When All Means Fail – a message for those in a critical battle with prostate cancer.

David Wilkerson was a famous Christian pastor and spiritual leader. In the 1950’s, he left his relatively rural background in Indiana and Pennsylvania and traveled to New York City to begin working with gang members and drug addicts. Out of that move was born Teen Challenge, a Christian drug and alcohol rehabilitation program which today has grown to 1,000 centers in the United States and in 80 other countries. Rev. Wilkerson’s experiences were depicted in a book, “The Cross and the Switchblade”, which has sold over 50 million copies and has been translated into 30 languages. In 1987, Rev. Wilkerson went on to establish Times Square Church near Broadway in New York City which he pastored for 23 years.  David Wilkerson was suddenly killed in an automobile accident on April 27th, 2011. The following is his personal devotional from that day, April 27th, which can be applied to anyone who is seriously battling prostate cancer. (See http://www.worldchallenge.org/in-memory-of-david-wilkerson/.)

“To believe when all means fail is exceedingly pleasing to God and is most acceptable. Jesus said to Thomas, ‘You have believed because you have seen, but blessed are those who believe and have not seen’ (John 20:29). Blessed are those who believe when there is no evidence of an answer to prayer – who trust beyond hope when all means have failed.

Someone has come to the place of hopelessness – the end of hope – the end of all means. A loved one is facing death and doctors give no hope. Death seems inevitable. Hope is gone. The miracle prayed for is not happening.

That is when Satan’s hordes come to attack your mind with fear, anger and over-whelming questions: ‘Where is your God now? You prayed until you had no tears left. You fasted. You stood on promises. You trusted.’  Blasphemous thoughts will be injected into your mind: ‘Prayer failed. Faith failed. Don’t quit on God – just do not trust him anymore. It doesn’t pay.’ Even questioning God’s existence will be injected into your mind. These have been the devices of Satan for centuries. Some of the godliest men and women who ever lived were under such demonic attacks.

To those going through the valley and shadow of death, hear this word: Weeping will last through some dark, awful nights – and in that darkness you will soon hear the Father whisper, ‘I am with you. I cannot tell you why right now, but one day it will all make sense. You will see it was all part of my plan. It was no accident. It was no failure on your part. Hold fast. Let me embrace you in your hour of pain.’

Beloved, God has never failed to act but in goodness and love. When all means fail – His love prevails. Hold fast to your faith.  Stand fast on His Word. There is no other hope in this world.”

GOOD NEWS!!! New Regimens and Therapeutic Agents in the Pipeline; a Visit with my Oncologist.

Every six months, I have an appointment with my oncologist at the Moffitt Cancer Center, on the campus of the University of South Florida, in Tampa. Moffitt is a designated National Cancer Institute (NCI, National Institutes of Health, my former employer) Comprehensive Cancer Center, a highly-sought-after distinction. My oncologist had been highly recommended to me by former program directors at the National Cancer Institute. I am always grateful for the opportunity to discuss with him not only my own situation but to learn about new potential therapies in various stages of clinical trials.

One such earlier appointment is chronicled in the My Story section of this website, November 25th, 2009. At that time, we had discussed the positive results seen in prostate cancer patients treated with either Provenge or abiraterone. In 2011, both of these drugs have now received FDA approval. This has affected my own prognosis dramatically. When a prostate cancer patient becomes resistant (refractory) to standard hormonal therapy and the cancer metastasizes, the next chemotherapy option is usually taxotere and prednisone. Serious side effects often accompany taxotere / prednisone treatment. I am currently in my 5th year on hormonal therapy and my oncologist informed me that I could be maintained in this non-symptomatic manner for years before I would become refractory. Looking ahead, I did not look forward to chemotherapy with taxotere. But with the availability of new therapies, my own “treatment schedule” had changed. After hormonal therapy, I would probably be placed sequentially on Provenge and/or abiraterone, both of which are effective and well tolerated. All in all, the goal of prostate cancer patients like myself is simply to “buy quality time” unless God chooses to heal us directly (which is always possible). I am now nearly 70 years of age. I just may out-live this disease. God uses many methods and the God-given talents of many people to heal or stabilize our diseases.

To make the situation more optimistic, the following are several new potential therapies in various stages of clinical trials. [For an excellent overview of the various phases (I, II, III) of clinical testing required of a drug to obtain FDA approval, see the Johns Hopkins Health Alert related to prescription drugs,  posted March 10, 2009. Phase I studies focus mainly on biological effects, including harmful side effects of the drug on the human body; Phase II studies attempt to demonstrate whether the drug provides a safe benefit in treating people with a specific condition; and, Phase III studies better define the benefits, risks and side effects of the drug.]

1) As a follow-up to current hormonal (androgen deprivation) therapy, Millennium and its parent company Takeda Pharmaceutical, are developing TAK-700 (future name to be Ortoronel), a selective, oral, non-steroidal androgen synthesis inhibitor. In preclinical studies TAK-700 has been shown to bind to and inhibit the enzyme 17,20-lyase 1 in the testes and adrenal glands. TAK-700 is now in Phase III clinical trials in metastatic, castration-resistant prostate cancer and studies are planned for patients who have failed taxotere as well. For information, see the “New Prostate Cancer Info Link,

2) Another new drug is Exelexis’ capozantinib (XL184) which has already received FDA orphan drug approval for the treatment of certain thyroid cancers.  Optimistic reports for XL 184 came from Phase II clinical trials on patients with metastatic  prostate cancer who had failed hormonal therapy. In a group of patients, 95% achieved complete or partial resolution of metastatic bone lesions. Bone scans taken after treatment could not detect any metastases on patients whose previous scans demonstrated substantial cancer spread. The pain accompanying cancer metastasis to the bone was also alleviated.  While XL184 was well tolerated and demonstrated substantial activity against bone metastases, similar dramatic activity against the primary tumor was observed in only six (6) of the 100 patients. Therefore it is too early to predict whether XL184 will extend survival.  XL184, a member of a class of drugs known as tyrosine kinase inhibitors, is designed to work as follows. In cells, MET (otherwise known as hepatocyte growth factor, HGF) and vascular endothelial growth factor type-2 (VEGF2) are both proteins produced by cells. MET is involved in tumor cell proliferation, invasion and tumor spread as well as bone metastasis; while VEGF-2 stimulates angiogenesis, the growth of new blood vessels to feed the tumors. Drugs like XL184 have the potential to “switch off” processes (initiated by tyrosine kinases) within a cell that promote tumor growth.  MET and VEGF also play roles in the function of healthy bone cells such as osteoblasts and osteoclasts. “Switching off” MET and VEGF  simultaneously may block the progression of bone lesions.  While Phase III trials are planned, phase II trials are still recruiting prostate cancer patients in ten states; see http://www.clinicaltrials.gov/ct2/show/NCT00940225.  XL184 is also being evaluated against other tumors such as ovarian.  (Reference: Dr. Mark Scholz, in PCRI Insights, May, 2011, Vol. 14, No. 2, pp.12-14).

3) A third drug to watch for is Yervoy (previously known as ipilimumab) from Bristol-Myers-Squibb. Yervoy, a human  monoclonal antibody, is a cancer immunotherapy that has previously received FDA approval in March, 2011 to treat melanoma.  The Yervoy antibody targets cytotoxic T lymphocyte antigen-4, preventing the antigen from interacting with its ligands and thereby activating the patient’s own immune system by causing these T-cells to potentially combat tumor cells.  More simply, Yervoy blocks a switch that turns off an anti-tumor cellular response. Therefore, Yervoy is an agent that “blocks a blocker” thereby aiding the immune system to fight the tumor.  It should also be mentioned that nearly 13% of patients taking Yervoy had severe autoimmune reactions, consisting of mostly of fatigue and severe skin and gastrointestinal reactions.  The FDA is allowing Yervoy to be evaluated against prostate cancer.

So You’ve Been Diagnosed With Prostate Cancer!! Now What??

In my case, my initial diagnosis occurred in 1995 when I was 54 years of age. At that time, the only option for me was surgery by the best urologist-surgeon I could find. Since that time, over fifteen years have passed which have yielded volumes of clinical data concerning treatment successes and failures, tumor grades, Gleason scores, survival rates, side effects etc. For many men, “watchful waiting” is now an option to be seriously considered along with surgery. If you have been given a recent diagnosis of prostate cancer, two articles have recently been published in the National Cancer Institute (NCI) Cancer Bulletin which you should share with your physician. The first article entitled “Prostate Cancer Study Provides More Data on Surgery versus Watchful Waiting” was published in the May 17th, 2011 issue (Volume 8, Number 10). The most recent entitled “Study Questions Benefit of Surgery versus Watchful Waiting in Some with Prostate Cancer” appeared as a feature article in the May 31st, 2011 issue (Volume 8, Number 11). While one cannot formulate a general rule for every man regarding the question of surgery versus “watchful waiting”, it may be useful to share this information with your physician / health provider before devising the best strategy for your individual prognosis and treatment plan, if any.  As Dr. Julio Pow-Sang of the Moffitt Cancer Center at the University of South Florida stated, “the bottom line is that treatment of early-stage prostate cancer must be individualized.”

Countering Weight Gain as a Result of Hormonal Therapy.

Benefits and risks accompany virtually every method of treatment. Hormonal therapy for prostate cancer is no exception. Potential risks include osteoporosis and bone fractures, cardiac effects, diabetes, depression, hot flashes and metabolic changes resulting in weight gain. (These issues are discussed on this website under “My Story”, 2009 entries of July 5th-27th, September 29th, October 20th, November 25th, and December 6th, as well as March 12th, 2010.) I have been on continuous or intermittent hormonal therapy since August, 2006. Fortunately, my side effects have been minimal although I had gained approximately fifteen pounds. I was told by a urologist that it was difficult to lose weight while on hormonal therapy. Eventually however, I was determined to lose these unwanted pounds. It has not been easy but I have lost most of the weight while continuing my therapy. I found that once I made up my mind to lose the weight, it was indeed possible with diet and exercise. Here are some practical tips I learned along the way.

Personally, it helped to make an initial investment and enroll in one of the popular advertised weight loss programs. It did not take long to begin to understand their general principles and one could discontinue enrolling after a month or so thus saving money. The diets in general consisted of very low-fat, low-carbohydrate meals with moderate protein content. I found the following strategies to be helpful.

1) Eat a fairly substantial breakfast of whole-grain cereals, fruits and light soy or low-fat milk; eggs (omelets) can be substituted.

2) Eat about 5 small meals a day and eat less as the day progresses. Mid-morning and mid-afternoon 100-calorie snacks (cheese, yogurt, fruit) were useful in curbing hunger.

3) If possible, eat dinner at mid-day and your usual lunch as the evening meal. Low fat meats such as chicken, turkey, lean beef (ground sirloin, lean roast beef) as well as fish become staples. Bread was limited to 1-2 slices of 40-calorie whole grain bread daily. Fresh vegetables and salads with low-fat dressing are of course encouraged. Low-fat mayonnaise is recommended but I personally found that one could never fully replace the flavor of real mayonnaise, so I used it in moderation.

4) Sip on water during the day; drinking an 8 oz. glass before meals helped me eat less while feeling satisfied. Diet drinks can be used but I found that water alone was best in satisfying my hunger.

5) Exercise is a must. Aerobic and weight-bearing exercises are also good for healthy bones. My wife and I exercise for 60 minutes in a gym three-times a week.

6) Minimize the use of alcohol, although a small glass of wine on occasions can be incorporated.

7) To satisfy my salt craving, pretzels seemed to be lowest in calorie content.

8) Don’t eat within three hours of bedtime except for a small piece of fruit or similar low calorie snacks. Midnight snacks are forbidden.

9) The eventual goal is portion control. I found that after a few weeks, my hunger was fully satisfied with 33% less food than I had previously consumed. Maintaining this level remains my goal.