A Winter Break

All of the emotional trauma of last Fall has subsided. Thanks to reassurance from the chief, I find myself much less fearful. We were able to enjoy good times at Thanksgiving and Christmas with family.
Results from the genetic analysis of the biopsy samples are back. These offer renewed hope, but also point to more challenges on our path to “durable remission”. The chart (click on thumbnail below) shows continued decline of my PSA. I expect the CT scan scheduled for January 12th will show continued shrinkage of the lymph node metastases.
I feel I need a break from this most recent chemotherapy regimen, and the chief agrees. I have gone back into physical therapy so that I can regain the strength to climb the stairs in our California townhouse. We are headed back to California at the end of the month, hopefully for the rest of the winter. While we’re there, I may need one or more “maintenance” doses of chemotherapy. In the meantime the chief promises to devise a new treatment regimen from the results of the genetic analysis. It will almost certainly mean more chemotherapy with Taxotere. The plan is to start the new regimen when more pleasant weather returns to the mid-Atlantic.

Heidi

Heidi and Bob with grandchildren, Alexis, Luke, and Kate Ashton, Chrismas 2014

Winter break → Springtime challenge

All of the emotional trauma of last Fall has subsided. Thanks to reassurance from the chief, I find myself much less fearful. We were able to enjoy good times at Thanksgiving and Christmas with family.
Results from the genetic analysis of the biopsy samples are back. Finding these new drugs that are tuned to my tumor characteristics has provided new hope, but the particulars point to more challenges on our path to “durable remission”. The chart (click on thumbnail below) shows continued decline of both my PSA and bone-specific alkaline phosphatase. PSA:BoneALP Chart 2014
Details
I completed five more infusions on December 29th – 13 in all since mid-August. Last Saturday we went for the January blood test for the chief. The trends shown on the above chart are signs the cancer is under control, at least for now. I’ll get another CT scan next Monday, the 12th; we’ll be looking for continued shrinkage of the lymph node tumors that started all this ruckus last summer.
Molecular profiling
This is one of the terms geneticists use for analysis of tumor samples. The chief reported three significant items from the Caris Dx study of my samples. First, it’s clear now why Taxotere chemotherapy has been so consistently successful at “pulling me back from the brink” in the last four years. I have a gene known as TP53. This gene is missing in many PCa patients. It is known to prevent PCa cells from becoming resistant to Taxotere. So, while the tumors in many of my compatriots have eventually become resistant to Taxotere, heretofore PCa medicine’s last line of attack before death, I and some others still surviving are lucky enough to have this particular gene.
Next, the analysis showed that my tumors appear to be susceptible to a drug called Erbitux, used principally to treat colorectal cancer, and Xoleda, a drug used to treat breast cancer. Each of these would likely be used in combination with more Taxotere. I feel worn out from all this. So, we will take a holiday for at least a month to give me a chance to regain a little strength. Further, the potential side effects of each of these drugs are a bit daunting. So much so that I want to wait for more pleasant weather in the mid-Atlantic region before embarking on yet another arduous treatment regimen. In the meantime we will escape this brutal January weather and go back to the Bay Area, hopefully for the rest of the winter. If PSA takes off so rapidly that I need more Taxotere to bring the cancer back under control, I’m already established as a “winter patient” at an excellent nearby cancer clinic.

In retrospect
In the days before molecular profiling, the chief would have few new choices to suggest at this point. We would know that Taxotere continues to work, but not understand why. I have gotten weary of the shotgun aspect of chemotherapy. Similarly, we would not have a clue that Erbitux and Xoleda might be more useful than many others for treating my lymph node mets. I think these new techniques will soon help many advanced PCa patients obtain more targeted therapies and suffer less “collateral damage” to their bodies in the process.

Renewed Hope, again

After recovering from a our frightening summer, we got a great lift from our Tuesday visit with the chief. He is happy that my bone metastases seem to remain in remission, and confident there are tools for controlling the new soft tissue mets in my abdomen. At the rate I was losing weight up through the beginning of October, I thought I had also been afflicted by cachexia (kah-kek’-si-ah), a wasting disease that claims about 25% of advanced PCa patients.

Happily, I have started to regain some weight, now about 140, up from 132. My new rolling walker helps me keep my balance and lets me walk around feeling much less lower back fatigue. Weather permitting, I have been going longer and longer distances outside. I am really anxious to get strong enough to walk comfortably.

At present, the best tool we have to shrink these mets is Taxotere chemo infusions. In search of a less-punishing alternative, I’m going to get a biopsy of these soft tissue mets on the 24th. Getting good (cancer-laden) samples is tricky. If successful, the chief is also confident that analysis of these samples will provide new information on what drugs might work on these tumors in place of the chemotherapy with Taxotere.

Best wishes to you and your families for a joyous Thanksgiving!

Love, Heidi and Bob

Bob and

Bob and Heidi with her sister, Debbie, in late October

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Bob with daughter Stacy and her children on Stacy’s birthday in early October