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Suggest Treatment For Blood In Urine
Question: Hello,
My father, aged 64 years and 2 months, is a patient of Castration Resistant Prostate Cancer. His original diagonosis (Stage III a) was in March 2011 and he started Zoladex from May of that year. He received tomotherapy in November of that year. His PSA XXXXXXX was 0.016 However, his PSA started progressing from about a year later and crossed the progression threshold around October 2013. From October 2013 he started having repeated instances of haematuria and urine retention, requiring several cystoscopies over the next eight months or so. During this phase it was confirmed that his disease had relapsed. We changed doctors around October 2014, and the new doctor performed an laser surgery to clear the penile strictures and an orchidectomy so that he wouldn't need to continue to be on Zoladex. However, even after this the PSA shot up to 12.5 and he was having issues with severe incontinence. He was then offered a three month course of abiraterone acetate and has been taking it for a little over a month. His PSA has come down to 4.07. However, he continues to have severe incontinence and passes blood and blood clots with urine. I would like to know therefore, how long (based on known averages) can we hope the abiraterone to have effect before the disease progresses again? In spite of the PSA coming down drastically, he continues to have haematuria and severe incontinence - how should we interpret this vis-a-vis the disease? Once the disease progresses again after abiraterone, is there any other option left, such as docetaxel? Or will it mean that there are no ther therapeutic possibilites and he'll need to be put on end-of-life care?
Thank you for answering.
XXXXXX
My father, aged 64 years and 2 months, is a patient of Castration Resistant Prostate Cancer. His original diagonosis (Stage III a) was in March 2011 and he started Zoladex from May of that year. He received tomotherapy in November of that year. His PSA XXXXXXX was 0.016 However, his PSA started progressing from about a year later and crossed the progression threshold around October 2013. From October 2013 he started having repeated instances of haematuria and urine retention, requiring several cystoscopies over the next eight months or so. During this phase it was confirmed that his disease had relapsed. We changed doctors around October 2014, and the new doctor performed an laser surgery to clear the penile strictures and an orchidectomy so that he wouldn't need to continue to be on Zoladex. However, even after this the PSA shot up to 12.5 and he was having issues with severe incontinence. He was then offered a three month course of abiraterone acetate and has been taking it for a little over a month. His PSA has come down to 4.07. However, he continues to have severe incontinence and passes blood and blood clots with urine. I would like to know therefore, how long (based on known averages) can we hope the abiraterone to have effect before the disease progresses again? In spite of the PSA coming down drastically, he continues to have haematuria and severe incontinence - how should we interpret this vis-a-vis the disease? Once the disease progresses again after abiraterone, is there any other option left, such as docetaxel? Or will it mean that there are no ther therapeutic possibilites and he'll need to be put on end-of-life care?
Thank you for answering.
XXXXXX
Brief Answer:
cabazitaxel
Detailed Answer:
Hi
Abiraterone Acetate will control progression free survival in prostate cancer to about 8.3 months.
Though he is having incontinence and passing blood in urine if the PSA is going down then there is notting to worry.
I would advise tranexamic acid tablets 500 mg thrice daily after food for 3 days which will control his bleeding.
After his disease progresses with abiraterone acetate he can be treated with docetaxel and after it progresses with that also he will have to be treated with the latest chemotherapy drug cabazitaxel.
Regards
DR DE
cabazitaxel
Detailed Answer:
Hi
Abiraterone Acetate will control progression free survival in prostate cancer to about 8.3 months.
Though he is having incontinence and passing blood in urine if the PSA is going down then there is notting to worry.
I would advise tranexamic acid tablets 500 mg thrice daily after food for 3 days which will control his bleeding.
After his disease progresses with abiraterone acetate he can be treated with docetaxel and after it progresses with that also he will have to be treated with the latest chemotherapy drug cabazitaxel.
Regards
DR DE
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Dear Dr. De,
Many thanks for your prompt answer. At present he takes tab. Pause 500 mg on an SOS basis. Is this the same as what you are suggesting?
While I am somewhat disappointed to know that abiraterone will only control the disease for about 8.3 months, it is good to know that docetaxel and cabazitaxel will still be options even when progression recurs. My only remaining question is, can cabazitaxel be given to patients more than 65 years, as he will probably have crossed 65 by the time he needs cabazitaxel?
Many thanks,
XXXXXX
Many thanks for your prompt answer. At present he takes tab. Pause 500 mg on an SOS basis. Is this the same as what you are suggesting?
While I am somewhat disappointed to know that abiraterone will only control the disease for about 8.3 months, it is good to know that docetaxel and cabazitaxel will still be options even when progression recurs. My only remaining question is, can cabazitaxel be given to patients more than 65 years, as he will probably have crossed 65 by the time he needs cabazitaxel?
Many thanks,
XXXXXX
Brief Answer:
Can be given with reduced dose
Detailed Answer:
Hi
Yes tablet pause and tranexamic acid tablets are the same.
Cabazitaxel may cause certain adverse reactions such as low white blood cell count with or without fever in patients 65 years or older and needs to be given with caution to such patients.
It also causes tiredness, weakness, fever, dizziness, urinary tract infection and dehydration and that is why when his disease progresses i would advise the drug cabazitaxel in reduced dose which still will have a great impact to control his prostate cancer.
If you have no more clarifications then please rate the answer and close the thread.
Regards
DR DE
Can be given with reduced dose
Detailed Answer:
Hi
Yes tablet pause and tranexamic acid tablets are the same.
Cabazitaxel may cause certain adverse reactions such as low white blood cell count with or without fever in patients 65 years or older and needs to be given with caution to such patients.
It also causes tiredness, weakness, fever, dizziness, urinary tract infection and dehydration and that is why when his disease progresses i would advise the drug cabazitaxel in reduced dose which still will have a great impact to control his prostate cancer.
If you have no more clarifications then please rate the answer and close the thread.
Regards
DR DE
Note: For further queries related to kidney problems Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
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