabstractions@gmail.com

ciao

Lifesabstractions

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