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Advanced Prostate Cancer
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Not the treatment I was expecting for my 89 y/o Dad

My Dad and I met with the MO today,who is recommending Taxotere For his treatment. (Mets to skull, spine, pelvis & ribs) MO says Zytiga, Xtandia, and Radium 223 would not be as effective but can be tried if he can't tolerate the Taxotere. He says this is what is recommended as a 1st line of treatment by the NCI with my Dad's history of failed ADT. He says his chances of benefits are 25% with the Taxotere. Less with the other treatments. Any thoughts on this are appreciated. He is scheduled for his 1st infusion 3/29.

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With the mets mostly to bone I would have thought that Radium 223 would have been the way to go...sounds like you got a good MO

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You said he had a failed history with ADT. Can you provide more details about that such as the date when he started ADT and PSA at that time, mets, etc. Then how long did it work before it started to fail (PSA rise, progression of mets, etc.)

I just looked at your profile and it looks like he's been on ADT for quite a long time and if that's the case, and it was effective I can't see why they aren't going for second-line ADT such as Zytiga or Xtandi over chemotherapy, especially considering his age. I'd like to specifically know why the doctor wants to put him on chemo. Not making sense to me.

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He was diagnosed 11/1996, mets to pelvic lymph node. PSA 49. Treated with Lupron and Casodex × 5 years. PSA 1-2. Slowly rose to 5 in 5/2015. Mets to right scapula. Treated with Trelstar & Radiation x 2. PSA decreased 1.2? Started rising again 1/2018. January PSA 5.0. February PSA 7. Mets to skull, spine, ribs, pelvis and right scapula area increased in size. Today's PSA is pending.

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If you decide to go ahead with chemotherapy, I would suggest discussing weekly infusions to reduce the risks.

Heres an article about chemotherapy for older men with prostate cancer.

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

A quote from the article: "One strategy when administering docetaxel to older patients is to use weekly scheduling, which is generally perceived to be better tolerated due to lower rates of hematologic toxicity compared to the standard 3-weekly regimen."

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Like your father I had (was Dxd with) extensive bone mets +40. Hips, spine, ribs both scapulae and chest. Pelvic girdle lymphs, some 27 already 'eaten' by PCa and both seminal vesicles. ADT held me from 200 PSA to 18. Chemo from Nov '15 to 5.8 in May '16. Surprise all Mets gone. 2/3 months still ADT then Zytiga. Instant to 2.8 and for past 18 months 0.030. I recommend (as a patient) chemo. It kills cancer whereas other treatments contain development. David now 72.

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That is wonderful! I am happy for you. I hope my Dad has good results.

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Also consider Gene Mapping--takes 3 weeks for results---can lead to targeted Immunology drugs as well as targeted drugs. Call Foundation One--they will walk you thru--does not hurt to call and speak to an advocate---800 number can be found on their Web Page.

Nalakrats

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I think that's an excellent plan. Too often, elderly men aren't given the appropriate treatment due to ageism. It should be based on an assessment of his status, not on his age. He is right that docetaxel is likely to have a big impact on pain, quality of life, and survival. The latest clinical trials of abiraterone made clear that it carries an equal risk of serious side effects as docetaxel - they are no different in degree, only in kind. It makes sense to me that he would use it first while he can tolerate it best, and save the 2nd line hormonals for later. Xofigo will have to wait until after Zytiga. Docetaxel and Provenge may have a synergistic effect.

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I'm hoping he can tolerate the Docetaxel. It sounds like you are saying he can try the Zytiga after the Docetaxel, ( if he can't tolerate it) then the Xofigo if the Zytiga fails?

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In fact, there is some (scant) evidence that Zytiga or Xtandi may work better after docetaxel. In one pilot study, taxane therapy was able to reverse the AR-V7 splice variant (which is a genetic abnormality responsible for Zytiga resistance) in a few men. Perhaps he can get Provenge when he starts docetaxel. The immune boost may counter the immune-suppressive effect, and the docetaxel will kill a lot of cancer cells, making their antigens available to "charge" the Provenge.

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I mentioned Provenge to the MO and he stated that is given very late stage. I guess I should of asked what he considers late stage.

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If he is castration-resistant and has metastases, he qualifies for Provenge. It works better, as almost all medicines do, if used earlier (although it does not work well in hormone sensitive men). I suggest you email him the link below and ask to discuss at your next meeting.

It says, "These findings suggest that patients with less advanced disease may benefit the most from sipuleucel-T treatment and provide a rationale for immunotherapy as an early treatment strategy in sequencing algorithms for metastatic castration-resistant prostate cancer."

goldjournal.net/article/S00...

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Good morning,

My dad to is 89, in July. I had put off on chemo because I was afraid of the side effects. I will be interested in seeing how things go with your dad.

We're currently on our way to discuss a trial with his doc that I'm even more concerned about. A combo of Jervoy and Opdivo.

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I am worried about the side effects also. Keep me posted about your Dad's treatment.

Best wishes to you both.

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I will definitely keep you posted as I know how you feel. Best wishes to you as well.

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If you are lacking confidence in the treatment, get two more second opinions.

You are entitled to a fullsome explaination of your options and their tradeoffs.

It sounds like it is unlikely that this happened. With each second opinion you get, you will get a better understanding of your options and their tradeoffs.

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I love reading about the 21-22 year survivors. Like our newest MO said, “ you must be doing everything right!”

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Reading about these survivors who did not have access to today's myriad of drugs and treatments keeps me astonished and happy and HOPEFUL for all of us.

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