Advanced Prostate Cancer
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Recent diagnosis of advanced prostate cancer. Where to begin?

My 68 year old father was just diagnosed with advanced prostate cancer. He has bone mets on almost every rib, pelvis, hip and spine. PSA is 201 and Gleason 8-9. The dr wants to start hormone therapy this week and chemo (docetaxel) every three weeks for 6 treatments. We don’t live far from Mayo in Rochester and are thinking of traveling for a second opinion. I’m sure you all started like we are...lost. Any information would be helpful and greatly appreciated.

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Sorry you needed to find us, but glad you did. This is a reasonable approach, but I like second opinions--especially from great institutions. Please keep us posted.

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If you can get an appointment at Mayo in Rochester, very soon, go. You will more than likely be offered a similar treatment plan from the MO you seen. If it were me, I would have treatment start very soon. I was in a similar situation 3.5 years ago.

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Mayo is a great center. They will more than likely offer the same treatment that has already been suggested, as this is the new standard of care, and has shown to be very effective. Most likely he will get a great response to this, as most men do. I would not wait to long for a second opinion at mayo, In fact I think you could do that after starting treatment too. Be sure to check out ways to mitigate side effects of chemo on this site.

Dan

Dx2006, stage 4 Gleason 10, bpsa 148,

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I agree with your doctor, that's a good treatment plan and one that has recently been proven to be effective in the STAMPEDE and CHAARTED trials. Here's a video about adding early chemotherapy to the Standard of Care ADT treatment in the STAMPEDE trial. vimeo.com/149626704

This is the treatment I followed with good results. Many others here have also done it. This particular chemotherapy is well tolerated in most patients. I was really afraid of doing chemotherapy, but after the first cycle I realised it was not that difficult. Looking back at my descision, I am so glad I did it to give myself the best possibility of a long-term remission. My PSA was 463 at diagnosis and after one year is 1.77.

Good luck with your treatment decision and let us know how things go.

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Sounds like an excellent plan. With multiple mets, especially, docetaxel usually works very well. I don't see any reason to delay treatment by traveling to Mayo. However, if any of the site locations are nearby, you might consider the ARASENS clinical trial of docetaxel + darolutamide (ODM-201). You can call 888-84 22937 for the site nearest you. Here are the details:

clinicaltrials.gov/ct2/show...

Here's an article discussing the various therapies for this stage:

pcnrv.blogspot.com/2017/06/...

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My response with Abiraterone/Prednisone and Zoladex has been fantastic, arm G of the Stampede trial. PSA 571 at dx, it’s been immeasurable for the last 6+ years. A good alternative to docetaxel.

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As others have said, the treatment prescribed for your father has become a standard of care. I'd be very surprised if the Mayo Clinic oncologists didn't approve it.

It's not the only excellent treatment. As Tall_Allen suggests there are some good clinical trials right now and as TommyTV says, ADT + abiraterone is also an excellent treatment. But I don't think any prostate cancer specialists would say that ADT + docetaxel is anything other than an excellent treatment.

It may turn out that your Dad doesn't respond well to the chemo. If that happens then the other treatments might be better. Trying the chemo will tell one way or the other.

Be sure that whoever is doing the chemo treatment knows what he's doing. Read up on how to counter the nasty side effects of chemo - nausea, appetite loss, neuropathy - and talk to the doctor about them to be sure that the chemo will be handled in the most patient friendly way.

As for the second opinion at Mayo - it sounds like a great idea to me. If I had a choice between getting advice from a world class specialist and getting advice from a shnook like me on HealthUnlocked, (no offense intended to the non-shnooks here on HU), I'd want to hear what the world class specialist has to say. But if you can't get an appoint Real Soon, I wouldn't wait to start the ADT and chemo. The sooner that cancer can be stopped from growing, the easier it is to stop it.

Alan

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Fantastic Alan! I’m a shnook on HL , but proud to follow your sage opinions. Thank you for bringing truth and wisdom. .👣

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Hi Drew

Im 75 with similar diagnosis to you dad's.

Started ADT 5 days after diagnosis. Psa plunged from 168 to 24 within 3 weeks of first treatment. Chemo with Docetaxel has started combined with second injection of hormone(Firmagon). Reaction to chemo so far quite bearable. I feel good!

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Feeling is everything.

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Hello Drew, I sought four opinions from different oncologist here in the Philadelphia area and all are outstanding facilities. Each MO had the same line of treatment to kill the beast and that was ADT and 6 rounds of chemo. After 1 round, my PSA went from 415 to 6.5. It is currently holding steady at 0.2. I tolerated the side effects well which was fairly minimal. I feel great and resumed all activities that I was doing prior to treatment. Keep us posted.

Nick- dx 03/03/2017 age 53, GS 8

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Take the chemo. Mayo will concur. This is standard treatment in your situation.

Gourd Dancer

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Yes ! I know what you are feeling for father..Initially , it’s all terrifying . Something that we hope will never happen to us or those that we love.Bam , you get hit in the head with a 2x4. It’s a simple to understand disease. Not simple to live with .Others here are more knowlageable about treatment options. If you focus on his daily happiness showing kindness and compassion for him Praise him and love him That’s what will make it all better. If he likes Frank Sinatra , play it for him. Anything to take our minds away is benificial for all. whatever path that presents itself you are there for him . There is no greater love than between father and daughter.A beautiful thing. He is blessed to have you . Take care of self as well as Papa. I feel that he’s in good hands..With love and support he will suffer but he can survive and get more time to spend with you. We all wish to extend our stay and not abandon our families. Good job finding this site now.I found it after a yr of treatments. Had no one to ask about anything We were petrified with a bad diagnosis and dismal life expectancies from doctors.

Tell dad not to listen to bad stats or negativity from doctors. If you take a negative outlook towards recovery it’s difficult to obtain .If the dr says you’ve got 6 months ,or 36 months, don’t listen ,many gents here have proven those bad death sentences wrong. . Dad will be chemically altered and it ain’t pretty ... he can live for many years if all goes well .. we are on a path of doing whatever it takes to extend our stay for as long as possible . With luck in treatments he should get to a better place after paying hell for a bit . You will make the best medical decisions together. Peace to dad!

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I’m sorry to hear about your dad’s diagnosis, but you are in a very supportive community here. As others have said, the Mayo will likely propose the same treatment plan as what he has already started on. The difference, as I have found from my own experience with the Mayo Clinic in Jacksinville, is the in the quality of care he will receive there, and what options they might offer for future treatment. I have gone through 3 years of ADT, and recently completed a course of 6 chemo treatments with docetaxel. There are side effects involved with all of it, but most are tolerable, and they become your “new normal”. Best wishes to your dad as he boards the train with the rest of us here.

Mark

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I have almost the same condition my doctor put me on Zytiga,Eligard,and Xgeva. I have been on it for one month and my PSA has gone from 13 to 0 and I feel better then I have in years with hardly Ang side effects.

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My doctor recommended the same treatment . I was stage 4. Lymph nodes,bone Mets spine,ribs. That was August 4 -16 just before my 66 birthday. I working for me. My hospital is affiated with Mayo

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