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Advanced Prostate Cancer
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Anyone who has done carboplatin after all other treatments, including early Taxotere?

My husband is wrestling with a looming recommendation of a second course of chemo with carboplatin. He did Taxotere early on (CHAARTED protocol). Did great on Xtandi for 2 years, now trying Zytiga (although we've been told it might not work, or work for long). He's resisting the idea of chemo because he thinks he will feel like crap during the chemo and won't get any real quality of life benefit after that -- just a longer, suffering life.

Note: He is only 56, very healthy otherwise, but his blood values really suffered during the Taxotere, and also the RA223/Xofigo therapies. He got Neupogen which kept him on schedule with the chemo (so I guess not as bad as some people) but his low blood counts get him really anxious.

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If he gets immunotherapy (like Provenge) at the same time, it may improve both. Provenge will amp up his immune system so there will be less myelosuppression from the chemo, and the chemo will destroy cancer cells thereby putting more cancer antigens in his bloodstream. The newly activated T cells can will get keyed into the new antigens and destroy more cancer cells throughout his body.

Also, is the reason for carboplatin due to some other type of prostate cancer being identified? If so, he may be eligible for a PARP inhibitor trial. I'm not sure if its effectiveness or side effect profile is any better.

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Already did Provenge. Mostly, he's done everything. He's been checked for the genetic markers that are known to be related -- doesn't have any so the PARP stuff is not relevant. We have asked the Prostate Cancer expert we work with at UCSF and he said the massive genomics test is not worth it because anything beyond the known ones (like PLD-1) is really just a guess at this point. But thanks for the suggestions.

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Might get ready for future use of targeted drugs--which many are in trial. But most trials require a Gene Mapping profile---as drugs have been designed to work against certain Mutations. I believe there are a dozen PARP Inhibitors, some available now and many coming shortly. Checkpoint Inhibitors is another type of Immunology.

So I am suggesting to inquire about getting Gene Mapped. Possible source is Foundation One--800 number on their Web Page---you get an advocate when you call---and it is all explained to you. Ask also if they do the tests for PD-L1---and others for Keytruda, at the same time.

Nalakrats

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Thanks. We had some basic genetic mapping done, including PDL-1. Waiting to see if a tumor gets large enough to try a direct sample, but so far -- no genetic markers for my husband generally, and likelihood of being on tumor is small. Thanks for the suggestion.

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Nalakrats, thanks for the information. I am currently looking at the options now for gene mapping.

Like many, I will end up paying for this myself. Do you have any idea what the cost is?

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I get the feeling it is in the 3500 dollar range---but i could be way way off---as everything that you can think of is handled by Foundation One, from the moment of your call to them. I am on Medicare--obviously at 74 years old. But one of the things they asked me was if I had a supplemental--which I did--and they told me the cost will be zero. I get some inkling that some of the guys here have had it done with their regular Insurance---and their regular insurance paid less the deductible. They have a list of insurance companies and what % is paid.

This is a no hassle deal--if you have biopsy or RP material---which is supposed to be kept for 10 years. You get a form on your e-mail which you print and have your Doctor sign, and fax back to Foundation One--they do the rest. If no material is around then there is a blood test they can do---this will cost extra--as once the draw is made it has to be refrigerated-shipped--overnight, to their labs. Basically called a Liquid Biopsy. Not every one can do the draw. Labs that do PSA's can.

You become a customer for life---you can get consultations as to your mutations and you are up-dated on any new drugs being used--either approved or unapproved for your particular mutations--as well as where every trial in the world is on-going or accepting patients as to your particular mutation. If questions later cannot be answered by their advocates---they will have a Doctor--usually a Geneticist call you back within 24 hours.

I was just 2 months after my RP, and I had not quite yet hit my Undetectable PSA, when I had it done. Glad I did as I was able to warn offspring--that my mutations were Familial, and everyone including nephews and nieces have been mapped---re: Breast and Prostate Cancer. Brother unfortunately got Pca also. At least everyone is getting tested twice a year because of the Familial Nature of the mutations--so any cancer can be detected very early, and cured.

Your profile Gregg--seems to me to warrant testing--IMO.

Nalakrats

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Nalakrats, my profile needs to be updated, but my PSA is slowly starting to rise. It's still low, but now is a good time for me to do it.

Thanks for all the useful information, though I would like to add that if you are using old tissue from a biospy for testing, it may not have the most recent somatic mutations which have occurred. The whole idea of the testing is to see which mutaions have developed during treatment. Some could be inherited (germline) but others develop over the course of treatment (somatic).

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All tissue is kept frozen---this is where you do not make your own scientific analysis---leave to the Geneticists--talk to them! If there is to be mutational changes as you indicate let the experts advise---you and I cannot---trust me on this, their knowledge will blow you away.

Nalakrats

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Hi, My name is Lynn, husband did chemo, been n Zytsga, Xtandi also. Sam started at age 65 now74 young. This past operation he had a cancerous LN removed, his mutations qualified him for two plus

Targeted therapy drugs. Sunitinib and Cabozantinib,these were two of the drugs that his oncologist wanted for him. I never heard of either but they both are FDA approved?? Waiting to hear if we can get one?? One drug co. already said they had no gov.. grants ?? I read that these targeted therapy drugs are a game changer for men with late stage PC . Sam had LN out right after Christmas, took a few weeks to get biopsy results back. His PSA was 65 in Janauary, this past week it's up to a 100.00.

Still waiting and nervous to see if we can get one of these drugs.

Wishing you and your husband best wishes and keep me and the rest posted!!

We always have hope and there are always new treatments being made.

Take care, hang in there!! Hugs, Lynn Pa.

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Good Tuesday Morning Caring7,

I have been in this battle for almost 6 years (please see bio for complete treatment history).

Just completed 6 cycles of chemo with Docetaxel/Carboplatin combo, as I now have prostate cancer mets in liver.

PSA was 10.8 before chemo and dropped to .4 after 6 cycles. Always left infusion center with an On Body Injector of Neulasta to boost white blood cells.

Overall not too bad. On a chemo break, currently at 2 months!

Best wishes. Never Give In.

Mark, Atlanta

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Congrats on the PSA plunge. How are you feeling? I know that during the chemo you just take whatever you can get -- but is the after effect worth it? That is my husband's concern. Thanks for sharing your experience. - Brenda

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Still have some fatigue but hair is growing back! I iced hands and feet during Docetaxel infusion to mitigate peripheral neuropathy, but Carboplatin does not have that side effect.

Mark, Atlanta

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Good quality Beta Glucan has helped people get through this by helping the immune system. Better way health has some good glucan.

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One other thought--Guardant360 liquid biopsy requires only 2 vials of blood and will look for genetic defects. One of mine revealed an ATM defect and Dr. "Snuffy " Myers could prescribe Lynparza, a PARP inhibitor.

Mark, Atlanta

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My father 79y/p on carboplatin and has minimal side effects (constipation) and besides the usual fatigue with Lupron. Hemoglobin has dropped but wbc have been normal with neulasta. Mild hair loss, no changes in taste or neuropathy as of yet. We do ice his hands and feet. Good luck to your husband lots of hugs and prayers!

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Thanks.

We are not quite there yet but I'm trying to get a bigger picture of him to consider than "this is just a last ditch desperate effort."

These responses are helping.

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Hi Caring7.

My husband is on Carbo Platin. Apart from tiredness and the need for more sleep he doesn't feel bad at all. In fact, he feels a lot better than he has done in a long time. This Chemo is really working for him. So, if I were your husband, I would try it.

Best wishes

Mel.

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Thanks. We have pushed chemo off with trying Zytiga first (after Xtandi stopped working). Here's hoping we get some time out of it. But good to know this because it's coming. Glad it's working so well for your guy!

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