Well the checkup has come and gone with the suspected outcome confirmed, the Zytiga has no effect. The more surprising thing is that my PSA, while on the Zytiga, rose more dramatically, perhaps stunningly, than ever before.  With my last PSA being 9.8, I projected a PSA somewhere in the high teens or low twenties, an expected 2.5 or 3 times higher than previously measured.  As it turned out, it came back significantly higher, it came back at 40.2, an increase of more than four times the previous value.  While I had prepared to discuss a marginal increase the a decision on whether to continue with the Zytiga, but instead the conversation went directly to alternatives, the last possible options left to defer advance of the disease.  It was an interesting conversation, one which included my health care proxy, my younger nephew.

When considering alternatives the first,  enzalutamide, was quickly dismissed since its efficacy following Zytiga failure is poor at best.  The next option, Provenge, something of a controversial drug given the cost and modest proven, on average, to increase life by  4 months.  It too was dismissed given my unwillingness to accept what I see as poor results for an exorbitant cost.  That left us with two options, IMRT, a highly targeted and intense radiation or chemotherapy whose administration requires employing a risky protocol referred to as ‘desensitization’.  It was an interesting conversation, consideration of each of the options and their possible outcomes.  In the end the decision came down to three guiding elements, the three things I’ve always considered in choosing therapies.  In short, the questions asked of each were; is the therapy reasonable, does it offer some positive outcome for me and would something be learned, would we be adding to the science.  The tests were clear and the decision easily attained.

When considering radiation, the known objective was palliative, it would, in rather short order, reduce my level of pain.  Radiation at this point of my progression is generally considered ‘standard of care’ and while being a reasonable option, little, if anything could be learned from its use.  The desensitization protocol comes with considerable risk, with a real possibility of not surviving the treatment, albeit death would be considered catastrophic.  The good thing about desensitization is my history of a very positive response to chemotherapy and therefore, while taking longer, it would also be palliative.  However, when it comes to the remaining tests, particularly that of learning, desensitization becomes quite interesting.  It seems that when it comes to prostate cancer, neither Ron nor Paul have ever done the procedure, more so, neither know of it being attempted with a prostate cancer patient.  Clearly there is a learning component and therefore contribution to the science.  Lastly, chemotherapy for prostate cancer patients in my stage is not typical and therefore knowledge on its ability to extend life is largely unknown.  With all these elements and despite the risk, the choice is clear and arrangements for the desensitization are underway and in time the outcome will be known.   I will concede that while I am comfortable with the decision, I harbor a certain degree of apprehension and that is unusual for me.

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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