A Patient's Guide to Managing Hormone-Refractory Prostate Cancer  

Chapter 4. Challenge the HRPCa Diagnosis


Having HRPCa is neither an honor nor an enviable distinction. So the first step you want to take is to see if you can get out from under this designation.

Assuming you have been treated with Lupron® (or one of the LHRH agonists, as they are called), you need to make sure that you have been given an adequate dose. You will need to get a blood test for testosterone to see if the Lupron has been suppressing it below 20 ng/ml, which is called the “castrate” level. It is necessary to achieve this level to ensure effective treatment of the cancer.

If your blood testosterone is below 20 ng/ml and your PSA is rising, then you should consider the tactics in this book for fighting HRPCa. By the way, you should have at least two increasing PSA values, taken over a month or more apart, to ensure that the trend is upward and not simply a test error or a fluctuation due to infection.

If your blood test shows that you have a higher testosterone level, you will need to discuss this with your oncologist and ask that he increase the dose sufficiently to drive the testosterone below the level of 20 ng/ml. You will need to get another serum testosterone test to ensure this has been done.

If the increased dose now begins to suppress your spa, you will want to continue with this treatment and forget about HRPCa so long as you are successful with the hormone therapy.

If you succeed with Lupron, you may also want to consult with a doctor who is familiar with “intermittent hormone therapy,” which has been shown clinically to extend the efficacy of this regimen. You may also want to discuss the use of Casodex and radiation therapy. In any case, it would be desirable to add an oncologist who specializes in prostate cancer to your medical team. (See the next section on this topic.)


Continue to Chapter 5