Stilbestrol swapped for Dexamethasone?

User

Posted 14 Dec 2020 at 02:01

My 86 year-old friend, who has had what must be a slow-growing PCa for five years, has metastasis to his pelvis, yet was discharged back to urology from oncology.

His original PSA was 300-odd, but Bicalutamide brought that down to 12, before it stopped working after two years. He was then put on Stilbestrol, on which he seemed to be doing OK, but his latest PSA tests show a rise from 26 to 37. His urology consultant had a telephone consultation with him, which he didn’t really understand, as I normally take him to his hospital appointments.

The upshot of this is that he has been told to stop the Stilbestrol, and to start on the corticosteroid Doximethasone. They are completely different drugs, the former a female hormone drug and the latter a steroid for skin complaints.

Since typing this a couple of hours ago, I have looked up Doximethasone as part of a cancer regimen, and discovered that it can stult testerosterone production.

The urologist told me she is not allowed to prescribe Abiraterone or Enzalutamide, which is why I got him referred to Oncology in the first place.

I have told my mate that he will die with PCa, rather than of it, to which he replied, only half-heartedly: “The sooner the better!”

He is recently widowed in a four bedroom house out in the country with an elderly step-daughter who is not in the best of health either, who is not his favourite person in the world.

Many thanks.

Cheers, John.

Edited by member 14 Dec 2020 at 07:51 | Reason: Not specified

User

Posted 14 Dec 2020 at 08:44

How preposterous! Unless he has missed a key piece of information - dexamethasone is usually prescribed with docetaxel to reduce the sickness and nausea side effects of the chemo. Could they possibly be considering chemo???? Is there any chance of getting a referral back to the onco?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 14 Dec 2020 at 09:09

Thank you Matron.

Just as I thought, something’s not quite right. A bit sneaky of the urologist to phone my mate up out of the blue for a telephone consultation when she knows I always accompany him by way of a translator!

I have been to hospital three times in the last few weeks, twice with my father-in-law, and once for my skin biopsy and they seem to have got over the Plague Panic Paranoia, and are coping more or less as normal with (masked) face-to-face consultations.

I went to a metal components manufacturer last week and they insisted on taking my temperature. The guy looked a bit downcast when I told him I had been to three hospitals where they had not...

So my friend, by coincidence, is going to his GP this afternoon and I’ll ask if his doctor can speak to me directly.

Cheers, John.

User

Posted 14 Dec 2020 at 09:15

Do you know why he's not being prescribed GnRH Agonist/Antagonist drugs? (Zoladex, Prostap, Decapeptyl, Degarelix.)

Diethylstilbestrol was the first hormone therapy drug (a synthetic estrogen), but is now only used near end-stage, because long term use killed around 1/3rd of the men on it due to a side effect. (If you ignore that one fatal side effect, it had fewer side effects than the current GnRH analogues.)

Steroids do lower PSA, and I think this maps to reduced cancer activity. Use of steroids for other purposes sometimes messes up PSA monitoring measurements.

Why has someone with mets been discharged from oncology?

Edited by member 14 Dec 2020 at 09:18 | Reason: Not specified

User

Posted 14 Dec 2020 at 10:36

He has a quarterly injection of generic Zoladex.

I think the medics have given up on him, although he he is bursting with life, that I see sadly ebbing away...

I asked him yesterday to accompany us for a sanction-busting pub lunch down the road in Oxfordshire (Tier 2 - pubs open) but he couldn’t be bothered.

I will take up your latter point, Andy.

Cheers, John.

User

Posted 14 Dec 2020 at 12:12

Stilboestrol is an old treatment but it is still a valid choice for some men and can be very effective. Devonmaid's John was on it for 10 years despite a diagnosis of advanced PCa with mets. Clearly, in Bollinge's friend's case, it has stopped being effective but they should be offering Prostap or similar since he cannot be described as castrate resistant. I have some doubts about this uro but perhaps there is some info that has been lost in translation?

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 14 Dec 2020 at 12:37

Isn't zoladex a prostrap equivalent??

User

Posted 14 Dec 2020 at 12:38

Re sanctions busting for an 80 year old - that may solve all his problems in one! You are a very naughty man!

User

Posted 14 Dec 2020 at 16:31

So my mate has been to the Doctor’s today, where he saw a nurse regarding knee pain (not PCa, more 86 year-old, related), and not the Doctor.

The nurse told him the above drug was the only one prescribed, not any additional one as we all thought here would be appropriate, but then helpfully told him to take up the matter and ask any questions about it of his pharmacist!

When did chemists prescribe chemotherapy or super-cancer drugs at four grand a month?

Anyway, I’ll phone his urology Consultant’s secretary tomorrow and see if the Consultant will call me back to find out what’s going on. Like someone else said (Andy I think), why was he discharged from oncology with metastatic cancer?

I’m learning so much about this bloody disease which may stand me in good stead if my cancer ever returns!

Cheers, John.

User

Posted 14 Dec 2020 at 17:06

My wife's dad was given steroids by the palliative care hospice doctor (in Poland, around 2007) pretty much 5-6 weeks before he died. His prostate cancer had spread everywhere and there were no further options available after trying a few other palliative treatments (Strontium 90 and 3 or 4 rounds of Aredia).

What it did, though, is give him a final flourish. We did some crazy things during that time (like carrying an old very large and heavy gas boiler up from the basement and taking it apart outside). It also enabled him to do some of the things he enjoyed, pretty much right up until the end.

That's the only other possibility I can think of, unless it's just a simple error or omission.

_____

Two cannibals named Ectomy and Prost, all alone on a Desert island.

Prost was the strongest, so Prost ate Ectomy.

User

Posted 14 Dec 2020 at 18:34

Originally Posted by: Online Community Member

Isn't zoladex a prostrap equivalent??

Yes - I missed the key bit of information in Bollinge's follow up comment :-/

Bollinge, just clarify - was he on Zoladex and Stilboestrol at the same time and they have swapped the stilboestrol for dexa? I am perplexed, it is just unheard of to prescribe both zolly and stilboestrol at the same time!

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 15 Dec 2020 at 03:19

He has been on the three-monthly Zoladex injections from his diagnosis five years ago. He went on Bicalutamide three years ago - he only told me he had PCa when I told him I had it. Like I have said before, they come out of the woodwork!

So that stopped working after two years, and he was put on Stilbestrol, still maintaining the quarterly injection. With his latest rise in PSA he’s been told to stop Stilbestrol, and take the corticosteroid instead. He is quite well, apart from his limp, but depressed like everyone else because of the plague lockdown, and still down after his bereavement a couple of years ago.

Although he was a successful businessman, his late wife used to do everything for him, putting out his clothing for the day every morning, booking holidays, giving him his pocket money. She was still skiing down black runs with me in her early eighties!

I will try and speak with his urology consultant today.

Cheers, John.

Edited by member 15 Dec 2020 at 03:20 | Reason: Not specified

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