POSTED: August 28, 2018

Dr. Vogelzang Offers Advice for Men Prescribed Chemo For Prostate Cancer

Dr. Vogelzang 2015Dr. Nicholas Vogelzang is a medical oncologist at Comprehensive Cancer Centers of Nevada. He is a member of the 2018 Class of Giants of Cancer Care, a designation awarded to healthcare professionals advancing the field of oncology by their contributions in research and clinical practice.

He also serves as Associate Chair for the Genitourinary Committee of US Oncology, the Vice Chair SWOG GU committee, and the Associate Editor of Kidney Cancer Journal and Clinical Genitourinary Cancer.

Prostatepedia spoke to him recently about the development of chemotherapy for prostate cancer. He also offers advice for men prescribed chemotherapy and thoughts on a new class of drugs called PARP inhibitors.

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Do you have any advice for men who have been prescribed chemotherapy? For many patients, it’s a frightening thing. There’s a cultural concept that chemotherapy is terrible.

Dr. Vogelzang: I understand how seriously patients take this issue, although it’s an unfounded fear. I have a patient who is dying. He’s a retired pilot. He refused to take chemotherapy. Yet, he went to the Philippines and spent $30,000 on some herbal potion rather than go on chemotherapy. He came back far worse than when he left. At this point, he’s trying chemotherapy, but he’s just taken too long to get it.

There are a couple of things I’d say. Number one: don’t wait too long. Take chemotherapy when you’re strong. Number two: all the side effects are reversible. You don’t suffer the whole time, although fatigue is real. You’ll have nausea for a day and some folks get bad diarrhea. We have developed dramatically effective drugs to prevent diarrhea, nausea, and vomiting. You don’t vomit anymore. You may not even get nauseated. About the only thing you get is fatigue. Taxotere (docetaxel) can cause hair loss, but Jevtana (cabazitaxel) does not.

If you use an ice cap, like women do with breast cancer, you don’t lose your hair. You can get some numbness in the fingers, but you can prevent that by using ice on your hands. There’s even a product on the market now, called the cold cap, that you can buy for $300 or so that you wear on your head. It looks like a World War I flying cap from the Red Baron. You put it on your head during the one hour of chemotherapy. It virtually prevents the hair loss.

There are also mittens and stockings that protect against fingernail and nerve damage in the hands and feet. You can do it the inexpensive way and put your hands and feet in ice. People come into my clinic and ask what all those guys are doing with their feet in ice? It’s to prevent nerve damage from the chemotherapy.

Like I said, Jevtana (cabazitaxel) avoids those side effects. I try to give Jevtana (cabazitaxel) whenever I can first for that reason. Usually, the insurance requires Taxotere (docetaxel) first because Jevtana (cabazitaxel) is a lot more expensive. Jevtana (cabazitaxel) can be really well tolerated for a long time. I have one patient who is a rancher originally from Minnesota. He is on dose number 27 of Jevtana (cabazitaxel). His PSA started in the high hundreds and now it’s 11. In some patients, chemotherapy is highly effective, long lasting, and is clearly not to be feared.

It’s just urban legend that somehow chemotherapy is bad. We figured out many years ago that chemotherapy is not to be feared.

Join us to read the rest of Dr. Vogelzang’s comments on chemotherapy for prostate cancer.

2 Comment

Ken

I finished docetaxel two years ago and lost every hair on my scalp, face and most of my body. I had a beard for 50 years and it has not grown back except for a mustache and straggly goatee. My skin is still extremely dry and my finger and toenails are still brittle, although much less so than a year ago. Say what you will about “chemo brain,” but I am very much aware (as are my friends) that since chemo I have to search for words that used to flow automatically. (I was a college professor for 29 years.) My voice has remained hoarse compared to pre-chemo. During chemo I had pains like electrical shocks from my hips to my toes day and night.

Other than that, I had no nausea and my appetite was good except that anything sweet tasted bitter. Oh and one other little side effect… two days after my first chemo, I wound up in the hospital emergency room for the first time in my life. My white blood count was so low, and fever so high, that they kept me there for four days. “Urban legend?”

Posted: Jan 15, 2019

gerald stern

I recently completed nine docetaxel treatments for metastatic prostate cancer (in my lungs) . I am 83 and I believe the older a patient is, the more serious the side effects are. Loss of hair was the least of my problems. Fatigue and dizziness (for a week after each treatment) was tough. And the other drugs also had side effects.

Faintings, falls, pneumonia twice; but the worst is my current neuropathy in my toes, feet and legs (compounded by edema). That developed after seven chemo treatments. And so far (after a month of no chemo), it seems to be getting worse. I’m not sorry I took the chemo treatments, especially if it extends my longevity for a few years. I would encourage anyone not to avoid chemo that is medically recommended.

I am searching for help with my neuropathy.

Gerald Stern
White Plains, NY

Posted: Jan 15, 2019

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