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Advanced Prostate Cancer
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Chemo After Provenge?

My husband had his last treatment of Provenge on April 12th and Oncologist Is Wanting To Start him on Chemo Cabazitaxel because his PSA was up to 250 on Mar. 28th but yet Urologist that gave the Provenge infusions thinks it's too early after the Provenge. Wanting to see if anyone else out there has had this experience and what they did.

Thank-You

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I'm afraid I haven't - but, I'd drop the urologist...I did...I need different help, now, and he can't give it to me.

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He actually has a urologist at the VA but only went to this other Urologist to be able to get the Provenge treatment and then his oncologist is also at the VA and he's the one who is wanting to get him started on the chemo right away and we're just afraid that the chemo will damage the treatments of Provenge before they have a chance to do anything yet. It's just all so confusing on knowing who to trust and who not to.

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I agree with Spinosa. The urologist doesn't have a clue because it's outside of his field of expertise. Immunotherapy and chemo (or RT) is actually a synergistic combination. The immunotherapy boosts the immune system which can otherwise become depleted by the chemo. And the chemo destroys cancer cells, making their antigens more available for the stimulated immune cells to latch onto so that they can "seek-and-destroy" cancer cells throughout the body. It's a win-win. There are numerous clinical trials of such combinations.

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This is something I never understood. I read a theory once that said that chemo damages the immune system by interfering with cell division in rapidly dividing cells - which includes the bone marrow cells that generate immune system cells. The claim therefore was that patients should have chemo first, then, after the immune system recovers, try the immunotherapy. The idea is that the chemo weakens the immune system so badly that you get no benefit from the immunotherapy. In that theory, ADT + immuno is good, chemo + immuno is not better, or not much better, than chemo alone.

However I've also read, as you point out, that there are trials of concurrent chemo + immunotherapy, perhaps working on the theory that you advanced above.

I guess we'll know more when the trials make their reports.

Alan

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Provenge extracts some of the patient's own dendritic cells and boosts their cancer fighting power by adding an immune stimulant and a prostate-specific antigen to it in a test tube, and then injecting the amped up cells back into the patient. In fact, they often give a similar immune stimulant (like Leukine) to patients getting chemo to prevent or correct any myelosuppression that occurs. That combo is known to work well from past experience. I've never seen any study contraindicating use with chemo.

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Hope you have a good MO---listen to the MO--he is the cancer expert.

Nalakrats

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Please keep us posted. I am on a similar path. I completed Provenge in October 2018 and PSA began an increase with recent measurement of 65.6. My Urologist ordered CT scan and it showed no change in cluster of cancer in lymph nodes. Now I am scheduled for a bone scan and then expect to begin chemo. Doctor has not yet identified specifics as the bone scan will be determinate in the next step. Note that my Urologist was not particularly concerned about the level of PSA, but was surprised that the lymph node involvement was not yet decreased by Provenge. I am walking with you on this path - chin up!

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Go for the Gold... an oncologist who's specialty and expertise is in treating PCa. If not in the V.A. then go outside the V.A.

Good Luck and Good Health.

j-o-h-n Wednesday 04/25/2018 1:32 PM EDT

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Thank-You Actually the oncologist he went to for the Provenge has specialty in Prostate cancer. His name is Dr. Neil Shore in Myrtle Beach SC BUT we live in NC near Asheville so it's very hard to go to him all the time that's why he goes to the VA. The VA actually didn't even offer the Provenge so his oncologist at VA told him about the urologist down in SC.

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You're welcome.... Ask here if anyone knows of a good oncologist near Asheville N.C.

Good Luck and Good Health.

j-o-h-n Wednesday 04/25/2018 5:32 PM EDT

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