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First,, Some History: My Father Had Well Controlled (with Hormone
Question: First,, some history:
My father had well controlled (with hormone treatments) Prostate Adenocarcinoma, which mutated into Small Cell Carcinoma of the Prostate. Our largest concern are his liver lesions.
He became symptomatic when a mass blocked his uterer, causing him pain, which he thought was a muscular strain. In the weeks he was laid up, including one in the hospital, he lost a lot of muscle mass. He could still, for instance, take 4 laps around the oncology ward the first admission.
He asked to leave the day after getting the stent, which is when it hit the fan. At home his blood pressure was undetectable with our machine, he became unresponsive. He was sent to the ER, and stayed in oncology for another week. He was totally immobile from pain everywhere, and he lost more muscle. Even his vocal cords stopped working, whereas his voice was just weak before.
We brought him home at his request, and told he had days to live. Sepsis was suspected, but not seen in cultures. Perhaps it was just not detected, as his WBC was real high a week after his return, and is now normal.
Now a month has passed and he is slowly gaining strength, but also becoming anemic. The day he came back from the hospital he started feeding himself, and walking short distances with a walker. Today for the first time he is able to reliably project his voice, and used it to say he feels stronger. Combined with the cancer, and the anemia, it is difficult for him to exercise, and continue gaining strength.
It hasn't been a straight path, today is great, yesterday was terrible. That said, we had to fire hospice and put him on home care, because even getting a palliative transfusion was impossible. (Scheduled for Monday).
His oncologist really doesn't do much for us, besides tell us he is dying. He is fighting, and we can't even give him hypotensive meds for the occasional drops in BP he sees. She prescribed table salt instead.. In fact, I think part of the crisis that got him back in the hospital was a result of not eliminating his hypertension meds, despite the fact that even on IV in the hospital, his BP was below normal, due to the weight he lost.
Here is my question:
I agree that he is too weak to do a course of platinum chemo meds, but my understanding is that the immunotherapy available to him -- although they don't work all that well for most people -- are far more tolerable. However, they are supposed to be 2nd line.
I'm pretty sure, given how his cancer has impacted him, that we won't get a chance for 1st line, so why can't we do second line first, and see if it gets him a shot for 1st? How is nothing the ethical choice, when the doc's are already more than a half a magnitude too pessimistic on him. He doesn't look like he's going anywhere soon.
We recognize how grim his prognosis is, but he wants a chance to fight, and his oncologist seems to refuse to give him one. His home care doc got us the transfusion. His oncologist would not, and actually overstated how low he'd have to be to qualify, causing us all to waste time looking into direct donation.
It is as if her ego is hurt that he not only still lives, but regains function and strength -- despite the anemia -- and despite no interventions intended to help him get stronger. We just got an appetite stimulant today, and again, it was only because we asked for it. It will take weeks to work.. When asked why not add EPO, she said it is not technically approved for patients not on chemo. When asked what the harm would be, she responded there is a long term risk of heart attack or stroke. Seriously. She also told me radiation was never used on the liver, as it kills more liver than cancer. I'm reading that this is not the case. I have no idea why she'd misrepresent that.
His home care doctor is much more amenable to try things that make him less unwell.
I have other complaints, but for the sake of brevity, I'll simply restate that my question is about using immunotherapy as a 1st line treatment for SMCPa, in a situation like this, where it is not clear that we'll have time to get him strong enough for chemo.
Thanks in advance.
My father had well controlled (with hormone treatments) Prostate Adenocarcinoma, which mutated into Small Cell Carcinoma of the Prostate. Our largest concern are his liver lesions.
He became symptomatic when a mass blocked his uterer, causing him pain, which he thought was a muscular strain. In the weeks he was laid up, including one in the hospital, he lost a lot of muscle mass. He could still, for instance, take 4 laps around the oncology ward the first admission.
He asked to leave the day after getting the stent, which is when it hit the fan. At home his blood pressure was undetectable with our machine, he became unresponsive. He was sent to the ER, and stayed in oncology for another week. He was totally immobile from pain everywhere, and he lost more muscle. Even his vocal cords stopped working, whereas his voice was just weak before.
We brought him home at his request, and told he had days to live. Sepsis was suspected, but not seen in cultures. Perhaps it was just not detected, as his WBC was real high a week after his return, and is now normal.
Now a month has passed and he is slowly gaining strength, but also becoming anemic. The day he came back from the hospital he started feeding himself, and walking short distances with a walker. Today for the first time he is able to reliably project his voice, and used it to say he feels stronger. Combined with the cancer, and the anemia, it is difficult for him to exercise, and continue gaining strength.
It hasn't been a straight path, today is great, yesterday was terrible. That said, we had to fire hospice and put him on home care, because even getting a palliative transfusion was impossible. (Scheduled for Monday).
His oncologist really doesn't do much for us, besides tell us he is dying. He is fighting, and we can't even give him hypotensive meds for the occasional drops in BP he sees. She prescribed table salt instead.. In fact, I think part of the crisis that got him back in the hospital was a result of not eliminating his hypertension meds, despite the fact that even on IV in the hospital, his BP was below normal, due to the weight he lost.
Here is my question:
I agree that he is too weak to do a course of platinum chemo meds, but my understanding is that the immunotherapy available to him -- although they don't work all that well for most people -- are far more tolerable. However, they are supposed to be 2nd line.
I'm pretty sure, given how his cancer has impacted him, that we won't get a chance for 1st line, so why can't we do second line first, and see if it gets him a shot for 1st? How is nothing the ethical choice, when the doc's are already more than a half a magnitude too pessimistic on him. He doesn't look like he's going anywhere soon.
We recognize how grim his prognosis is, but he wants a chance to fight, and his oncologist seems to refuse to give him one. His home care doc got us the transfusion. His oncologist would not, and actually overstated how low he'd have to be to qualify, causing us all to waste time looking into direct donation.
It is as if her ego is hurt that he not only still lives, but regains function and strength -- despite the anemia -- and despite no interventions intended to help him get stronger. We just got an appetite stimulant today, and again, it was only because we asked for it. It will take weeks to work.. When asked why not add EPO, she said it is not technically approved for patients not on chemo. When asked what the harm would be, she responded there is a long term risk of heart attack or stroke. Seriously. She also told me radiation was never used on the liver, as it kills more liver than cancer. I'm reading that this is not the case. I have no idea why she'd misrepresent that.
His home care doctor is much more amenable to try things that make him less unwell.
I have other complaints, but for the sake of brevity, I'll simply restate that my question is about using immunotherapy as a 1st line treatment for SMCPa, in a situation like this, where it is not clear that we'll have time to get him strong enough for chemo.
Thanks in advance.
First,, some history:
My father had well controlled (with hormone treatments) Prostate Adenocarcinoma, which mutated into Small Cell Carcinoma of the Prostate. Our largest concern are his liver lesions.
He became symptomatic when a mass blocked his uterer, causing him pain, which he thought was a muscular strain. In the weeks he was laid up, including one in the hospital, he lost a lot of muscle mass. He could still, for instance, take 4 laps around the oncology ward the first admission.
He asked to leave the day after getting the stent, which is when it hit the fan. At home his blood pressure was undetectable with our machine, he became unresponsive. He was sent to the ER, and stayed in oncology for another week. He was totally immobile from pain everywhere, and he lost more muscle. Even his vocal cords stopped working, whereas his voice was just weak before.
We brought him home at his request, and told he had days to live. Sepsis was suspected, but not seen in cultures. Perhaps it was just not detected, as his WBC was real high a week after his return, and is now normal.
Now a month has passed and he is slowly gaining strength, but also becoming anemic. The day he came back from the hospital he started feeding himself, and walking short distances with a walker. Today for the first time he is able to reliably project his voice, and used it to say he feels stronger. Combined with the cancer, and the anemia, it is difficult for him to exercise, and continue gaining strength.
It hasn't been a straight path, today is great, yesterday was terrible. That said, we had to fire hospice and put him on home care, because even getting a palliative transfusion was impossible. (Scheduled for Monday).
His oncologist really doesn't do much for us, besides tell us he is dying. He is fighting, and we can't even give him hypotensive meds for the occasional drops in BP he sees. She prescribed table salt instead.. In fact, I think part of the crisis that got him back in the hospital was a result of not eliminating his hypertension meds, despite the fact that even on IV in the hospital, his BP was below normal, due to the weight he lost.
Here is my question:
I agree that he is too weak to do a course of platinum chemo meds, but my understanding is that the immunotherapy available to him -- although they don't work all that well for most people -- are far more tolerable. However, they are supposed to be 2nd line.
I'm pretty sure, given how his cancer has impacted him, that we won't get a chance for 1st line, so why can't we do second line first, and see if it gets him a shot for 1st? How is nothing the ethical choice, when the doc's are already more than a half a magnitude too pessimistic on him. He doesn't look like he's going anywhere soon.
We recognize how grim his prognosis is, but he wants a chance to fight, and his oncologist seems to refuse to give him one. His home care doc got us the transfusion. His oncologist would not, and actually overstated how low he'd have to be to qualify, causing us all to waste time looking into direct donation.
It is as if her ego is hurt that he not only still lives, but regains function and strength -- despite the anemia -- and despite no interventions intended to help him get stronger. We just got an appetite stimulant today, and again, it was only because we asked for it. It will take weeks to work.. When asked why not add EPO, she said it is not technically approved for patients not on chemo. When asked what the harm would be, she responded there is a long term risk of heart attack or stroke. Seriously. She also told me radiation was never used on the liver, as it kills more liver than cancer. I'm reading that this is not the case. I have no idea why she'd misrepresent that.
His home care doctor is much more amenable to try things that make him less unwell.
I have other complaints, but for the sake of brevity, I'll simply restate that my question is about using immunotherapy as a 1st line treatment for SMCPa, in a situation like this, where it is not clear that we'll have time to get him strong enough for chemo.
Thanks in advance.
My father had well controlled (with hormone treatments) Prostate Adenocarcinoma, which mutated into Small Cell Carcinoma of the Prostate. Our largest concern are his liver lesions.
He became symptomatic when a mass blocked his uterer, causing him pain, which he thought was a muscular strain. In the weeks he was laid up, including one in the hospital, he lost a lot of muscle mass. He could still, for instance, take 4 laps around the oncology ward the first admission.
He asked to leave the day after getting the stent, which is when it hit the fan. At home his blood pressure was undetectable with our machine, he became unresponsive. He was sent to the ER, and stayed in oncology for another week. He was totally immobile from pain everywhere, and he lost more muscle. Even his vocal cords stopped working, whereas his voice was just weak before.
We brought him home at his request, and told he had days to live. Sepsis was suspected, but not seen in cultures. Perhaps it was just not detected, as his WBC was real high a week after his return, and is now normal.
Now a month has passed and he is slowly gaining strength, but also becoming anemic. The day he came back from the hospital he started feeding himself, and walking short distances with a walker. Today for the first time he is able to reliably project his voice, and used it to say he feels stronger. Combined with the cancer, and the anemia, it is difficult for him to exercise, and continue gaining strength.
It hasn't been a straight path, today is great, yesterday was terrible. That said, we had to fire hospice and put him on home care, because even getting a palliative transfusion was impossible. (Scheduled for Monday).
His oncologist really doesn't do much for us, besides tell us he is dying. He is fighting, and we can't even give him hypotensive meds for the occasional drops in BP he sees. She prescribed table salt instead.. In fact, I think part of the crisis that got him back in the hospital was a result of not eliminating his hypertension meds, despite the fact that even on IV in the hospital, his BP was below normal, due to the weight he lost.
Here is my question:
I agree that he is too weak to do a course of platinum chemo meds, but my understanding is that the immunotherapy available to him -- although they don't work all that well for most people -- are far more tolerable. However, they are supposed to be 2nd line.
I'm pretty sure, given how his cancer has impacted him, that we won't get a chance for 1st line, so why can't we do second line first, and see if it gets him a shot for 1st? How is nothing the ethical choice, when the doc's are already more than a half a magnitude too pessimistic on him. He doesn't look like he's going anywhere soon.
We recognize how grim his prognosis is, but he wants a chance to fight, and his oncologist seems to refuse to give him one. His home care doc got us the transfusion. His oncologist would not, and actually overstated how low he'd have to be to qualify, causing us all to waste time looking into direct donation.
It is as if her ego is hurt that he not only still lives, but regains function and strength -- despite the anemia -- and despite no interventions intended to help him get stronger. We just got an appetite stimulant today, and again, it was only because we asked for it. It will take weeks to work.. When asked why not add EPO, she said it is not technically approved for patients not on chemo. When asked what the harm would be, she responded there is a long term risk of heart attack or stroke. Seriously. She also told me radiation was never used on the liver, as it kills more liver than cancer. I'm reading that this is not the case. I have no idea why she'd misrepresent that.
His home care doctor is much more amenable to try things that make him less unwell.
I have other complaints, but for the sake of brevity, I'll simply restate that my question is about using immunotherapy as a 1st line treatment for SMCPa, in a situation like this, where it is not clear that we'll have time to get him strong enough for chemo.
Thanks in advance.
Brief Answer:
Metastatic prostatic carcinoma
Detailed Answer:
Dear XXXXXXX
As I have gone through the history of your father I understand it is because of asthenia (gen. Weakness}. He went into hypotension and feeble body reactions. Giving any form of chemotherapy at this time is not recommended. Because in a debilitated patients it does more harm than good. Continue to give him palliative treatment. In the form of good nutrition and adequate fluids until he gains good strength. Waiting for some time will not cause any harm. It is a very slow-growing tumor. As the unusual turning of adenocarcinoma into squamous cell carcinoma has a very slow progression. I will advise giving vitamin d { alphacalcidol } available on the counter with high-calorie diet. Once he improves further chemotherapy can be tried. Radiation will not be useful in liver mets. Chemotherapy has also a doubtful role. So continue with good palliation and you will see him going stronger.
Truly
Metastatic prostatic carcinoma
Detailed Answer:
Dear XXXXXXX
As I have gone through the history of your father I understand it is because of asthenia (gen. Weakness}. He went into hypotension and feeble body reactions. Giving any form of chemotherapy at this time is not recommended. Because in a debilitated patients it does more harm than good. Continue to give him palliative treatment. In the form of good nutrition and adequate fluids until he gains good strength. Waiting for some time will not cause any harm. It is a very slow-growing tumor. As the unusual turning of adenocarcinoma into squamous cell carcinoma has a very slow progression. I will advise giving vitamin d { alphacalcidol } available on the counter with high-calorie diet. Once he improves further chemotherapy can be tried. Radiation will not be useful in liver mets. Chemotherapy has also a doubtful role. So continue with good palliation and you will see him going stronger.
Truly
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Metastatic prostatic carcinoma
Detailed Answer:
Dear XXXXXXX
As I have gone through the history of your father I understand it is because of asthenia (gen. Weakness}. He went into hypotension and feeble body reactions. Giving any form of chemotherapy at this time is not recommended. Because in a debilitated patients it does more harm than good. Continue to give him palliative treatment. In the form of good nutrition and adequate fluids until he gains good strength. Waiting for some time will not cause any harm. It is a very slow-growing tumor. As the unusual turning of adenocarcinoma into squamous cell carcinoma has a very slow progression. I will advise giving vitamin d { alphacalcidol } available on the counter with high-calorie diet. Once he improves further chemotherapy can be tried. Radiation will not be useful in liver mets. Chemotherapy has also a doubtful role. So continue with good palliation and you will see him going stronger.
Truly
Metastatic prostatic carcinoma
Detailed Answer:
Dear XXXXXXX
As I have gone through the history of your father I understand it is because of asthenia (gen. Weakness}. He went into hypotension and feeble body reactions. Giving any form of chemotherapy at this time is not recommended. Because in a debilitated patients it does more harm than good. Continue to give him palliative treatment. In the form of good nutrition and adequate fluids until he gains good strength. Waiting for some time will not cause any harm. It is a very slow-growing tumor. As the unusual turning of adenocarcinoma into squamous cell carcinoma has a very slow progression. I will advise giving vitamin d { alphacalcidol } available on the counter with high-calorie diet. Once he improves further chemotherapy can be tried. Radiation will not be useful in liver mets. Chemotherapy has also a doubtful role. So continue with good palliation and you will see him going stronger.
Truly
Above answer was peer-reviewed by :
Dr. Prasad
Would you recommendnd against palliative radiotherapy for the liver? It seems to be the 9nly organ affected by the SCC, and the source of his weakness?
Would you recommendnd against palliative radiotherapy for the liver? It seems to be the 9nly organ affected by the SCC, and the source of his weakness?
Also, thank you for the respone.
Also, thank you for the respone.
Brief Answer:
MET. PROSTATIC CARCINOMA
Detailed Answer:
Dear XXXXXXX
Thanks for reverting.
Radiation tolerance of liver is very low compared to the amount of radiation to be used for hitting the metastatic lesion in the liver. Though there are improved methods of delivering radiation sparing the normal tissue even then the damage will be more. More so it is not a recognized treatment for liver metastasis. If your father shows good performance status post palliation, chemotherapy or immunotherapy is the only answer. If after some time the lesion in the liver is still solitary the lesion can be removed. Let your father achieve good strength.
MET. PROSTATIC CARCINOMA
Detailed Answer:
Dear XXXXXXX
Thanks for reverting.
Radiation tolerance of liver is very low compared to the amount of radiation to be used for hitting the metastatic lesion in the liver. Though there are improved methods of delivering radiation sparing the normal tissue even then the damage will be more. More so it is not a recognized treatment for liver metastasis. If your father shows good performance status post palliation, chemotherapy or immunotherapy is the only answer. If after some time the lesion in the liver is still solitary the lesion can be removed. Let your father achieve good strength.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Brief Answer:
MET. PROSTATIC CARCINOMA
Detailed Answer:
Dear XXXXXXX
Thanks for reverting.
Radiation tolerance of liver is very low compared to the amount of radiation to be used for hitting the metastatic lesion in the liver. Though there are improved methods of delivering radiation sparing the normal tissue even then the damage will be more. More so it is not a recognized treatment for liver metastasis. If your father shows good performance status post palliation, chemotherapy or immunotherapy is the only answer. If after some time the lesion in the liver is still solitary the lesion can be removed. Let your father achieve good strength.
MET. PROSTATIC CARCINOMA
Detailed Answer:
Dear XXXXXXX
Thanks for reverting.
Radiation tolerance of liver is very low compared to the amount of radiation to be used for hitting the metastatic lesion in the liver. Though there are improved methods of delivering radiation sparing the normal tissue even then the damage will be more. More so it is not a recognized treatment for liver metastasis. If your father shows good performance status post palliation, chemotherapy or immunotherapy is the only answer. If after some time the lesion in the liver is still solitary the lesion can be removed. Let your father achieve good strength.
Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Thank you again for the response, Doctor.
Setting aside for a moment the issue at hand,, I'd like to further compensate you for your time. However, it is not clear to me from my XXXXXXX device, how to do so. Please advise.
Returning to the issue at hand: I noticed before that you had said that SCC is normally slow, however we have blood panels taken 29/9, 9/10, and 14/10. (I can provide these in .xsl format.)
His CEA has gone from 1600 to 3000 in this time. His alkaline phosphotase is not as bad looking , but definitely not great (537).
AST and ALT are about 20% over reference range.
Aside from his anemia, for which we are getting a palliative transfusion, his blood panels have otherwise improved, e.g. WBC back in normal range, and metamyelocytes from 6 to 1. He was tested for sepsis, and it was not found in the cultures, but there does seem to be a left-shift in that regard. (Doctors warned us it could be a false negative).
Or, perhaps,, is the 8mg/day of dexamethasone suppressing his immune system? My intuition says that there was infection, but I am only a layman.
We do not suspect brain metastases at this point, but we are beginning to suspect dexamethasone psychosis (8 mg over 35 days). A small dose of haloperidol today did help to alleviate his confusion somewhat, and did much more to help with the malaise/hypoactivity, both of which have occasionally been preventing his participation in his own recovery.
As such, we are titrating him over to prednisone, or perhaps just CBD. He no longer has resting pain, and I suspect that when he had it, infection was the cause.
His weakness is such that he can only speak in whispers, most of the time. A voice therapist suggested it could be vocal chord paralysis of unknown origin. I am much more certain that it is just weakness, having been with him and speaking to him throughout his cachexia.
We have been treating him with the experimental SARM Ostarine, which is in FDA trials for cancer cachexia, for 11 days (5mg/day, now up to 10). We have also subseqently added testosterone ciprionate, as he is still hypogonadal (hormone treatment for original PCa stopped over a month ago).
I'm am going to have his doctors release the rest of their records to us to.orrow.
HERE IS THE QUESTION:
Given everything I've written above: are you more inclined to recommend some kind of cancer ablation therapy to his liver sooner than before?
Setting aside for a moment the issue at hand,, I'd like to further compensate you for your time. However, it is not clear to me from my XXXXXXX device, how to do so. Please advise.
Returning to the issue at hand: I noticed before that you had said that SCC is normally slow, however we have blood panels taken 29/9, 9/10, and 14/10. (I can provide these in .xsl format.)
His CEA has gone from 1600 to 3000 in this time. His alkaline phosphotase is not as bad looking , but definitely not great (537).
AST and ALT are about 20% over reference range.
Aside from his anemia, for which we are getting a palliative transfusion, his blood panels have otherwise improved, e.g. WBC back in normal range, and metamyelocytes from 6 to 1. He was tested for sepsis, and it was not found in the cultures, but there does seem to be a left-shift in that regard. (Doctors warned us it could be a false negative).
Or, perhaps,, is the 8mg/day of dexamethasone suppressing his immune system? My intuition says that there was infection, but I am only a layman.
We do not suspect brain metastases at this point, but we are beginning to suspect dexamethasone psychosis (8 mg over 35 days). A small dose of haloperidol today did help to alleviate his confusion somewhat, and did much more to help with the malaise/hypoactivity, both of which have occasionally been preventing his participation in his own recovery.
As such, we are titrating him over to prednisone, or perhaps just CBD. He no longer has resting pain, and I suspect that when he had it, infection was the cause.
His weakness is such that he can only speak in whispers, most of the time. A voice therapist suggested it could be vocal chord paralysis of unknown origin. I am much more certain that it is just weakness, having been with him and speaking to him throughout his cachexia.
We have been treating him with the experimental SARM Ostarine, which is in FDA trials for cancer cachexia, for 11 days (5mg/day, now up to 10). We have also subseqently added testosterone ciprionate, as he is still hypogonadal (hormone treatment for original PCa stopped over a month ago).
I'm am going to have his doctors release the rest of their records to us to.orrow.
HERE IS THE QUESTION:
Given everything I've written above: are you more inclined to recommend some kind of cancer ablation therapy to his liver sooner than before?
Thank you again for the response, Doctor.
Setting aside for a moment the issue at hand,, I'd like to further compensate you for your time. However, it is not clear to me from my XXXXXXX device, how to do so. Please advise.
Returning to the issue at hand: I noticed before that you had said that SCC is normally slow, however we have blood panels taken 29/9, 9/10, and 14/10. (I can provide these in .xsl format.)
His CEA has gone from 1600 to 3000 in this time. His alkaline phosphotase is not as bad looking , but definitely not great (537).
AST and ALT are about 20% over reference range.
Aside from his anemia, for which we are getting a palliative transfusion, his blood panels have otherwise improved, e.g. WBC back in normal range, and metamyelocytes from 6 to 1. He was tested for sepsis, and it was not found in the cultures, but there does seem to be a left-shift in that regard. (Doctors warned us it could be a false negative).
Or, perhaps,, is the 8mg/day of dexamethasone suppressing his immune system? My intuition says that there was infection, but I am only a layman.
We do not suspect brain metastases at this point, but we are beginning to suspect dexamethasone psychosis (8 mg over 35 days). A small dose of haloperidol today did help to alleviate his confusion somewhat, and did much more to help with the malaise/hypoactivity, both of which have occasionally been preventing his participation in his own recovery.
As such, we are titrating him over to prednisone, or perhaps just CBD. He no longer has resting pain, and I suspect that when he had it, infection was the cause.
His weakness is such that he can only speak in whispers, most of the time. A voice therapist suggested it could be vocal chord paralysis of unknown origin. I am much more certain that it is just weakness, having been with him and speaking to him throughout his cachexia.
We have been treating him with the experimental SARM Ostarine, which is in FDA trials for cancer cachexia, for 11 days (5mg/day, now up to 10). We have also subseqently added testosterone ciprionate, as he is still hypogonadal (hormone treatment for original PCa stopped over a month ago).
I'm am going to have his doctors release the rest of their records to us to.orrow.
HERE IS THE QUESTION:
Given everything I've written above: are you more inclined to recommend some kind of cancer ablation therapy to his liver sooner than before?
Setting aside for a moment the issue at hand,, I'd like to further compensate you for your time. However, it is not clear to me from my XXXXXXX device, how to do so. Please advise.
Returning to the issue at hand: I noticed before that you had said that SCC is normally slow, however we have blood panels taken 29/9, 9/10, and 14/10. (I can provide these in .xsl format.)
His CEA has gone from 1600 to 3000 in this time. His alkaline phosphotase is not as bad looking , but definitely not great (537).
AST and ALT are about 20% over reference range.
Aside from his anemia, for which we are getting a palliative transfusion, his blood panels have otherwise improved, e.g. WBC back in normal range, and metamyelocytes from 6 to 1. He was tested for sepsis, and it was not found in the cultures, but there does seem to be a left-shift in that regard. (Doctors warned us it could be a false negative).
Or, perhaps,, is the 8mg/day of dexamethasone suppressing his immune system? My intuition says that there was infection, but I am only a layman.
We do not suspect brain metastases at this point, but we are beginning to suspect dexamethasone psychosis (8 mg over 35 days). A small dose of haloperidol today did help to alleviate his confusion somewhat, and did much more to help with the malaise/hypoactivity, both of which have occasionally been preventing his participation in his own recovery.
As such, we are titrating him over to prednisone, or perhaps just CBD. He no longer has resting pain, and I suspect that when he had it, infection was the cause.
His weakness is such that he can only speak in whispers, most of the time. A voice therapist suggested it could be vocal chord paralysis of unknown origin. I am much more certain that it is just weakness, having been with him and speaking to him throughout his cachexia.
We have been treating him with the experimental SARM Ostarine, which is in FDA trials for cancer cachexia, for 11 days (5mg/day, now up to 10). We have also subseqently added testosterone ciprionate, as he is still hypogonadal (hormone treatment for original PCa stopped over a month ago).
I'm am going to have his doctors release the rest of their records to us to.orrow.
HERE IS THE QUESTION:
Given everything I've written above: are you more inclined to recommend some kind of cancer ablation therapy to his liver sooner than before?
Brief Answer:
Prostatic Carcinoma
Detailed Answer:
DEAR XXXXXXX
Your queries are valid. There is some confusion somewhere. A patient with such levels of high CEA has never been seen by me. Normally this suggests that the tumor burden is very high and the patient is unexpected to be living with such a raised marker, rather your theory is that patient has been improving. The therapies you are giving for cachexia are OK. Let him improve a little more when we can consider tumor growth restraining therapy.
I have one curiosity to know as to how you came to the conclusion of transformation to squamous cell carcinoma from prostatic adenocarcinoma. I wonder if he is not having 2nd malignancy from elsewhere particularly lung which has lead to the change in voice pattern.
Anyway, if he shows further improvement with palliative therapy we can consider some active management. at this time conventional palliative management is the need.
Truly
Prostatic Carcinoma
Detailed Answer:
DEAR XXXXXXX
Your queries are valid. There is some confusion somewhere. A patient with such levels of high CEA has never been seen by me. Normally this suggests that the tumor burden is very high and the patient is unexpected to be living with such a raised marker, rather your theory is that patient has been improving. The therapies you are giving for cachexia are OK. Let him improve a little more when we can consider tumor growth restraining therapy.
I have one curiosity to know as to how you came to the conclusion of transformation to squamous cell carcinoma from prostatic adenocarcinoma. I wonder if he is not having 2nd malignancy from elsewhere particularly lung which has lead to the change in voice pattern.
Anyway, if he shows further improvement with palliative therapy we can consider some active management. at this time conventional palliative management is the need.
Truly
Above answer was peer-reviewed by :
Dr. Prasad
Brief Answer:
Prostatic Carcinoma
Detailed Answer:
DEAR XXXXXXX
Your queries are valid. There is some confusion somewhere. A patient with such levels of high CEA has never been seen by me. Normally this suggests that the tumor burden is very high and the patient is unexpected to be living with such a raised marker, rather your theory is that patient has been improving. The therapies you are giving for cachexia are OK. Let him improve a little more when we can consider tumor growth restraining therapy.
I have one curiosity to know as to how you came to the conclusion of transformation to squamous cell carcinoma from prostatic adenocarcinoma. I wonder if he is not having 2nd malignancy from elsewhere particularly lung which has lead to the change in voice pattern.
Anyway, if he shows further improvement with palliative therapy we can consider some active management. at this time conventional palliative management is the need.
Truly
Prostatic Carcinoma
Detailed Answer:
DEAR XXXXXXX
Your queries are valid. There is some confusion somewhere. A patient with such levels of high CEA has never been seen by me. Normally this suggests that the tumor burden is very high and the patient is unexpected to be living with such a raised marker, rather your theory is that patient has been improving. The therapies you are giving for cachexia are OK. Let him improve a little more when we can consider tumor growth restraining therapy.
I have one curiosity to know as to how you came to the conclusion of transformation to squamous cell carcinoma from prostatic adenocarcinoma. I wonder if he is not having 2nd malignancy from elsewhere particularly lung which has lead to the change in voice pattern.
Anyway, if he shows further improvement with palliative therapy we can consider some active management. at this time conventional palliative management is the need.
Truly
Above answer was peer-reviewed by :
Dr. Prasad
With respect to his CEA, I do not expect he will be living much longer, especially given his anemia. Today we had to give him enough morphine to render him semi unconscious, due to the sensation of being hypoxic.
His 0² was around 94 or higher, but his heart rate was over 130 from the anxiety of not being able to breath. I would not expect that, 94 O² would be so uncomfortable, so I assume the anemia is what is causing it.
We have a doctor willing to do transfusionss.
As to his progress, he has gained some strength and can project his voice, but the exhaustion and, i presume the anemia/hypoxia, make exercise impossible at this point.
If my mother is not amenable to the transfusion we will have to palliatively sedate him.
His 0² was around 94 or higher, but his heart rate was over 130 from the anxiety of not being able to breath. I would not expect that, 94 O² would be so uncomfortable, so I assume the anemia is what is causing it.
We have a doctor willing to do transfusionss.
As to his progress, he has gained some strength and can project his voice, but the exhaustion and, i presume the anemia/hypoxia, make exercise impossible at this point.
If my mother is not amenable to the transfusion we will have to palliatively sedate him.
With respect to his CEA, I do not expect he will be living much longer, especially given his anemia. Today we had to give him enough morphine to render him semi unconscious, due to the sensation of being hypoxic.
His 0² was around 94 or higher, but his heart rate was over 130 from the anxiety of not being able to breath. I would not expect that, 94 O² would be so uncomfortable, so I assume the anemia is what is causing it.
We have a doctor willing to do transfusionss.
As to his progress, he has gained some strength and can project his voice, but the exhaustion and, i presume the anemia/hypoxia, make exercise impossible at this point.
If my mother is not amenable to the transfusion we will have to palliatively sedate him.
His 0² was around 94 or higher, but his heart rate was over 130 from the anxiety of not being able to breath. I would not expect that, 94 O² would be so uncomfortable, so I assume the anemia is what is causing it.
We have a doctor willing to do transfusionss.
As to his progress, he has gained some strength and can project his voice, but the exhaustion and, i presume the anemia/hypoxia, make exercise impossible at this point.
If my mother is not amenable to the transfusion we will have to palliatively sedate him.
Brief Answer:
Prostatic Can.
Detailed Answer:
Dear XXXXXXX
If he is anemic not knowing his HB. Level, increase in heart rate is explainable. There no problem in giving Red Cell transfusion to raise his HB. Level. Oxygen saturation at 94 % will not cause techycardia. Very low level of HB. Will lead to cardiac arrest. I think take advice from your doctor about it.
Truly
Prostatic Can.
Detailed Answer:
Dear XXXXXXX
If he is anemic not knowing his HB. Level, increase in heart rate is explainable. There no problem in giving Red Cell transfusion to raise his HB. Level. Oxygen saturation at 94 % will not cause techycardia. Very low level of HB. Will lead to cardiac arrest. I think take advice from your doctor about it.
Truly
Above answer was peer-reviewed by :
Dr. Kampana
Brief Answer:
Prostatic Can.
Detailed Answer:
Dear XXXXXXX
If he is anemic not knowing his HB. Level, increase in heart rate is explainable. There no problem in giving Red Cell transfusion to raise his HB. Level. Oxygen saturation at 94 % will not cause techycardia. Very low level of HB. Will lead to cardiac arrest. I think take advice from your doctor about it.
Truly
Prostatic Can.
Detailed Answer:
Dear XXXXXXX
If he is anemic not knowing his HB. Level, increase in heart rate is explainable. There no problem in giving Red Cell transfusion to raise his HB. Level. Oxygen saturation at 94 % will not cause techycardia. Very low level of HB. Will lead to cardiac arrest. I think take advice from your doctor about it.
Truly
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Above answer was peer-reviewed by :
Dr. Kampana
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