Worried

[ForJoel]

My husband was just diagnosed with stage 4 metastatic prostate cancer. It has spread to his bones, but NOT to his soft tissue, lymph nodes or other organs. He is being given hormones, oral chemo, radiation and a new drug that starts with Fed... but I can't remember the rest. (I am livid that the doctors he goes to on a regular basis did not catch this sooner). He seems to be responding very well so far; he's been in the hospital since Friday. His legs are compromised and he was unable to walk right before they finally diagnosed him. He is only 59 years old, so I need some good news about his prognosis. The doctors say he can "live" with this. Please give me any advice or information you can.

[Tall_Allen]

I'm sorry to hear about his diagnosis. Have they biopsied any of his bone mets for histologic or genomic analysis? I am not aware of any standard "oral chemo" used for prostate cancer - it is usually docetaxel by infusion. Perhaps he is taking Casodex pills (a hormone therapy) and maybe the "Fed" is finasteride (also a hormone therapy)? How many bone mets did he have? Did they discuss Zytiga or Taxotere with him?

[DaughterOnAMission in reply to Tall_Allen]

Hi Allen, I've been wanting to ask you about a similar situation. Although my dad seems healthy and doesn't complain of pain...hes also stage 4. Trouble could be near, I suppose. He started Casodex, and is doing his first Lupron shot Thursday. 17.75psa, gleason 9, possible LNs, some small lumbar mets. We are debating starting zytiga/prednisone or doing 6 infusions of taxotere 3 wks apart. How do we choose? Hes 72, active, and in good spirits. He seems to think it's something he has to "kick". Still weed-wacks the whole hillside in our backyard for hours. but, alas, hes human and has APC. Would love to hear your thoughts. Also have him on flax seeds (crushed), vitamin d, lipitor, turmeric, fish oil, a probiotic, & saw palmetto.

[Tall_Allen in reply to DaughterOnAMission]

Taxotere in his situation is controversial, In the CHAARTED trial, they found that early use of Taxotere only increased survival among men with high volume mets. High-volume disease was defined as presence of visceral metastases and/or ≥ four bone metastases with at least one outside of the vertebral column and pelvis. So he doesn't meet that definition. But others argue that that subgroup analysis should not be applied to all patients. Early use of Zytiga is less controversial. Here's an article about it:

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

There's every reason to remain active while on Lupron. You can help by encouraging him to do MORE, rather than less. Plenty of strenuous exercise - both cardiovascular and weights - is just about the best thing he can do for himself.

As for the supplements... Vitamin D is OK if his blood levels are low. High levels have been associated with more aggressive PC. Omega-3 pills have also been implicated - stick to fish. Saw Palmetto is a really bad idea - it may artificially lower PSA. You want a PSA that reflects his true situation - it is an important diagnostic tool. The only supplement that has passed a randomized clinical trial is sulforaphane - but it has to be the kind with high myrosinase.

[Darcym1 in reply to Tall_Allen]

I wouldn’t write off the idea of using docetaxel and Lupron together early on after diagnosis with mets. The distinction between high and low volume Mets is arbitrary and they don’t always know where and to what degree PC has metastasized. Also, trial results, though informative and useful, are summarized by stats that don’t always tell the full story. Cancer is individual. What I’m saying is don’t discount treatments until you have fully satisfied yourself that you understand what the alternatives mean. The docetaxel/Lupron treatment has worked for me and I think they still don’t completely understand the extent of my Mets.

My $0.02

[DaughterOnAMission in reply to Tall_Allen]

Well it's possibly in the bladder too. I just don't want him to stay zytiga and have it fail in a few months and wish we had hit it harder. Doing chemo later maybe harder in his older age. He's strong now. I don't want to watch him suffer but if chemo will be better now than after other options fail then I want to pursue it. He seems to be up for it. Kaiser refused to do a MRI. So we don't know more than what sorta showed on the bone and ct scans

[ForJoel in reply to Tall_Allen]

Thank you. I will get more detailed info today and post.

[Scruffybut1 in reply to ForJoel]

Sorry for the slow reply. High number of hospital and doctor visits. My chemotherapy was 10 cycles commencing early November 2015 and my final treatment commenced May 10 2016. Throughout from Jan 12 2015 I received 3 monthly Zoladex injections. Next one due in one week.

[jimhagood]

Get additional and various medical opinion.

[ForJoel in reply to jimhagood]

Ok. Thank you

[Darcym1]

I had a similar diagnosis in 2014 ( Stage 4 PC), and could barely walk at the time due to Mets in my pelvis and hip joints. I was 57. Have been through chemo (docetaxel) and am on Eligard. These seem to have pushed back the cancer; my PSA has gone from an initial 100 to now undetectable. So life is pretty good,considering that my oncologist at the time gave me 3 to 5 years to live. I feel like life will be much longer than that. Dietary changes are important ( no sugar, red meat, or eggs). Lots of fruit and veggies, minimize dairy. Hang in there, he can live with this...

[ForJoel in reply to Darcym1]

I will post clearer info later today. Thank you.

[ForJoel in reply to Darcym1]

Thank you. He is having surgery tomorrow on his spine to relieve the compression that they believe will help him walk. We plan to do chemo when he rehabilitates. His PSA is down to 14 and he will have another dose of the hormone blocking drug mid July. (I can't remember the name of the drug right now, but it is new and only given once a month).

[Scruffybut1]

I was diagnosed 2014 PSA 167 rose to 200 in 3 weeks. Stage 4, over 40 bone Mets, all pelvic girdle lymph nodes 'eaten', seminal vesicles cancer, G9, aged 65. Within 2 years following docetaxel chemo all bone Mets gone. Treatment still Zoladex, Prednisolone, Zytiga. Past 2 years PSA 0.03 to 0.06 results monthly. It hasn't been a hard 4 years in fact very easy and I hope your man finds life the same. I remind myself that tomorrow is another day but I am a lifelong optimist and not a pessimist. Good luck and God Bless. David

[ForJoel in reply to Scruffybut1]

Thank you so much! 🙏🏻🙏🏻❤️

[ForJoel in reply to Scruffybut1]

Thank you again for your post. Can you tell me when you began chemo?