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Advanced Prostate Cancer
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Early chemotherapy vs waiting.

Hi everyone,

My husband is 58, he started on Sep 2017 a total of 3 firmagon (degarelix) shots every 28 days, plus zytiga and prednisone.

We went to MD yesterday and switched him to Lupron every 3 months.

My husband has 2 lymph nodes in the pelvic area.

He had Prostatectomy on February 2011 and Radiation after a rising psa of 0.5 2014

His PSA on Sep was 8.7 and thank God it is down to 0.1 The million dollar question is... will it be a good time to start chemotherapy now or to wait?

The MD said his cancer is responding good to the treatment but I wonder for how long?

Can hormone, plus early chemotherapy can take better care of the cancer then hormone alone or isn't that much of a difference?

Thanks, I hope the best for you all.

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Others will likely jump in with more details but two major studies have indicated that chemo plus Hormone treatment will increase your husband’s survival. Good luck.

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My doctors said the latest studies show that starting chemo early is beneficial. In the past, they would wait until drugs like Lupron stopped working before they would start chemo. Now they recommend chemo early along with Lupron. That's what I did and so far so good. Taxotere was no walk in the park but it wasn't terrible.

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How long has it been since your chemotherapy ended? What medication are you currently taking?

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Chemo ended in January 2017. Currently on Lupron and Xgeva. I get shots for both on the same day every three months. If my PSA goes any higher I will start taking Zytiga too. PSA is currently 4.

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Congratulations on getting PSA down to 0.1!

New studies recommend ADT plus Zytiga and prednisone OR ADT plus chemo. I think effectiveness of either is about the same. I did Lupron plus chemo (taxotere). Someone I’m sure will post the links to the studies I’m referencing so you can have have a good discussion with your oncologist and make an informed decision.

Good luck on your ongoing journey!

Happy holidays!

James

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I did the early chemo which was proven before early Zytiga in the CHAARTED and STAMPEDE trials. Taking Zytiga early was also shown to add about the same benefit as chemotherapy in the LATITUDE and STAMPEDE Trials.

Early chemotherapy has had more time than early Zytiga to be accepted and approved by insurance companies so chances are better of having it covered. Zytiga is less toxic and milder side effects, but must be taken over a much longer time. Chemo is more toxic, but over with in 18 weeks. That's the basics, but your individual medical situation could make either one of the two better.

I did the early chemotherapy and got great results, PSA went from 463 to .19 in around 6 months and still under .4 at 9 months. Don't be afraid of the chemotherapy, most tolerate Taxotere very well.

Good luck with your treatment decisions.

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I'll add a citation to a medical journal that might reinforce what others have said above:

ncbi.nlm.nih.gov/pmc/articl...

See also the additional citations in the side bar on the right.

I know this all sounds very scary but, as the testimonies of the previous posters show, a huge amount of progress has been made on prostate cancer treatment in just the last five years. I am hopeful that your husband will get a lot of benefit from these treatments and from the additional treatments that will become available soon. I know his life is changed, but I'm also hopeful that he and the family will be able to adapt and still live full and satisfying lives.

Best of luck.

Alan

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Hi Alan, The link help me to understand much better. Thank you so much!

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Hi Chiquis,

I was on Firmagon and Zytiga for about a year. But my PSA started to go up and I got sick the last couple of times I took Firmagon, so the oncologist changed my prescription to Lupron with Zytiga.

So far the side effects are less than the Firmagon and my PSA has gone down to 0.5. I hope it stays there for awhile! I am 75 years old but I feel good.So far there has been no pain to speak of. Even though cancer has metastized to my bones and and lymph nodes.

Hot flashes are a little more numerous with the Lupron , but I can handle those.I have a floor fan that I turn on when I get too hot. I hope this reply helps a bit!

The scientists are getting pretty darn close to finding a cure so hang in there.

Nick

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Thank you all for the Information. Highly appreciated.

My husband definitely has a lot of thinking to do. It seems that he's leaning to have Chemotherapy next month, to be honest I'm afraid of the side effects. Oh well, we climb the mountain when we get there. For now, we will try to enjoy our vacations. My prayers to all of you. Thank you very much.

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Good luck and please keep us in touch with your progress. I too am due to start chemotherapy in early January after 6 months on Caloxa (Bicalutamide ).

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Thank you, I hope everything goes well with the chemotherapy.

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My recommendation is to start chemo ASAP. I finished 6 x 3 weekly chemo ( docetaxel) at the end of February after 6 weeks of radiation ending in October 2016 and will have my 4 th Eligard injection in January ( 6 monthly dose). My 4 mets on both hips, left 6th rib and T11 vertebrae have reduced significantly ( rib & left hip cancer cannot be seen now) according to CT and bone scans last week. My psa is negligible and testosterone is where it should be, so all is being controlled. With rehab I feel fitter and stronger than ever. Still get tired at times and have osteoarthritis, but at 69 I am doing well. Hit it hard as soon as you can is my advice.

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I'm happy to hear your excellent results! Hopefully it stays that way for many many years. The best to you.

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You know, this is such an interesting question.

Years ago, I used to say to my husband but also to other people: "Never do Chemotherapy! It is so bad for your body!"

But today my thinking is completely different: I still think that Chemotherapy is a very aggressive treatment - but also that we are dealing with a very aggressive illness. In my husband's case, radiation and then hormone treatment worked for 14 years and now that his body is weak from the constant lack of testosteron and all the side-effects of the anti-hormone drugs the Chemotherapy is so hard on him. I often think that, if they had done the Chemo while he was still a lot younger and stronger, it would have been easier on him and maybe it wouldn't have come to the stage where he has mets in the liver.

So my personal opinion is, if I was asked: Do Chemotherapy now while he is still in good health!

On the other hand, though, if the Chemotherapy doesn't work well but still comes with all the side-effects, it might be more harmful than good in the end.

It is really a very personal decision. But I still think I would do Chemo now.

Mel.

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Great post - thanks for your insights. Very helpful for those of us at 'early' stage.

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Yes, enjoy the holiday season! That is what we are doing as well. :-)

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Major clinical trials in UK and USA have shown that starting chemo early in combination with ADT therapy provides excellent (the best) results. Check out Stampede (UK) Chaarted (USA).

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Have you considered having radiation to the lymph nodes known to be cancerous? Dr. Kwon is finding them early with c- 11 pet scans or f-18 pet scans and radiating them or surgically removing them. He is getting great results. You can see his videos on youtube. I'm pretty sure with a PSA of 8 the spots will show up on f-18 pet scan. The are able to see PCa with PSA of .5 as opposed to regular CT scans that require PSA being near 10 or higher.

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Hi, Six years ago I was diagnosed with stage 4,Gleason 9 Prostate cancer with mets in the groin area and aorta. The doc started me on Firmagon and at the next scan the mets had gone. In the meantime my psa plummeted from @480 to near zero.

About two years ago the Onc. got me to start on lupron every three months as the Firmagon was tortuous to me. These were the only meds I took besides from casodex for a year. Two months ago a new type of CT scan found small mets on L2 and my pelvis. I started taking Xtandi on the 15th of last month. Not much in the way of reactions aside from a psa dropping to around six from over twenty.

The onc. suggested I go to the gym when I first was diagnosed for bone conservation and that has been very successful for me.

I have led a normal life without giving up virtually anything and consider myself very fortunate. The onc . told me "Don't let the cancer run your life".

I have a moment now and again but I try. I'm no little Miss Sunshine but attitude seems to help me. The full support of my wife is a asset that can't have a value put on it too In the meantime my Oncologist has guided me well and answered any question I have in a forthright honest manner. I trust him and advise you to trust yours. Second opinions can always be had though, if that will help.

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