Trio of dolphins in Gulf of Mexico at Everglades National Park, Florida; BJ Gabrielsen photo.
Imagine God or Jesus Himself writing this to you. “Every time you affirm your trust in Me, you put a coin into my treasury. Thus you build up equity in preparation for days of trouble. I keep safely in My heart all trust invested in Me, with interest compounded continuously. The more you trust Me, the more I empower you to do so.
Practice trusting Me during quiet days when nothing much seems to be happening. Then when storms come, your trust balance will be sufficient to see you through. Store up for yourself treasure in heaven” (Matthew 6:20-1) “through placing your trust in Me. This practice will keep you in My Peace.”
Psalm 56:3-4: “When I am afraid, I will put my trust in Thee. In God, whose word I praise. In God I have put my trust; I shall not be afraid.”
The excerpt above was taken from January 10th, “Jesus Calling” by Sarah Young; Thomas Nelson publisher.
ODM-201 (also known as BAY-1841788) is a non-steroidal, oral anti-androgen (specifically a full and high-affinity antagonist of the androgen receptor (AR), that is under development by Orion and Bayer Healthcare for the treatment of advanced, hormone-resistant prostate cancer. [An antagonist is a drug (blocking agent) that binds to the cellular receptor for a hormone (e.g. testosterone) thus blocking the effect of the hormone without producing any physiologic effect itself.] Bayer HealthCare and Orion Corporation have begun to enroll patients in a Phase III trial with ODM-201. The study, called ARAMIS, evaluates ODM-201 in men with hormone-resistant prostate cancer (CRPC) who have rising Prostate-Specific Antigen (PSA) levels and no detectable metastases. The trial is designed to determine the effects of the treatment on metastasis-free survival (MFS). The trial is being conducted at 502 locations in the US. For enrollment and location information see the following clinicaltrials.gov link.
The ARAMIS trial is a randomized, Phase III, multicenter, double-blind, placebo-controlled trial evaluating the safety and efficacy of oral ODM-201 in patients with non-metastatic CRPC who are at high risk for developing metastatic disease. About 1,500 patients are planned to be randomized in a 2:1 ratio to receive 600mg of ODM-201 twice a day or matching placebo. Randomization will be stratified by PSA doubling time (PSADT < 6 months vs. > 6 months) and use of osteoclast-targeted therapy (yes vs. no). In men with progressive non-metastatic CRPC, a short PSA doubling time has been consistently associated with reduced time to first metastasis and death.
The primary endpoint of this study is metastasis-free survival (MFS), defined as time between randomization and evidence of metastasis or death from any cause. The secondary objectives of this study are overall survival (OS), time to first symptomatic skeletal event (SSE), time to initiation of first cytotoxic chemotherapy (such as taxotere), time to pain progression, and characterization of the safety and tolerability of ODM-201.
A Phase II clinical trial conducted in patients with progressive metastatic castration-resistant prostate cancer assessed the efficacy and safety of three dose levels of ODM-201 (100mg, 200mg and 700mg given twice a day) in 124 patients. The study included patients who were treated previously with abiraterone and/or chemotherapy as well as patients who were chemotherapy-naïve. The results showed that ODM-201 provided disease suppression and had a favorable safety profile. The results were presented at the international ECCO oncology congress at the end of September 2013 and published in June 2014 in The Lancet Oncology.
Relative to enzalutamide (MDV3100 or Xtandi) and apalutamide (ARN-509), two other recent non-steroidal antiandrogens, ODM-201 shows some advantages. ODM-201 appears to negligibly cross the blood-brain barrier. This is beneficial due to the reduced risk of seizures and other central side effects that tends to occur in non-steroidal antiandrogens that are structurally similar to enzalutamide.Moreover, in accordance with its lack of central penetration, ODM-201 does not seem to increase testosterone levels in mice or humans, unlike other non-steroidal antiandrogens. Another advantage is that ODM-201 has been found to block the activity of all tested/well-known mutant ARs in prostate cancer, including the recently-identified clinically-relevant F876L mutation that produces resistance to enzalutamide and ARN-509. ODM-201 has been studied in phase I and II clinical trials and has thus far been found to be effective and well-tolerated with the most commonly reported side effects including fatigue, nausea and diarrhea. No seizures have been observed. As of July 2015, ODM-201 is in phase III trials for CRPC. For more specific information, see the following link.
A new study published in the Journal of Urology suggests that anxiety may prompt prostate cancer patients to opt for potentially unnecessary treatments.
The research included more than 1,500 men newly diagnosed with localized prostate cancer. They were more likely to choose surgery and radiation therapy than active surveillance. Active surveillance — also known as “watchful waiting” — is when the patient is monitored closely, but not treated.
“Men’s level of emotional distress shortly after diagnosis predicted greater likelihood of choosing surgery over active surveillance,” said the researchers from the University at Buffalo and Roswell Park Cancer Institute in Buffalo, N.Y.
“Importantly, this was true among men with low-risk disease, for whom active surveillance may be a clinically viable option and side effects of surgery might be avoided,” they noted.
Though the study found an association between anxiety and more aggressive treatment, it didn’t prove cause and effect.
“Emotional distress may motivate men with low-risk prostate cancer to choose more aggressive treatment,” said study author Heather Orom, an associate professor of community health and health behavior at the University at Buffalo.
“If distress early on is influencing treatment choice, then maybe we help men by providing clearer information about prognosis and strategies for dealing with anxiety. We hope this will help improve the treatment decision-making process and ultimately, the patient’s quality of life,” Orom said in a university news release.
Study co-author Dr. Willie Underwood III, an associate professor in Roswell Park’s department of urology, said that to help men and families through this difficult process, “it is helpful for physicians to better understand what is motivating men’s decisions and to address negative motivators such as emotional distress to prevent men from receiving a treatment that they don’t need or will later regret.” Overtreatment is a concern because surgery and radiation therapy can cause side effects such as erectile dysfunction and incontinence. These problems can be avoided in men with low-risk prostate cancer by choosing active surveillance, the researchers said.
The National Institutes of Health (NIH) of the Department of Health and Human Services (DHHS) sponsors clinical trials related to many diseases and conditions including prostate cancer. (The National Cancer Institute, NCI, is the largest of all the institutes comprising NIH). The director of the NIH, Dr. Francis Collins recently discussed accessing information about these trials on their website, clinicaltrials.gov. The new NIH rules makes it easier for the public to access purposes of the trials, enrollment requirements, location, and especially summary results. I encourage you to view the following link to the short video by Dr. Collins who was a pioneer in the sequencing of the total human genome a few years ago.
The Prostate Cancer Foundation (PCF) just published an e mail review entitled “When Treatment Stops Working, Blame Resistance.” It describes multiple ways of treating advanced prostate cancer including androgen receptor blockers such as enzalutamide and abiraterone, chemotherapy, targeted drugs such as PARP inhibitors (olaparib and rucaparib), immunotherapy including checkpoint inhibitors, bipolar hormonal therapy, SBRT radiation, liquid biopsy and radiopharmaceuticals. See this link.
A western Norway fjord; Provided by Arnold Dalene.
I always knew the day had to come when the therapy I had been given for the last ten years inhibiting cancer cell growth would stop working and my PSA would start increasing despite the treatments. I had been living my life in four month increments of time between PSA tests. Now on December 5th, I finally saw the PSA rising uncontrolled. My local urologist called it “a bad day”, gave me a hug, kissed my wife on the cheek and in a “dismissal speech” said I’d have maybe 2-3 good years left before the painful and eventually fatal effects of advanced prostate cancer would manifest themselves. Meanwhile my oncologist told me I could maybe get ten years “if I hit the jackpot” in terms of additional therapies [e.g. enzalutamide (Xtandi® and abiraterone (Zytiga®] now available to me as an asymptomatic but metastatic patient. These drugs were not available as long I did not have clinical metastases. (I now see a medical need for the development of new therapeutic agents for prostate cancer patients like me who are asymptomatic yet metastatic.)
For several days, my mind was numb. I now could see an end-of-life coming into view. Even my personal relationship with God and Jesus seemed light years away through a combination of fear of dying, anger at therapeutic failure and extreme anxiety of near-future events. In my daily devotionals, I pleaded with God to allow me to hear something positive from Him now even though I knew He had spoken to my heart and mind many times in the past. An answer came from the Old Testament prophetic book of Micah 6:3-5 where God says to His people (and to me) “what have I done to you and how have I wearied you?” I quickly answered “You allowed the therapy that had worked for so long to fail.” Then He reminded me of so many instances in the past where He had delivered me from near-fatal accidents and illnesses just as He reminded His people (Israel) in verses 4-5 of the times He delivered them e.g. by parting the Red Sea among others. Then in verse 8, God reminded me to simply continue to “walk humbly with my God.” In addition, in the book of Hosea, God tells Israel (and me) “what shall I do with you”, your faith is like dew on morning grass which evaporates as soon as the hot sun hits it. Also as Jesus told His disciples when the storm arose nearly overwhelming them in their boat followed by His calming of the sea, “why are you so anxious, have you so little faith?”
While in this state of despair, I came upon a clinical trial of a new PET/CT scan imaging agent under development at Johns Hopkins designed to identify and localize tiny pockets of metastatic cancer sites. Upon contacting them, I was informed overnight that I would be an ideal candidate for the scan which I eventually received on December 12th in Baltimore. While my physicians and I had hoped the scan would find nothing, or perhaps one metastatic site which could be treated, the scan revealed three very small sites of cancer in three different lymph nodes which did not lend themselves to remedial treatment. In my disappointment however, I remembered that 13 years earlier I had a CT scan (Prostascint) at Hopkins which revealed the same three sites and which had not grown on size over the thirteen years that I was under hormonal therapy. I and my physicians took some encouragement in this comparison. But now of course, that limitation of starving the cells and controlling their growth is lifted.
So where does this leave me and perhaps you the reader if you can relate to my condition? Medically, I am in a watch-and-wait-and re-scan mode with several potential treatments available including immunotherapies like Provenge and soon Prostavac if and when needed. I am grateful for a team of cutting-edge and communicative physicians at Johns Hopkins (Maryland) and Moffitt Cancer Center in Tampa. In addition, I was honored to be asked to give a talk along with my Hopkins urologist at a conference entitled “Medicine and Religion” in March, 2017. I intend to describe my personal spiritual and medical experiences including “lessons learned” as described on this website over the years.
I have been reminded over and over to remember what God has told me in the past predominantly through His Word, the Bible and so directly and unexpectedly several times. Jesus has said He would take care of my body as long as I continue the “mission” He has given me of allowing Him to be seen through my cancer. (See the April 30th, 2015 link).
God may also want to change me from the inside rather than my circumstances. When we wait in silence before God, it gives Him the opportunity to communicate His thoughts to us. In Psalm 62:1,5 David writes, “my soul waits in silence for God only; from Him is my salvation…..My soul, wait in silence for God only, for my hope is from Him.” Verses 11-12 state that “power and lovingkindness belong to God.” It may be His will that I keep my prostate cancer but God will deliver me now in this life as well as in my eternal life which I possess as a free gift through personal faith in Christ.
I am also learning how to combat the negative cloud of anxiety which seems to overwhelm me at times of bad news. In Romans 12:1-2 the apostle Paul writes, “I urge you….to present your bodies a living and holy sacrifice, acceptable to God, which is your spiritual service of worship; and do not be conformed to this world, but be transformed by the renewing of your mind, that you may prove what the will of God is, that which is good and acceptable and perfect.” How do I “renew my mind”? In Christ, I am to become a “living sacrifice”. I need to say to Him as my Savior and Lord, “I trust You. Whatever You want me to do I am willing.” Then He “transforms” me by renewing my mind to focus on things that please God and are in my best interest as well. God will never call on us to do something for which He has not already equipped us.
God has also told me (through my wife) that what He can accomplish in and through me is directly proportional to how much I depend upon Him.
And so the journey continues. More medical and spiritual posts to come. If you cannot relate to having a personal, communicative relationship with God through His Son, Jesus Christ, see this link.
Hans Edvard Wisloff was a prominent Norwegian Lutheran Bishop, theologian and writer in the mid 20th century. Being of direct Norwegian ancestry myself, I found this short essay of encouragement.
“God has given us permission to bring everything to Him in prayer. Nothing is too big, nothing too small. He has promised that He will hear us; He has asked us to come boldly. God says what we ask in faith as we pray, we shall receive.
Faith is confidence. Faith does not command. In confidence and trust it leaves all in God’s hand. Faith acknowledges that we are short-sighted and that we do not always know for what we should pray.” (It has been suggested that when we pray, we should first be silent and ask God to tell us what He wants us to pray for.) “Faith clings to the wisdom of God. It knows that God knows best what we need. Therefore, the prayer of faith contains the phrase ‘according to Your will.’ The prayer of faith leaves everything in the Father-hands of God and from that moment knows that it is God who has assumed responsibility in our case.”
There has been a lot written recently about positron emission tomography (PET) scans. The following is a link to an overview published in Medical News Today on December 16th.
The following was added today to this website section entitled “Lessons Learned”.
We know that God has specific plans for our lives and knows in advance what we have to experience, both positive and negative. God told Moses in advance that Moses was to specifically lead Israel out of bondage. Yet Moses loudly proclaimed his weaknesses to God basically saying, “I can’t do this, You need to find someone else.” But as we know, Moses’ and Israel’s circumstances did not change but God changed Moses by showing him a series of examples of God’s power. So while our own personal circumstances may not change, God may use other people, methods, events and especially His Word to change us, “perfecting” us for any task we need to accomplish according to His will.
