How do you know if chemo is working?

Hi Guys, I've had 4 rounds of Docetaxel (Taxotere) and before the last round, I asked the oncologist how we can tell if the chemo is working. She said that we know it's working by my PSA being low and stable (it's at 1.0). I told her that my PSA was low and stable on Zolaedx alone, so how do we know if the chemo's doing anything more. She didn't give me much of an answer, other than to say we might do a PET scan if my PSA starts to rise. Does anyone know what tests I should be asking for to judge the success of otherwise? Thanks Paul.

17 Replies

  • Paul, how has your alk phos been? that is an indicator of cancer growing in the bones. Are you getting an ultrasensitive psa, one with 2 or 3 numbers after the decimal point, I have found there can be a big difference in psa test taken at different labs, scans are the way they most trust to see if chemo is working, It is a whole new game now that they are giving chemo early. May just have to trust hitting it hard with chemo while body is strong , and finish out chemo 6 cycles, if not to much trouble. You should be able to rechallenge with docetaxol/ Taxotere later in life if needed as shown on google scholar by Dr Dan Petrylak long ago. I wish you the best ,enjoy those kids, your family and every day, One benefit of cancer is that it shows us how to do this , and what is important in life.Airport in 2 hours , its 5 hours away, will be in Lisbon in Morning.

  • Thanks Dan, I'm not sure if my oncologist has alk phos number as she doesn't share the results with me. I've just had a private blood test and I've requested alk phos as part of the panel, so I'll know soon. Thanks again for your comments.

  • Paul mostly likely it is ok with that psa, your mo should be able to give you all copies of your labs,after all they are your labs. in Sesimbra Portugal this evening ,aft touring around in lisbon. absolutely beautiful hotel overlooking the beach in a quite seaside town on the Atlantic,jackpot!

  • Thanks Dan, get off this site and enjoy your holiday!

  • Paul,

    I'm asking myself the same question about doing chemo. I'm about to start cycle 3 if my ALT number has come down enough. I'll find out today.

    A few things come to mind. I agree with Dan59 about Alk Phos being an important indicator, as important as PSA since when it comes to bone mets, it's really the "bottom line" so to say. Another thing is that some PCa cells do not produce PSA as far as I know so you could be killing those with the chemo and not knowing it.

    And while the PSA number is still important, the main thing is how long it stays down there. The studies have shown that the most important benefit of early chemo is to lengthen the time to clinical progression. That's what you and I are shooting for. And of course we'll never really know how successful we were on that front, but we are giving ourselves the best chance for our time to be extended. I don't want to be thinking: "Maybe I could have had longer."

    For me, there's also the psychological side of knowing that I'm firing every weapon I have at my disposal. I take pleasure in knowing that I'm taking down as many of those bastards as I can. Fuck you cancer! While I'm going through the side effects, I know the cancer is suffering more. That helps me to keep my fighting spirit going.

  • Thanks Greg, much appreciated. I share all of your thoughts. Cheers Paul.

  • Hi Paul, I have received two treatments of Docetaxel and my oncologist told me that through my PSA and CTScans(every two to three months) would determine the effectiveness. My prostate cancer spread to my lymph nodes around the bladder. I have been on Lupron for several years, then Xtandi (when my PSA started climbing) and then he switched me to Zytiga but it still did not control the PSA and my CT Scan showed that some of the tumors were growing and that's when he put me on Docetaxel. My current PSA is 128 but that was after only the first treatment. I will know in three weeks when they do my PSA again if it is going down.

    Good Luck,


  • Thanks for that Lou, good luck to you also.

  • Paul,

    I'm wondering if circulating tumor cells [CTCs] is the most useful test. New paper:

    If a treatment is working, the metatastic potential is zero IMO.

    I know men who have had the test, but I know nothing of the cost or insurance coverage.

    {On the subject of CTCs, I believe that nattokinase, by targeting circulating microclots, can prevent further metastasis.}


  • Patrick, read my reply to Paul. Quest Labs on Biltmore Ave. does the draw, blood is refrigerated and sent to Virginia. As it has the reading equipment. Then the results go to the Doc. I had Donaldson write a Script for the test so there is a Doctors Order Against a CPT code, and it says Diagnosis---PCA, on the Script. So it might get by Medicare, at least the draw Part will.

    Since I have attacked both Refractive cells and PSA cells I need to know where I am. This is the only way to determine if I am vacation eligible. Even though an extrapolation guess will have to be made. Ductal Cribriform has been determined over the years upon completion of RP, to be 30% of the mix. So I will trust those figures. But I want a count---PSA's may be useless at this time, even though my Onc. thinks the PSA cells will show themselves sometime in the future. He is guessing, and is not up to speed on my or your attack programs. He says he is an integrative Doctor---but he has obviously not research things you and I have.

    I gave him 2 processes I do, and he said he never heard of it, and would have to research my reports. I will find out June 12th, my next visit to Charlotte[Levine Cancer Institute]. I hope to have the CTC test Done by that visit, but Donaldson will get the results.


  • Thanks Patrick, much appreciated.

  • Replying as to CTC testing. I have been researching for about 2 months. There are basically 2 technologies. One is a blood draw, and followed by a reagent added to the blood. The Pca cells fluoresce and they are actually counted per 7.5 mls. Another test., is the insertion into a vein a micro chip, and it captures Cancer Cells as they are larger that blood cells, and also counts cancer cells per 7.5 Mls. As you can see there is an industry standard---the 7.5 Ml/ cell count.

    Now here is the rub. The nano test is way out of the pocket cost. The CellSearch test performed by Quest Diagnostics, has an issue. It cannot count cells that are circulating that are dormant/hiding/sleeping. Which means they can only count refractive cells, those that do not give off a PSA. The PSA cells do not fluoresce. So if you have a measurable PSA, you get a total count. Those that have an undetectable PSA, only get a Refractive Pca cell count.

    But you can do extrapolation. I.E. If you have an agressive Pca, and have an undetectable PSA. Studies have shone that at any one time in the beginning, that 30% of the cancers cells are refractive[No PSA]. So in my case I am undetectable. If I take the test which I plan to do. I can take whatever cell count I have determine that the count it is all refractive, and multiply that number by 1.7, to estimate the dormant cells[PSA Sensitive]. To give me a total count.

    There comes with the test a chart that defines your OS, based on cell count. Under 5/7.5 Mls is very good. But if you have 4 and multiply by 1.7 for those that are undetectable, that is probably not so good. As to costs there is a Medicare Code 86152, and a test code, of 16812.

    But medicare does not acknowledge that it pays for it. So it is a crap shoot as to cost. My understanding is that the test is near 350 dollars--You can find some data on the Cell Search Web Site.


  • Thanks Nal, I appreciate your comments. I live in Perth, so these CTC tests may not be available to me here, but I will ask the question. Cheers Paul..

  • A pet scan should indicate if the treatment is working or not

  • Thanks Pennysue, my MO has scheduled a CT scan. Pet scans not covered by Australia PBS.

  • Hi Paul,

    I had an RP 12½ years ago and have been watching my PSA rise slowly from .03 to 1.1. After much research I am of the opinion that the two most valid scans available today are the 68Ga-PSMA- PET/CT and the F-18-PSMA- PET/CT and should be able to identify localized recurrence at PSA levels >0.7. I recently found out about these scans which are becoming increasing more available at worldwide hospitals and imaging centers. Ever since my PSA rose to around 0.5 (most doctors agree that recurrence is evident at about 0.2; however, still way too low for anything to locate the source) I have been inquiring about some kind of imaging that 'could' identify where the cancer is. The only 'relatively' sensitive scan that I was aware of was the Choline C-11- PET, approved in America and available at Mayo Clinic in Rochester, MN; however, it has shown to be of little value in metastases where a PSA is <1.7. A friend of mine that had HIFU performed a few years ago is experiencing recurrence and he just had the 68Ga scan done in London at a cost of about 3,500 Euros. My cost at UCLA (not approved in America yet) would have been $2650 US; consequently, I decided to run down to Melbourne, AU where it was $600 US. It identified three lesions in LN's adjacent to the sacral vertebrae and I am currently trying to decide on a course of action, i.e., robotic surgery, radiation, ADT or chemo. The confusion at this point is whether these are truly the only nodes involved. The F-18-PSMA scan is approved in America (the jury is still out as to how it compares to the 68Ga-PSMA); however, I was quoted a price of $10,000 US in Chicago. Let me know if I can answer any questions regarding my research on these subjects.

    Best regards,


  • Thanks for that Ron. I have a lot of mets (12 I think) in bones. I have had two PSMA scans (Gallium-68) in the past, one last May and one this January. My MO, seems to think a CT will suffice to see if my mets have worsened, or hopefully improved, post chemo. The other two tests I had were funded by me, but the cost (about $900AUD in Perth) is a bit high for my liking. Cheers Paul.

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