alkaline phosphate

When good isn’t good enough, then you get more

Advanced Prostate Cancer, alkaline phosphate, Boston, David Emerson, PSA, XL 184 -
Tuesday was my four week check up with my Oncologist, along with the usual blood tests and shots. The appointment was uneventful for the most part, the doctor was away and we saw the Physician’s Assistant. She is great, but no decisions were obviously made with the doctor away, this was all expected from the last appointment.
Last month I switched a few drugs around; I stopped Lupron and started Firmagon (testosterone blockade), stopped Zometa and started Xgeva (bone strengthener). After making these changes four weeks ago I did have mild to moderate pain a few times during the weeks that followed. As almost always happens, the week leading up to the doctor’s appointment was as close to normal as I’ve had in a while. I felt great and remain that way this week as well. The side effects from the Firmagon shot (tenderness, redness and slight swelling at the injection site) seem to be much less than June. Or maybe I am just more tolerant this time around.
The exciting news is my PSA was actually down to 421 (it was 433 the month before). Though this is somewhat good news, the drug I started back in January (Zytiga / Abiraterone) is not having the impact we had hoped. However, I am very grateful for the result. An additional marker we track closely is Alkaline Phosphatase. Normal levels are approximately 40-110, mine had been between 50 and 60 for years. With the rise in my PSA this year, the AlkPhos has also gone up. According to one specialist my type of prostate cancer is creating PSA primarily via the bone tumors. Hence, my need to find a treatment that targets bone.
Speaking of treatments that target bone, yesterday we received a call from the doctor’s office in Boston. Without looking too far ahead, it was good news and we now have an appointment with the doctor leading the trial the first week of August. We are cautiously optimistic as there is not a guarantee that I will qualify for the XL-184 trial the purpose of this meeting is to determine if I am eligible. The appointment will include a blood test, a bone scan, CT scan and exam by the doctor.  Although I appear to be an ideal candidate on paper, things can always pop up. Once again, we are cautiously optimistic!
Assuming that the tests and the appointment go well, I will have to return 4 weeks later to start the trail. The delay is where this gets a little risky. I will have to stop taking a number of medications for those four weeks. This includes:
– Zytiga (Abiraterone) and Prednisone (the current hormone blockade I have been on since January)
– Lovenox (a blood thinner I have been on since last fall when I was on DES and had several clots in my leg)
– Finisteride (I have been on this drug for almost 5 years, the short story is it blocks a form of testosterone)
Stopping the blood thinner is the least risky in my mind. The clots I developed on two separate occasions can be attributed to my treatments at the time, one being Taxotere and one being DES. I have been off DES since December.  As a precaution, Dr. V suggested I add a low dose aspirin to my daily regimen. Finisteride is also a minor risk since my testosterone level is always extremely low. Zytiga is the big risk but the potential of this new drug is so great that it is a risk I am willing to take.
So if the crazy schedule of ours wasn’t busy enough, now we add a trip to Boston the mix!

Unwanted, but hardly unexpected

Advanced Prostate Cancer, alkaline phosphate, CT scan, David Emerson, PSA, t -

If the past 55 months have been nothing else, they have been tumultuous. Today was just another example of the uncertainty that is my life.

My PSA number was back up, this time to 99.43

I was pretty bummed out, for about an hour. Seriously, by the time Mary and I got home I was pretty much over it. It’s a good time, if there ever was one, because I’m busy…between the preparation for the upcoming golf tournament, the reorganization going on in the office, and a few other irons I have in the fire, I have little time to slow down or dwell on my PSA number.

We did leave the doctor with this plan; on October 6th I will have follow up bone and CT scans. Aside from taking up most of a day, these don’t bother me too much. I am slightly concerned however about the total number of these I have had over the years. I should probably know this off the top of my head but I would estimate that this makes a dozen. That much radioactive dye can’t be that good for me. On the 6th I will also have a PSA, CTC and alkaline phosphate test. The combined results of these tests are what we are hoping will lead us to a new plan.

The choices for my next treatment are limited; DES (estrogen), another round of chemo (3 weeks on, 1 week off versus last time when I did 1 on 3 off) or a yet to be determined clinical trial.

So that’s the update, pretty crummy overall but we’ll get through this like we have before. Many, many thanks for all the kind thoughts and prayers!

Summer time, summer time, sum-sum-summer time!

alkaline phosphate, CTC, David Emerson, hrpca, PSA -

On Monday we met with Dr. V for my monthly appointment.

PSA = 39.75

This is up slightly from four weeks ago (36.16) but not significantly.
He reviewed the letter from Dr. L at MD Anderson and we discussed the recommendations at length. He is in agreement with the recommendations and he ordered the two new tests. We will use a combination of these three tests two determine when we make our next move.

I already have total alkaline phosphates measured each month as part of a standard CBC Blood panel but the first new test will break it down further. Here are some details from my friend Howard at hrpca.org:
Alkaline Phosphatase, serum Bone-specific alkaline phosphatase (BAP.) When alkaline phosphatase is measured, it is actually the sum of the bone-specific and liver-specific components (isoenzymes.) BAP can indicate excess osteoblastic cell activity which may indicate bone metastases. Metra Systems, Inc., says that Bone Alkaline Phosphatase is an osteoblast membrane-bound molecule which is involved in bone formation. Levels of this enzyme are thought to be indicative of the activity of osteoblasts.

Another description of AlkPhos is that it is an enzyme that is found on the surface of osteoblasts(the cells that build bone) and as such is used as a serum marker of increased osteoblast activity. Since bone is being added at prostate cancer bone metastases, an increased alkaline phosphatase can mean increased bone met formation. A recent paper by MR Smith et al in Urology discussed BAP and NTx in their role as predictors of skeletal complications in HRPC patients (MR Smith, et al, Urology 70: 315-319, 2007.) Their conclusion was that elevated baseline levels of BAP are associated with a greater risk of adverse skeletal outcomes – events such as shorter time to radiotherapy or shorter time to first pathologic fracture. NTx was also found to be of value in monitoring patients on bisphosphonates.

The second new test will measure the amount of CTC’s or Circulating Tumor Cells. Recent studies suggest that for men with advanced disease, measuring whether the number of cancer cells circulating (CTC) in the blood stream is rising or falling may be a more accurate method for determining response than PSA. CTC’s are found in many cancers but are most common in prostate cancer.

So we ran both tests in order to establish a baseline and I will have the tests repeated in three months along with an updated bone scan and MRI. So unless my PSA goes crazy or I develop pain somewhere, no foreseen changes for the next three months.

Not sure if you caught that, three months, as in July!!!

Woo-hoo!!!