Went for a second opinion last Friday, and even though I appear to have responded well to my first 3 months of treatment, it was an eye opener. Because I believe the quality of care we receive is to a significant degree related to our willingness to ask informed questions, to engage our oncologists in discussion of treatment options, and to be proactive in making treatment choices, I want to share what I learned in the hope that some of it may be useful.
I was diagnosed Nov. 2017. PSA 36, G 4+4, Mets in local lymph nodes, pubic bone, acetubulum and one rib. Also a large tumor outside the prostate. Treatment is Firmagon and Xgeva 1x / 4 wks, casodex daily, prednisone 5 mg 2x / day, and docetaxel every 3 wks. PSA is down to 0.14. Had my fifth of 6 docetaxel infusions today.
Second opinion doctor is at a teaching hospital and he specializes in prostate, bladder and testicular cancers. He says I have been severely OVERMEDICATED. Says prednisone is unnecessary except when on zytiga. Says casodex only a temporary drug to prevent testosterone spikes when main ADT drug is started. Says Xgeva has significant risk for liver damage and understated risk for osteonecrosis of jaw. He would give Xgeva once every 6 months.
He did not commit to a plan, telling me to finish the docetaxel first. Then new scans and blood work, including testosterone levels test, will make the plan clear. He did say that Zytiga, radiation and DNA testing may be in my immediate future.
This guy knew every study and drug that I mentioned, and was willing to talk about them. We spent 45 minutes together. Choosing him to assume my treatment was a no brainer.