Advanced Prostate Cancer
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An update post chemo

Hi Folks, its been 5 months since my last post, trying to stay on-board this roller coaster. I was diagnosed as advanced in Oct 2017 (age 60) with PSA of 193 and was put on Cosadex, then leuprolide acetate (Eligard). I have had two injections of Eligard (2 x 3 month cycles), and completed a full cycle of chemo (Docetaxel). At the time of diagnosis, cancer had escaped the capsule and is in two lymph glands. No bone mets.

In my latest blood test, the PSA was down to 1.4. It went from 193 to 18, 10, 4, 3, 1.4 and my MO has started to canvas what next steps should be. The MO described the results from ADT and Chemo as "fabulous". ADT seems to be working. I've given him the objective of getting me to ten years!. I've consulted two surgeons, both of whom feel that surgery might be helpful, but the growth into the bladder sphincter means that incontinence is a certainty and probably can't be rectified. It may also require stents from kidneys.

I go for PSMA-PET, MRI and Bone Scans in a couple of weeks, once my systems start to recover from chemo.

As a result, we are debating next steps. Options considered:

Oriechtomy - fastest, and sharpest drop in T production, but only works until cancer becomes resistant. My MO suggests that new treatments are coming all the time and this surgery may not be necessary in the future. It is also not reversible.

Radiotherapy - can target lymph nodes and possibly prostate, but side effects could result in faecal incontinance.

Different drugs (once CRPC is reached).

The thing I wanted to post about here was my experience with 'frozen mittens' to minimise neuropathy. I was treated in the day oncology clinic at Epworth Hospital in Melbourne Australia. Overall, pretty straightforward and very good nurses.

When I was scheduled to go in, I had done some research on side effects and the nurses got these frozen mittens. It hurt like hell (imagine frostbite) but I have to say it worked. I have quite extensive neuropathy in my toes and the front portion of my foot, but little or nothing in my hands. The nurses say the feet can recover over 12 to 18 months, and there is a small chance it won't recover. So I am a data point in support of this approach.

Keep up the great dialogue, and in particular the research papers. I have some deep conversations with my MO on several of them.

Best wishes to all.

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Hi Jimbob-

First, I want to congratulate you on the excellent response to therapy so far. If you ever do chemo again, try ice packs on your feet as well, and ice chips in your mouth to prevent dysgeusia. (And extra blankets to keep your core warm).

I'll give my 2¢ about the issues you raised:

1. Orchiectomy - It doesn't matter if you become castration resistant, you will still have to continue on Eligard for life. Other therapies will be added on top of it, not instead of it. The only good reason for not having the orchiectomy is if you think it likely that you will have ADT vacations (intermittent ADT). You are not a great candidate for intermittent ADT, however.

2. Radiotherapy. Fecal and urinary incontinence are very rare side effects of radiation. you have probably not spoken to a radiation oncologist, and you are probably taking advice from doctors who have no experience with it. You are right that the advantage of radiation is that it can treat the ENTIRE pelvic area and NOT leave you incontinent. Talk to an RO! Here's are a couple of articles you may want to read:

pcnrv.blogspot.com/2016/08/...

pcnrv.blogspot.com/2016/08/...

3. Drugs for mCRPC. The approved options are Zytiga, Xtandi, Provenge, Xofigo, estrogen patches, more docetaxel, and Jevtana. There are many clinical trials of new drugs.

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Thanks Tall Allen

Did I read you correctly, that orchiectomy should be done?

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It is a reasonable option if you expect to be on continuous ADT anyway.

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