TL;DR: I had bad news at the oncologist. A rather simplistic estimate of survival is 1 year > 90%, 1.5 years > 80%, 2 years > 60%, all assuming my insurance covers the new treatment. As before, there will likely be months of deteriorating health before I die.
At my latest oncologist appointment, everything changed. My psa levels hsve started rising again.
This is the first indicator of “hormone refractory” or “castrate resistant” cancer. The treatment that I have been receiving, which suppresses testosterone production, is no longer effective against all of the tumor cells. Starving the prostate cells of testosterone kills them, but it does it slowly. They have time to adapt, and some of mine have adapted.
The survival curve in my previous post showed an almost 1 in 3 chance of me surviving to 5 years. But I’m not on that curve any more. I am just over one year after diagnosis and I have crossed over to the next phase of the disease.
Until just a few years ago, the only treatment that would have been available is chemotherapy. It can’t cure prostate cancer, but it can delay it for a while and reduce the pain. But chemo really sucks from a quality of life view. Fortunately, now there are a few more treatments for prostate cancer.
It happens that one way the cells adapt is to make their own testosterone. The drug my oncologist recommends next is Zytiga. It suppresses the teststerone production at an different step than the commonly used anti-androgens. The important part is that a cluster of prostate cells can evolve to make their own testosterone (by switching on genes that would otherwise be idle), but Zytiga can still interfere with the production of testosterone — for a time. The cells eventually evolve other ways of surviving.
There is a survival curve in the paper here and the actual graph is here. If the insurance covers it, I will be on the abiraterone curve. It’s a little hard to read from this graph, but it shows that survival to 1 year > 90%, 1.5 years > 80%, 2 years > 60%.
We will know this treatment is working if the PSA levels fall or remain stable. When they start rising again, the implication is that it has stopped working, at least for some of them. There are other treatments to try after that, though my review of the literature so far suggests that each successive type of treatment is less effective as the third-round treatment than it is as the second-round treatment.
There is no happy ending here.