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Advanced Prostate Cancer
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Provenge?

I'm sure this has been hashed over a zillion times but I'm trying to decide to go through the Provenge treatment or advance right to Zytiga. Any input appreciated, thanks.

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My understanding is...Zytiga first...if everything fails, then-after genetic testing-possibly Provenge. I'm positive many other here will offer advice.

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There's no reason I know of that you can't take them concurrently. Provenge works better if you use it earlier, so you wouldn't want to delay it until after Zytiga fails. Provenge probably has a synergistic effect with docetaxel or radiation.

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this is what I did...it was great while it lasted

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I was talking about this with my oncologist yesterday. I have an editorial from (IIRC) an ASCO conference discussing this issue if anyone is interested.

What it boils down to is that Provenge and other immunotherapies don't usually lower PSA, don't generally shrink tumors, don't obviously help.

But the patients who take them tend to live longer.

My oncologist explained that the clinical trials used to get drugs approved tend to select men in the end stage of the disease. They are likely to die soon in any case, so there is less concern about trying new treatments.

But my oncologist said that the profession is coming to realize that immunotherapy probably helps to slow the cancer. That doesn't show up in men who all die in 6 months no matter what you do. So oncologists are giving immunotherapy to patients earlier.

In any case, you can do both. If I had to choose one now, I would choose Provenge or some other immunotherapy, and keep Zytiga as an option for later.

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Great, great reply. You put it in English that I could understand. Thank you.

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Our understanding was that you can only do Provenge in the window between advanced to mCRPC and visceral involvement (spread to organs) -- which can be a big window but also an unpredictably closing one. My husband took Provenge just before switching to Xtandi (did not start with Zytiga). -- So not at the same time but I think that was just our process rather than a medical issues?

It's also true - the only reason we know Provenge works is from the clinical trials. There is no empirical evidence (PSA esp.) that 'proves' it in individual cases. Leap of scientific faith? The same is true for RA223 -- although one might see evidence of slowing/regressing bone mets on scans.

Probably the decisions are mutually exclusive. Even thought we did Provenge, then started Xtandi, I don't have anything in our notes about that being necessary. It's just kind of how it got sorted out.

Maybe? --> Consider Provenge and decide on that. Consider Zytiga and decide on that (probably more of a priority?) OR -- given post I just saw below this one -- if the prednisone is contraindicated -- see if you can start with Xtandi (no pred)?

NOTE: We opted to start with Xtandi rather than Zytiga (which is apparently the less common path). He got great mileage out of the Xtandi (2+ years) but now we've had to switch to Zytiga with our fingers crossed that he is in the ?10% group for which it actually works well after Xtandi.

These decisions are tough, and they are not absolutely urgent (you don't have to decide within days) so ask lots of questions of your docs and keep on with the research.

Also look elsewhere on this site. Most men do fine on Provenge but there is a possibility of flu-like side effects. Weird for my husband first two treatments were fine (a little tired) but the third one gave him "flu" -- he went to ER for fluids and checkup for sepsis or other issues (he was fine) - but he felt pretty awful for a day or two. It seems from the unscientific survey on this forum though that most men do fine with minimal side effects. It is a long process, esp. the extraction part (first art). Bring a laptop with a movie or two! (My husband discovered he couldn't take a nap because you have to keep squeezing the ball to keep the blood flowing.) The re-infusion (3-days later) is like a chemo session (and you can nap!).

Best wishes to you -- and realize that you still have a lot of options right now.

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Incredibly written Caring7. You pretty much summed up the entire process. Thank you for your time.

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We felt so sort of stranded when we were going through all this. I didn't find this site until about a year ago -- wish I'd found it sooner!! So happy to help someone else in the earlier stages navigate all this complexity!!

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What is your current psa? And how fast is it increasing? I like the idea of doing provenge early, as it is hard to do when psa and cancer is galloping ,as it does not control psa ,but has a proven survival advantage. I had heard it may make future treatments work better. I was told by my MO that it is not done with zytiga as zytiga must be taken with prednisone which has a negative effect on the immune system. Just what I was told, and my own opinions.

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It's about a year and a half old, but this Consensus Panel paper has lots of "food for thought" to chew on about the topic of the timing of Provenge (Sipuleucel-T) in advanced prostate cancer. Several notable prostate cancer researchers were members of the Panel.

It may help inform your decision-making as you continue to discuss these things with your doctor. Meanwhile, that's Great News about your PSA response so far. Your treatments are working.

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

Charles

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I underwent Provenge treatment 14 months ago. Unfortunately, it did nothing for me. Perhaps because I was already at Stage IV. Hope it works for you should you decide to opt for it. Best of luck.

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My husband was on Zytiga a few months ago but it only worked for him maybe 3-4 months so now he's doing the Provenge treatment but oncologist says he'll probably be needing more chemo this year .

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I had nodules in my lungs and went on Provenge. No side effects. The worst part of it was having a tube sticking out my chest for six weeks. I was so happy to get that taken out.

The nodules shrank and I have had no further problems.

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Depends on the clinic -- but you might be able to avoid what they call the "catheter" (the chest tube thing) if you have good arm veins. My husband declined and did not have to have the catheter (which is often used for extensive chemo treatments) -- but this is only 3 treatments of infusion. The extraction -- I think -- has to go in and out of arm veins any way? Sometimes clinics have "weird" (some reason but maybe not always the reason) protocols. We have questioned these when they come up -- sometimes we avoid what they want to do, sometimes not -- but it's your body so you get to ask!

Magnus -- glad you had shrinkage of nodules!!

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My husband had Provenge ending Oct 2017 along with lung Mets. So far his aren’t shrinking on scan and his PSA continued to rise.

His Provenge was interrupted by Hurricane Irma so it was finished in MN where they were dismayed to see he had that catheter in him. MN did the original trial and didn’t believe in using the implanted catheter where one can’t shower for six weeks.

Those researching Provenge need to turn down that catheter.

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