chemo question..

[lyrikos]

Is chemotherapy a death sentence ?i would really appreciate your experiences and your point of views on this matter

[maack1]

Rather than look at chemotherapy as a death sentence, it should rather be looked at as another medication intended to rein in cancer development permitting the patient to better manage his/her cancer. It is not considered curative, and in the case of we prostate cancer patients, it is intended to be a part of medication protocols for palliative therapy with the hope that in company with other medications may prolong our lives for an indefinite period. It should be noted, however, that when our cancer has recurred despite surgical removal of the prostate gland or radiation to that gland or to the prostatic bed and periphery, we are moved to palliative care wherein for some of us, various medications - and there is a pretty good arsenal of medications currently available - we are able to continue our lives for many years. But, admittedly, for others - and that would depend on the extent of the cancer - our lives may be shorter lived. So, "death sentence," no, but a recognition that we must pay attention to our cancer, do some personal research to understand the extent of our cancer and methods of treatment with that knowledge, and work with and discuss with our treating physician the protocol that may work best for our continued survival.

[lyrikos in reply to maack1]

Thank you Chuck...you are always there for me and for so many others ....It is just that my father hasnt finshed all his treatments choices and he is in great shape after almost four years....he has just had zytiga and bicalutamide along with leuproline injection and denosumab for the bone metastases....the onc now thinks it s better to have chemo rather than later...i guess its pretty logical .....

[maack1 in reply to lyrikos]

I believe we have email exchanges. How about sending an email to me so I can look up past exchanges and possibly make more comment. [e-mail]

[lyrikos in reply to maack1]

You already have answered to me dear Chuck in private..you always do ...

[maack1 in reply to lyrikos]

Ahha! Nikos!

[lyrikos in reply to maack1]

Yes my dear friend..sorry for not writing my name....

[Darryl Partner]

You can also direct message people, right here. simply click on the persons' name and click "message" on their profile (upper right part of the screen)

[maack1 in reply to Darryl]

Still working on figuring things out, Darryl. I have been working with this man for quite some time in direct contact, and where that helps me is that I save in a specific folder with his name all our exchanges. In that way I always have that folder to go over what has been exchanged in the past.

[Hidden]

I never looked at chemo as a palliative treatment for Advanced Prostate Cancer, but rather a very aggressive treatment plan. With two mets to L2 & T3 (PSA-32.3 with Gleason 4+3), I took chemo for six months about 11 1/2 years ago. I stopped taking Lupron five years ago. My PSA is still undetectable. Mets continue to be resolved. Couple with a positive environment and prayer from people of all religions, I enjoyed kicking the bastard. At 69 years of age, I simply enjoy life and my family and friends.

Last point, doesn't it make sense to attack your cancer when the tumor burden is minimal and your body is strong; rather than to wait when the tumor burden is enhanced and your body is weaken from the ravishes of out of control cells multiplying?

I wish you the best and what ever treatment plan you select, may it be the one that extends a productive and happy life.

Mike

[JoelT in reply to Hidden]

Mike,

In response to your question about attacking the cancer when it is minimal and your body is strong, it depends. Clearly, from a logical approach you would think so, but it isn't necessarily the case. For example, the clinical trial (E3805) that demonstrated that early chemotherapy for men newly diagnosed with advanced prostate cancer also showed that the only men who benefited from the early use of chemotherapy were those with the most aggressive and most advanced prostate cancer. The men who were diagnosed with less aggressive disease had no benefit from the early use of chemotherapy.

advancedprostatecancer.net/...

advancedprostatecancer.net/...

Logic is important, but when it comes to cancer we need real evidence based medicine to make the best decisions.

Joel

[lyrikos in reply to JoelT]

Last point, doesn't it make sense to attack your cancer when the tumor burden is minimal and your body is strong; rather than to wait when the tumor burden is enhanced and your body is weaken from the ravishes of out of control cells multiplying?.....

yes it does to me gourd_dancer since my father does have extensive metastases and two lymph nodes involved now....so i guess Joel he is in the right target group... the funny thing guys is that my father almost 3,5 years now doesnt experience any symptom from this lethal disease...if we hadnt seen his ct scans or mris or blood test with psa we would easily think that he doesnt have anything to deal with....this kind of cancer is really strange....at least the way it treats my dad...so the real question is ...if tomorrow my dads psa is lower should we start chemo or not?

[JoelT in reply to lyrikos]

Lyrikos,

I don't have access to your dad's complete history and current numbers. So, I can not respond to your very specific question.

Joel

[lyrikos in reply to JoelT]

DX 12/2012 PSA 205

METASTATIC PROSTATE CANCER

EXTENSIVE BONE METS

ORIGINALLY TREATED WITH BICALUTAMIDE,ZOMETA,LEUPROLINE INJECTION EVERY 84 DAYS

JUNE 2013 BECAME CASTRATE RESISTANT PSA 15

TRIED ESTRAMUCINE NO GOOD PSA 40

WENT OFF BICALUTAMIDE AND ESTRAMUCINE AND STARTED HORMONE VACATION

HE ALSO STARTED AVODART AND XGEVA INJECTION (NO MORE ZOMETA INFUSIONS)

PSA UNTIL SEPTEMBER 2014 STABLE AT 10 THEN UP TO 50

STARTED ZYTIGA WITH PREDNISONE PSA WENT UP TO 120 THEN 180 THEN 220 AND AFTER FIVE MONTHS 240 THEN 180 UNTIL SEPTEMBER 2015 WHERE IT HIT 260

STOPPED ZYTIGA AND IN A MONTH HIS PSA WAS 70

NOVEMBER 2015 PSA 77

STARTED AGAIN BICALUTAMIDE AND AFTER THREE MONTHS PSA 180

ALL THIS TIME CT SCANS STABLE EXCEPT FOR THE LAST ONE ON FEBRUARY 2016 THAT SHOWED A LITTLE INCREASE IN TWO LYMPH NODES

STOPPED BICALUTAMIDE ALMOST A MONTH NOW AND WE ARE WAITING FOR HIS NEW PSA TOMORROW....

SORRY FOR THE CAPITALS

Nick

[JoelT in reply to lyrikos]

Nick,

Looks like the missing options are enzaludamide (Xtandi); Chemotherapy with Docetaxel (Taxotere); Chemotherapy with cabaziltaxel (Jevtana); radium 223 (Oofigo) and mitozantrone.

Given these options the better next choices would be either the enzaludamide or Docetaxel. There are no trials that I am aware of that might point to the better choice.

For no good reason that I can think of I believe that I would go first with the chemotherapy with Docetaxel since he has failed the Zytiga which is a hormone therapy and wait on the other available hormone therapy drug Xtandi until later on.

Joel

[lyrikos in reply to JoelT]

thank you Joel for your answer ......just a clarification .....our onc suggested that we might try again zytiga after chemo ....is that an option?

Nick

P.S. What is mitoxantrone?I never heard of it

[JoelT in reply to lyrikos]

Yes, you could. There is a history of being able to go back to some of the drugs that have stopped working after having gone on to another unrelated type of treatment and then again having some limited positive result. I would talk to the oncologist about this after you had gone to Xtandi and failed it. There is evidence that these drugs cause some cross resistance to the other. I think that he has a better shot at a more positive response from the Xtandi as opposed to a second round of Zytiga. More Zytiga could create more resistance to the Xtandi.

Mitoxantrone is an older chemotherapy drug that was used before the approval of Docetaxel. It does not have any life extension benefits, but it does provide palliative benefits.

At this much later stage you could work on the oncologist to reach into the land of breast cancer chemotherapy drugs, which could also be helpful on a trial and error basis.

[Hidden in reply to JoelT]

Joel, I have read the E3805 Trial. So much is unknown and Trials have a tendency to pinpoint looking to add to the magic "Gold Standard" of treating Prostate Cancer. I am so glad that I found a Prostate Cancer Researcher in an academia setting as my Medical Oncologist who, some have said, theorizes outside of the box for treatment protocols; and developing a hypothesis to work from. For example, his hypothesis for the Trial which I underwent was based on:

" Chemotherapy in a setting of hormone refractory prostate cancer has shown palliative benefit especially with substantial PSA decline strongly suggesting that disease modifying potential exists. Recently, chemotherapy is beginning to show a survival advantage. The stage is set for chemotherapy given earlier in a disease course. As a working hypothesis, we suspect that the transformation from an androgen-dependent to an androgen-independent phenotype is mediated by the expansion of an androgen-independent clone already present at the time of androgen deprivation. If this model is correct, then it would be desirable to bring treatment to bear on the androgen-independent component when the corresponding tumor burden is minimal. Thus, we view the androgen-independent component as analogous to “microscopic residual” or “micro-metastatic” disease for which adjuvant chemotherapy has shown to be effective in other contexts."

In my case, primary treatment of Brachytherapy with 117 Pd seeds and a 26 course IMRT external radiation never really brought my PSA down and I found myself with an exploding PSA and metastatic disease within 10 months of treatment. In other words, I had micro-metastatic disease when cancer was first discovered according to my two radiation Oncologists.

An Abstract can be found here:

ncbi.nlm.nih.gov/pubmed/236...

This Abstract was based on 46 original patients with 45 patients that were evaluable. Fortunately, I was one of the nine who had complete response and continue to be tracked 11 1/2 years later. I was an early disease progression patient; some were middle to late disease progression. I understand that over 400 patients have been treated using this protocol now.

My best opinion, based on my experience, to anyone with this terrible disease is to find the best Medical Oncologist available who specializes in Advanced Prostate Cancer; preferably, a Researcher.

BTW, interesting Patient Population for the E3805 Trial:

Patient Population

•Histologically or cytologically confirmed prostate cancer with metastatic disease.

•May have started hormonal therapy, but not more than 120 days prior to randomization.

•Will be stratified by presence of low volume disease (metastatic disease that is not extensive) or high volume disease (any visceral metastases (extranodal) and/or at least four bone lesions, one of which must be outside the spinal column or pelvis).

•PSA must not have risen and met criteria for progression (see Section 6.3.1) from its lowest point between the beginning of androgen deprivation and the date of randomization.

•Must have discontinued hormonal therapy in the adjuvant and/or neoadjuvent setting 12 months prior to beginning protocol therapy AND must not have exceeded 24 months of therapy AND must have been NED for at least 12 months after completing adjuvant or neoadjuvent hormonal therapy.

•No prior chemotherapy in the adjuvant or neoadjuvent setting.

•No prior hormone therapy in the metastatic setting.

•Prior palliative radiation allowed as long as it commenced 30 days within starting androgen therapy.

Mike

[JoelT in reply to Hidden]

Mike,

Thanks for the very well thought out reply. I can not agree more that the best doc is usually one who understands the genetic and cellular aspects of prostate cancer. With some exceptions this usually means an academic researcher clinician.

Those of us who because of location or insurance issues, able to employee this type of doctor should try and create the blended model where a local oncologist is the first and regular everyday line doctor who relies on the expertise and knowledge of an academic consultant through regular contacts between them.

Joel

[Bryan_Metcalf_UK]

I have had two sets of ten infusions of chemotherapy (1st Doxetaxol and 2nd Carbazitaxol. True you hear of some folk losing their live during chemo mainly due to infections during low immunity. I am living proof that at least one of us (and I know of more) are still living beyond chemo.

It was instilled in us to go to the hospital with any signs of infection.

[lyrikos in reply to Bryan_Metcalf_UK]

thank you Bryan for your answer....I know that chemo is not something easy but it is necessary when you have advanced prostate cancer...my father will walk this path for sure ....I also know that in most cases fromwhat i ve read its beneficial ....so why not?

[lyrikos]

PSA shot up to 520 so chemo starts next wednesday...hope it works for my dad

[bryson43]

Last year had 9 cycles of taxotere -did not want to start but had to after 9 years of hormone therapy -originally diagnosed August2005 with PSA 24and gleeson 4+4 =metastatic -chemo was not too bad -mainly fatigue -it worked dropped PSA from 37 to 1 but started increasing again -now PSA 11 and having a break

[lyrikos]

Thank you Bryson43 for sharing your experience....We start on wednesday....I will keep all of you posted with results and side effects