Prostatic adenocarcinoma – additional information
Short Summary

78-years-old male with poorly differentiated hormone resistant prostate cancer. The expert recommends treatment with Ketoconazole as a "second line" hormonal treatment, together with LHRH agonist that he currently takes.

Patient's Questions
1)            Do you agree with the treatment based on using Ketoconazole?
2)            Do you believe it correct to postpone or delay use of Taxotere?
Medical Background

Sex: M, Age: 78
Diagnosis: Prostatic adenocarcinoma.
This report updates the previous information of March 2008.
Following the doctor's reply, the patient changed healthcare facilities, transferring from the Istituto Clinico Humanitas in Rozzano (Milan) to the Istituto Nazionale dei Tumori in Milan.
Therefore, the report of the examination made at the latter facility on April 2008 by Dr. X is provided in full:
“Patient carrier of prostatic heteroplasia judged to be hormone resistant. The patient was cared for at ICH (Istituto Clinico Humanitas):
èThe dose of Estramustine was high, and the side effects with 9 tablets a day were foreseeable;
èThe hormonal treatments did not include Eulexin or Androcur;
èUse of Ketonazole should be evaluated as one of the drugs under study;
èAt this time I have doubts about using Taxotere.

The results of the laboratory tests of 4/4/08 are: Glycaemia 77; Uric Acid 4.21; Creatinine 0.65; Alkaline phosphatase 205; GGT 31; LDH 306; AST 26; ALT 21; Sodium 139; Potassium 4.21; Chlorine 102; Calcium 8.76; Bilirubin 0.63; White corpuscles 10.4; Red corpuscles 4.40; Haemoglobin 14.5; Neutrophils 78.8%; lymphocytes 11.7%.
The last PSA test was on Feb 2008 = 73.58.
Patient candidate for Ketoconazole, to be examined within next few days”.
Treatment with Ketoconazole at the following posology was confirmed following the examination on April 2008:
Ketoconazole 200-mg tablets -> 1 tablet every 8 hours on continuous basis.

Expert's Opinion

I do agree that not all treatment options to the patient's androgen independent prostatic cancer were exhausted. Ketoconazole is indeed a reasonable treatment to this stage of his disease. Taxotere treatment can be deferred to a later stage and I do believe there is no harm doing so.
Ketoconazole is reasonable "second line" hormonal treatment. We do not stop the treatment with LHRH agonist (Superfact Depot) although the disease is already defined as hormone refractory due to the fact that the tumor is heterogenous and some of the tumor mass is hormone sensitive and the patient might benefit from the ongoing treatment.
At the present I highly recommend consulting with Dr. Cora sternberg from Rome regarding chemotherapy.
Dr. Cora Sternberg, a worldwide known medical oncologist, is leading the treatment of HRPC patients. (Department of Medical Oncology, San Camillo Forlanini Hospital)

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