It hasn't been easy but after 24 months of hot flashes, sleep turmoil, back aches and general low energy (plus cognitive 'fuzz' and memory lapses) the androgen deprivation therapy with Firmagon now shows some decent progress. At least according to the latest MRI back in May.
Namely:
- Elimination of the metastases in the lymph nodes which were evident two years ago, and
-Reduction of the number of metastastic adenocarcinomas in the prostate gland to one - down from two.
The treatment of choice was one Firmagon injection in the belly each month, the graphic at top showing the needle's entry and the 'depot' or the mass of the chemical left behind.
Firmagon, far less any other androgen deprivation treatment (ADT), was not my choice as I will admit. But a PSMA scan in March, 2024 showing the spread of lesions (with greater SUV intensity) to pelvic region and lymph nodes changed that. (Intensity of uptake of radionuclide by cancer cells is defined by the SUV or standardized uptake value.
Where: SUV = C(T)/[injection dose (MBq)/patient's weight (kg)]
So the sole remaining option was to go on ADT which consequences- side effects are summarized in the table below:
I had originally hoped to start Orgovyx, the newest (and ‘greatest’) ADT medication which had the benefit of: a) being taken in pill form as opposed to regular injections - which usually leave massive swelling at the injection site, and b) fewer myocardial infarctions ( by about 43%) . But the path to support was scuttled because the company terminated its lower cost “bridge support. Simply put, I was not prepared to cough up $2,500 a month for this solution.
Both Firmagon and Orgovyx work by blocking the pituitary gland from making hormones called luteinizing hormone and follicle-stimulating hormone, thereby reducing the amount of testosterone the testicles are able to make. With testosterone reduction the cancer's fuel intake is lowered and hence there is less havoc caused by tumor growth - including metastasis.
Let me quickly add here the ADT regimen is rarely used for early prostate cancer. But there are more sites now that will, when PSMA scans show suspicious SUV values, deliver radiation - usually SBRT ( Stereotactic body radiotherapy ) with ADT. I also had the option but declined the radiation given I already had high dose brachytherapy 12 years ago,
Of course, my urologist has been adamant I need to go further to drive the "T" down to 0 from the already castrate level of 10 ng/dl. This is to ensure the remaining lesion-tumor, some 0.8 cm across, does not "escape the capsule", i.e break through and grow into the rectum. To that end he is proposing the addition of another ADT drug (Nubequa) as well as a form of immunotherapy for metastatic prostate cancer. This combined regimen is currently scheduled to begin this month, pending Medicare approval.
The latter involves use of 'provenge' - a personalized cellular vaccine used for asymptomatic or minimally symptomatic metastatic castration-resistant prostate cancer. It involves extracting white blood cells, exposing them to a prostate protein in a lab, and infusing them back to stimulate an immune response. I've been informed the worst that can happen in terms of side effects are symptoms mimicking a bad flu during infusion. Rashes and auto-immune inflammation in healthy organs are also possible.
As for the Nubequa, the possible serious side effects include:
-Weight gain and high blood sugar levels
- Rash
- Increased risk of seizure or momentary loss of consciousness
- Potential blockage of the arteries in the heart leading to death
Of course, given a calcium scan back in 2025,
showed a 57 % blockage in the right coronary artery, that is a cause for concern. And even more reason I want to opt for the lower dosage
Look, I ain't looking forward to any of this, but if I can get a decent cancer remission it will be worth it. My one demand will be to start the Nubequa at the lower dose (300 mg twice a day) as opposed to the higher, though I know the cancer specialist always want to go for the 'kill shot'. Me, I'm ok with a half shot and not having everything fried that still works.
See Also:
Prostate Cancer and Androgen Deprivation Therapy (youtube.com)
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