Hormones plus Chemotherapy — A New Standard of Care

Being HIV-positive was the least of Peter Girardin’s problems. The former corporate executive chef had moved to Cathedral City, California from Cleveland, Ohio in 1999. Diagnosed in 2004, at which time he temporarily came out of retirement to work in the catering department at Eisenhower Health, Girardin became a client of Desert AIDS Project in Palm Springs, undergoing quarterly clinical evaluations. His viral load was undetectable. His T-cell count was more than adequate. Despite a minor stroke suffered in 2006, which marked the end of his working days, life was good. Then suddenly, a routine prostate-specific antigen (PSA) test scored off the charts. Girardin had difficulty urinating, had no energy, experienced generalized pain, and was losing weight. A biopsy revealed a dire diagnosis on November 18, 2016. “I had stage four prostate cancer,” recalls the 72-year-old. “Very depressed, I told myself, ‘Oh, my God, I’m going to die.’”

“Multiple scans were done, and they all showed that the cancer had spread to the lymph nodes and to the bones,” says Murthy Andavolu, MD, MBA, Board Certified in Medical Oncology, Hematology and Internal Medicine.

“HIV had no effect on the rapidity of Girardin’s disease’s progression,” notes Dr. Andavolu, “but the fact that the cancer had metastasized within a year of a previous, normal PSA test result indicated it was very aggressive in nature.”

Thankfully, he and his team of infusion nurses had an equally aggressive treatment in store.

A New Treatment Approach

Prostate cancer has historically been treated with two hormones — the orally administered bicalutamide and the injectable leuprolide, both of which impair the body’s production of testosterone and its adverse effects. “Recent studies done in both the United States and Europe show that the addition of chemotherapy upfront to patients with prostate cancer prolongs survival,” says Dr. Andavolu. “So that’s what we did for Mr. Girardin, and that’s why he had, I would say, a very impressive response — a near complete response.”

Initially too ill to tolerate the chemotherapy, Girardin immediately began hormone treatment under Dr. Andavolu’s care. Six sessions of chemotherapy were then scheduled at three-week intervals from December 2016 to May 2017. “He did extremely well,” says Dr. Andavolu, “with the PSA coming down to almost normal levels.”

“When I worked in catering at Eisenhower, I got to know the rhythm of the hospital and the excellent reputation of the doctors, including those at the Lucy Curci Cancer Center,” says Girardin. “The minute I met Dr. Andavolu, he just exuded confidence. If I asked him a question, he told me the answer, and it was straightforward. There was no holding punches. He told me right away, ‘You’ve got stage four prostate cancer, but this is what we’re going to do.’”

Compassionate Care

Girardin was just as impressed with the team of infusion nurses assigned to his case. “They put me at ease right away. Nothing was rushed, nothing was panicky. It was all very controlled, and again, I was well-advised as to what was happening to me.”

“Our infusion nurses are very well-trained and the most professional and compassionate you’ll find in the entire valley,” asserts Dr. Andavolu. “They’re very considerate, and they take care of their patients’ every need, from social, psychological, emotional, and logistical concerns to treatment planning and delivery.”

Today, while not cured, Girardin is once again living the good life, with no further need for chemotherapy in the foreseeable future. “He will continue hormone therapy as long as needed in terms of keeping the PSA as low as possible,” advises Dr. Andavolu. “If he starts having side effects, we can give him a little break. That’s something we can consider as needed. He will also have multiple lines of therapy options available down the road.”

“I know I’m in good hands,” concludes the grateful patient, “and that everything’s going to be okay.”