Long-Term Remission

Meet Jeff Finerman, prostate cancer survivor and exceptional responder.  

            A couple months ago, I got one of the best emails ever.  It came from Jeff Finerman, a man I had interviewed in 2017 for the Prostate Cancer Foundation (PCF)’s website.  When I wrote that story, I began with these very true words: “Metastatic prostate cancer can turn on a dime.  For too long, a sudden shift in the disease has meant bad news.  But now, more men are seeing a sudden turn in the right direction.  Jeff Finerman is one of them.”

Jeff had experienced an excellent response to Zytiga (abiraterone plus prednisone, an androgen receptor-blocking combination), along with Lupron, a form of androgen deprivation therapy (ADT), and Xgeva, a drug that specifically targets and strengthens cancer-riddled areas in the bone.

No one had any idea just how good his response would be.  In his email, Jeff said: “Last week, my oncology team of many years declared my cancer in full remission. I am the first person with stage 4 metastatic prostate cancer with numerous tumors on my bones that’s ever gone into full remission to their knowledge.  When you research my severity of cancer, the typical life expectancy once metastasized to the bones is in the neighborhood of two years, I just completed my 10th year. They’ve stopped 100% all injections and all medication related to my advanced prostate cancer. What a way to start the new year!”

I had to read that last sentence again.  Wow!!  I asked if I could do another interview, and he agreed.

What Makes Your Particular Cancer “Tick?”

Before we continue Jeff’s remarkable story, there are some important points we need to consider:

Every man’s prostate cancer is different.  Let’s say several men, sitting in a doctor’s waiting room, happen to be diagnosed with the identical stage and grade of cancer.  Although it might seem that they should all respond the exact same way to treatment, this hardly ever happens – because, like snowflake crystals, each man’s particular prostate cancer has its own unique genetic and molecular makeup.

When it comes to treating advanced prostate cancer, the mechanisms and pathways that make your cancer “tick” may be completely different from those of the next guy in the waiting room.  One size does not fit all.  For example: one man in our waiting room might have an altered gene, such as BRCA1 or BRCA2, which can make the cancer more responsive to medicines called PARP inhibitors.  The man in the next chair might have a less common form of prostate cancer, with a faulty DNA mismatch-repair gene and high “microsatellite instability” – cancer that is more responsive to an immunotherapy drug such as pembrolizumab (see the story linked below).  Another man, like Jeff, might have a very high percentage of cancer cells that are sensitive to hormones, and his cancer might respond mightily to androgen deprivation therapy (ADT) and an androgen receptor pathway-inhibiting drug, such as enzalutamide or abiraterone.

More new drugs are being developed all the time.  Not just new variations of drugs that do the same basic thing, but entirely new ways to treat cancer, like PSMA-targeted radionuclide therapy.  These new drugs are being tested in clinical trials.  Thus:

The playbook on treating advanced prostate cancer is always evolving.  Good oncologists are keeping up with the new treatments entering trials and the new standards of care.

Other parts of the cancer-fighting equation are very important, as well.  Jeff has two essential factors that have helped him manage his cancer:  a positive attitude, and strong family support.

   So, keep all of these things in mind as you read about Jeff.  He wants to share his story to encourage other men fighting prostate cancer, and on one key point he, his doctors, and PCF agree:  there is more cause for hope every day, and the right treatment can cause the disease to change course very quickly.

 Now, here’s his story.

Lows and Highs

Jeff Finerman had a good and pretty ordinary life until 2013, when he was diagnosed with metastatic prostate cancer at age 62.  For the next eight years or so, his life was more like a roller coaster ride, with serious lows and amazing highs.

Now, 11 years after that diagnosis, Jeff has a good and extraordinary life.  His cancer is in remission, and he has been taken off of all of the cancer-fighting agents he was taking – including hormone therapy!   He is one of a small but growing new group of prostate cancer survivors:  the exceptional responder.

Jeff’s prostate cancer journey has been characterized by many sudden shifts.  Back in 2013, his urologist was watching his PSA level closely, because it had risen to 4.  Within three months, it shot up to 23.  A biopsy found cancer in 12 out of 12 samples – aggressive cancer, with Gleason 4 + 5 disease on both sides of the prostate.  Bone scans and CT imaging showed tumors on the L4 vertebra in his lower spine.

            Jeff and his wife, Karen, were determined to fight this cancer hard.  They have faced it as a team along with their twin daughters, who were teenagers when cancer was first diagnosed.   In 2013, they did their own research and found oncologist Charles Ryan, M.D., then at UCSF (now at the University of Minnesota).  Ryan – who is also the father of twin girls – made time to see Jeff on his lunch hour.  “He gave us so much hope,” says Jeff.  “He said, ‘You’re young. We’re going to be aggressive.  We’re going to knock this.’  We owe it all to Dr. Ryan.”

            Ryan started Jeff on ADT, with leuprolide (Lupron) injections and bicalutamide (Casodex).  Jeff also received 45 treatments of external-beam radiation therapy to his prostate, pelvic area, lymph nodes, and lower spine.  He had an excellent response: the cancer shrank, and his PSA dropped to nearly undetectable levels.  In October 2014 his oncologist (Ryan’s colleague at UCSF) gave him a respite from hormonal therapy, and then restarted both drugs in July 2016, when Jeff’s PSA began to rise again.  Cancer came back in his right hip; Jeff underwent more radiation to treat it.  His PSA continued to rise, and the oncologist took him off bicalutamide.

            In 2017, a PSMA-PET scan showed only the spot of cancer in his hip – but a few weeks later, Jeff developed bone pain in multiple places.  A bone scan showed “at least a dozen tumors” – the one in his hip, now doubled in size; cancer in his right femur, left knee, several vertebrae, ribs, and clavicle.   “Every two weeks, my PSA was going up,” he recalls.  It reached 12.4, and his pain was terrible.  Jeff, who had been leading an active life, went from walking three or four miles a day plus lifting weights to lying for hours in the bathtub to ease the pain in his bones.

Jeff switched his care to UCLA, much closer to home than UCSF.  He started taking abiraterone (Zytiga^®) and prednisone, and the results were dramatic:  “Within two weeks of starting abiraterone, 100 percent of the pain was gone,” says Jeff.  “The rest is basically history.”

Jeff turned out to be a “super responder” to abiraterone and prednisone, says medical oncologist Sandy Liu, M.D., formerly at UCLA and now on the faculty at City of Hope in Irvine.  In 2018, she also started Jeff on denosumab (Xgeva^®), a bone-targeting drug that helps prevent fractures.  It was supposed to be for 11 months, “to try to strengthen the bones where I had the metastases,” says Jeff.  “I was on it for five years!  It worked so well, she just kept me on it!”

About four years ago, Jeff’s PSA became undetectable.  And about two years ago, Liu decided to do something she had never done before:  “She said, ‘We’re going to start phasing you off of everything.” 

Why do this – what happened to “if it ain’t broke, don’t fix it?”  Because hormonal therapy has significant long-term side effects, and Liu felt that Jeff, whose disease seems to have stopped in its tracks, no longer needed it.

“We will never call Jeff cured,” says Liu, “but he is in long-term remission.  He has an undetectable PSA and no evidence on PSMA-PET or other scans of active metastatic disease.”

Very slowly and very cautiously, over a two-year period, Liu tapered Jeff’s medicine, starting with the abiraterone and prednisone.  And then the leuprolide.  “It’s been over a year since I’ve had a Lupron injection,” says Jeff.  Then she stopped the denosumab.  “She said, ‘Your bone scan was so good, you don’t need it anymore.’”  Says Liu:  “His bone density scans, CT scans, and PSMA PET scans all showed nothing:  no new lesions.  Nothing has progressed since 2018.”  And of course, he will be closely followed with PSA screening and imaging for the rest of his life.

Jeff’s only medicine now is for his heart, after valve repair surgery.  “I had a couple of bad valves in 2013 when I was diagnosed with metastatic prostate cancer,” says Jeff.  “The conclusion was that the cancer’s probably going to kill me, so we’re not going to worry about the heart.  My life expectancy at that point was not very positive.”  Also, the surgeons and Liu had worried that the surgery would somehow disrupt or activate Jeff’s metastases in the ribs and other areas.  “Finally, in 2022, Dr. Liu went ahead and authorized what the cardiac surgeon needed to do.”

For the last two years, Jeff and Karen have been feeling “so miraculous,” says Jeff.  “Dr. Liu felt the same way.  Every time I’d walk into her office, she’d give me a big hug, and say, ‘You’re my golden boy!’  I’m doing great!  In fact, better than great!”  He does have some joint pain, which he attributes to stopping the prednisone.  He has seen a rheumatologist and undergone numerous x-rays, and “other than normal wear and tear on my joints, it all looks good.  Nobody really knows why I have that joint pain.”  It could also be related to stopping the denosumab after being on it for five years.

“Not only did I see my girls graduate high school, but they both graduated college, one with a master’s degree, and one of my daughters just got married!  When they were in high school, we didn’t even know if I would make it to their graduation.  I’m so fortunate!”

Attitude and Support

            “Jeff has the most positive attitude,” says Liu.  “He is always so upbeat.  I am convinced that this does make a difference,” in survival and in handling the curveballs of cancer – particularly, pain – and the side effects of treatment.

            He also has a dedicated care partner:  Karen.  “I go to almost all the appointments,” says Karen.  “Sometimes when you’re a patient, you might hear the words, but you’re not hearing the real words because it gets scary and it gets complicated.  I help translate that, and advocate and make sure everything’s going the way it’s supposed to go.”  He also credits his family with helping him remain upbeat.  “Nobody in my family would let me get down.”

            Jeff encourages cancer patients to bring a family member or friend to medical appointments, if they can.  For patients who don’t have that immediate support, Liu suggests taking part in an online or in-person prostate cancer support group.  “Talking about your treatment and what you’re going through with others who have faced it, too, can be very beneficial.”

            These days, says Jeff, “I wake up every morning with a smile on my face.”   What if the cancer comes back?  “Dr. Liu told me, ‘There are quite a few new meds that have come on the market since we started you on Zytiga and prednisone five years ago.  There’s been a lot of progress over the years.”   The message:  “Don’t give up!  There’s hope, and enough research being done that there are always more things on the horizon.”

            One last note:  Jeff is a U.S. Veteran, who served in the Army/National Guard during the Vietnam era, from 1969 to 1975.  PCF has established Prostate Cancer Precision Medicine centers at more than a dozen VA hospitals throughout the country, where Veterans can get precision diagnosis.  I will be posting about this soon.

In addition to the book, I have written about prostate cancer on the Prostate Cancer Foundation’s website, pcf.org.  The stories I’ve written are under the categories, “Understanding Prostate Cancer,” and “For Patients.”  I firmly believe that knowledge is power.  Saving your life may start with you going to the doctor and knowing the right questions to ask.  I hope all men will put prostate cancer on their radar. Get a baseline PSA blood test in your early 40s, and if you are of African descent, or if cancer and/or prostate cancer runs in your family, you need to be screened regularly for the disease.  Many doctors don’t do this, so it’s up to you to ask for it.

©Janet Farrar Worthington