In 20 years, Harry Peterson exhausts his doctor’s ‘Bag of Tricks,” finds hope in a clinical trial
More than 20 years have passed since President Clinton was elected and two more presidents have served, yet Harry, now 81, continues to fight prostate cancer—despite exhausting two doctors’ “bags of tricks.”
“I was beyond what my urologist and oncologist Dr. David Link could offer,” Harry explains. “I was at the end of the road. I’d had such good luck with previous treatments—and then to live for 15-plus years, it was a big surprise to see everything go to pot.”
Today, Harry’s not giving up hope. He’s turned to urologic medical oncologist Thomas Flaig, MD, and a clinical trial at the University of Colorado Cancer Center.
“This clinical trial is a unique treatment option not available at other places in Colorado,” says Flaig. “Patients like Harry have the opportunity to participate in trials that determine the effectiveness of a new a hormonal agent for prostate cancer.”
By choosing the clinical trial of a genetically targeted treatment, Harry anticipates he’ll avoid chemotherapy’s harsh side effects and outlive his latest prognosis.
Watchful but Waiting
This year nearly 242,000 American men will be diagnosed with prostate cancer, the most common cancer in men. Of those diagnosed, nearly two thirds are 65 or older. Very few cases are diagnosed prior to age 40. Although most men die with and not from prostate cancer, still, nearly 30,000 lose their lives every year.
At 65, Harry’s first warning signs were an elevated prostate specific antigen (PSA) and a small growth on his prostate. After a sonogram and biopsy, the growth was found to be benign. A number of benign prostate conditions can cause an elevated PSA so Harry and his physician weren’t too concerned.
“Back in the day they didn’t take a lot of specimens,” Harry recalls. “At first, my prostate cancer didn’t develop a lot of PSA; it wasn’t as elevated as the doctors were looking for.”
Harry and his physician decided it was best to continue to monitor his PSA, a strategy called “watchful waiting,” to see if levels stabilized.
While Harry waited, his brother-in-law was also diagnosed with prostate cancer. Unlike Harry, his PSA climbed drastically in a short period of time. He opted for brachytherapy, a type of treatment where tiny radioactive pellets are implanted in the prostate to kill the tumor.
Harry had a feeling it was time for him to go back to his doctor. Could his PSA also be rising?
By now it was 1996. Four years had passed since the watchful waiting began, but his PSA graphs were inconclusive. He decided it was time to have another sonogram and a set of biopsies. They were conclusive: Harry had cancer.
Rather than undergo brachytherapy like his brother-in-law, Harry opted for a radical prostatectomy in early 1997. He hoped by removing the cancerous prostate he’d be cancer free. He wasn’t so lucky.
“It turned out that the cancer was everywhere and it wasn’t slow-growing,” Harry says. “It was a seven on the Gleason scale.”
The Gleason scale is the most common system used to grade prostate cancer. Scores range from two to 10. In order to come up with the Gleason score, a pathologist looks at the patterns of cells in the prostate tissue samples. The most common pattern of cells is given a grade of one to five. Five is the most abnormal. An additional score is given to a second common pattern of one to five and these two scores are added together to get the Gleason sum score.
With a Gleason score of seven, Harry’s life expectancy was five years at best, he was told. Despite the odds, he wanted to face cancer the same way he faced work and life—with perfection.
Harry has had to get through good times and bad for more than 60 years—thankfully, he’s had his wife right by his side all those years. As a 19-year-old college sophomore at Colorado A&M, now Colorado State University, Harry married Delores, “Dee,” his high school sweetheart.
“We didn’t know any better when we got married,” Harry says. “Our moms were a little upset. They didn’t think we’d make it through school.”
Determined to beat the odds, Harry finished his bachelor’s. Subsequently, he was accepted into the engineering mechanics PhD program at Cornell University and was offered a teaching position. This was the start of his career as an engineering professor, eventually leading him to the Martin Marietta Corporation (now Lockheed Martin), University of Denver and Colorado School of Mines.
In the late 1960’s, Harry began researching motorcycle accidents and rider injuries through computer simulation with the U.S. Department of Transportation and a British testing lab. His research concluded the need for leg protectors and redesigned fuel systems.
“Back then guys were basically riding around with tin cans between their legs that could easily catch on fire,” Harry explains. “We researched ways to prevent severe leg burns and injuries.”
By 1973, Harry was an expert witness in motorcycle accidents around the country. That work, plus teaching, kept him busy up until 1995, when he retired.
“I was never able to put my work aside,” says Harry. “I couldn’t stop working until it was complete. Some people call it perfectionism; it was my life.”
Another Five, 10 Years
With determination, Harry survived the first five years post prostatectomy, despite rising and falling PSA’s. Six months of radiation helped his PSA drop, but it escalated once treatment was complete.
“When he first started treatment, Harry’s urologist said if he could keep him alive for five years there would probably be better drugs available for someone like him,” Dee says.
“Well, that was years ago,” Harry chimes in. “The good Lord must have been looking out for me because those five years are long gone.”
In 1999, Harry started leuprolide (Lupron) injections every four months to help decrease testosterone, prostate cancer’s fuel. Harry’s PSA started to drop and stabilize.
Another 10 years flew by.
By late 2010, Harry’s PSA was going wild. Leuprolide was failing. Hoping to again control the testosterone, his urologist introduced bicalutamide (Casodex) into his treatment regimen. Bicalutamide is another hormonal therapy that works to block the effects of testosterone in conjunction with leuprolide.
The combination therapy didn’t work. The only option his oncologist had left was chemotherapy; life expectancy at that point wasn’t great—three months to three years. His oncologist’s “bag of tricks” was empty. “There were very few options left,” Dee says. “He was at the end.”
A Less Toxic Choice
With only chemotherapy left, Harry’s oncologist contacted Dr. Flaig, who’s also the medical director of the Clinical Investigations Shared Resource at CU Cancer Center, to ask if any clinical trials were open for advanced prostate cancer patients.
Harry was in luck.
The PREVAIL study, a global Phase III clinical trial of an investigational drug, was enrolling patients with advanced prostate cancer. Harry qualified and enrolled in 2011. At this point, his PSA was doubling every two months.
“I was certainly praying I could get on the clinical trial,” says Harry, “but I worried it was a double-blind study. I could potentially get the placebo.”
The randomized, double-blind, placebo-controlled, multinational PREVAIL trial enrolled 1,680 patients with metastatic prostate cancer who had progressed despite treatment with androgen deprivation therapy, like leuprolide or bicalutamide. In addition to standard-of-care treatments (Harry stayed on leuprolide), half of the participants get a placebo and the other half get the drug enzalutamide.
“We’re looking to see if we can use a less toxic hormonal pill to treat advanced prostate cancer cases where we’d traditionally use chemotherapy,” says Flaig. “Enzalutamide has already been proven to help patients live longer in more advanced settings in which the patient has already received chemotherapy. Now we want to see if it works as well if used before chemotherapy.”
In the year and a half Harry’s been on the clinical trial, he’s already started to feel better and he hasn’t had to endure the harsh side effects of chemotherapy.
“The difference between the side effects of taking this pill versus undergoing chemotherapy is night and day for most patients,” Flaig explains. “The pill makes sense and we need to see if we can use it earlier in the process and delay the need for chemotherapy.”
With time Harry has seen his PSA drop. More time will tell if it stabilizes. Right now, he doesn’t know if he’s taking the placebo or enzalutamide.
“I really owe Dr. Flaig a debt. He’s kept me alive a lot longer than was expected,” Harry says. “I don’t think I was supposed to survive this long.”
“It’s gratifying to see patients respond well to new treatments,” says Flaig. “We’ll be excited to see the results of this clinical trial in the months to come.”
While it’s been a long 20 years, another year or two of waiting is just a drop in Harry’s bucket. Flaig hopes the trial’s results will be published in 2013.
Until then, Harry continues to simply live.
Despite diabetes, arthritis and old age, Harry says, life’s been good. He hasn’t needed a support group. “I don’t know what I’d complain about,” he says. “For better or worse, it’s something that’s there, but it hasn’t made a big difference in our life.”
When Harry’s arthritis isn’t getting the best of him, you’ll find him and a buddy tinkering with his English car collection. Today, he’s probably out working on his 1962 Morgan Drophead Coupe, a car “that outshines them all,” he says.
He, too, is outshining prostate cancer.