Today at my Med Onc visit I was given the choice of adding either Abiraterone or Doxetaxel to my just initiated androgen-deprivation therapy. They said at this point there is no real definitive studies as to which is superior and either would be an fine. The expense of Abiraterone would be a consideration and Doxetaxel is still a viable option and either can be used as a follow up. All things being equal does anyone know if there is proven survival benefit to starting with either one?
Kevin
They are exactly right. Because docetaxel seems to have particular efficacy in men with multiple mets, you can use that as a decision guide.
pcnrv.blogspot.com/2017/06/...
Thanks for that info Allen, as I have a few mets on my spine so it appears that Abiraterone is the proper choice. I am starting 5 radiation sessions to the spine today and need to follow that with either Abiraterone or Doxetaxel as per Oncs plan of attack.
You are so luck to have options. Could you describe the type of radiation you're having on the mets? Is it SBRT? Palliative radiation? Thanks!
How many spinal mets? If there are 5, I'd start with docetaxel.
If you have multiple mets, you need to carpet bomb them with chemo. Chemo flat out kills things, good and bad. It is some bad ass stuff that that went inside my body and performed genocide. I couldn't be happier that I used it, it was an experience I will never forget. I still have Abiraterone in my back pocket when the need comes along. With chemo, its "you can meet me now or meet me later." Good luck.
This is a meta-analysis of the Abiraterone and Docetaxel trials.
What is the optimal systemic treatment of men with metastatic, hormone-naive prostate cancer? A STOPCAP systematic review and network meta-analysis .
I'm on Abiraterone and Eligard and they are having a very good effect. After initial treatments I had a recurrence and my PSA went from 0 to 10 to. After 6 months of hormone and Abiraterone it went to 0.1, and it should go to zero. It is expensive but check to make sure your insurance covers (and be sure you ask for monetary support from manufacturer if needed). Both Abiraterone and Docetaxel have about the same efficacy from what I hear. I'm not sure which has worse side effects. Since I have 5 lymph node metastases, my doctor and I agreed to stay with Abiraterone and reserve Docetaxel for a recurrent increase in PSA. If you have a larger number of metastases, you may want to go with Docetaxel. The real question is when will they try Docetaxel and Abiraterone. I think men with recurring PC and metastases should get multimodal treatments.
Thanks for the reply, I do have Mets to the spine, so chemo seems to be the way to go
I had 40+ bone Mets at DX plus CA had 'eaten' my pelvic girdle lymphs. Went on Docetaxel Nov 25, finished May 10 2016. PSA from 200 to 13.6.
Then Zytiga within 2 months to 0.03. 2 years later still Zytiga 0.03 to 0.06 minimal changes monthly.
Zoladex every 3 months since DX and always throughout other treatments.
I did the early chemo. It was all that was available at the time. The approval for early Abiraterone happened about half way through my chemo.
I think in retrospect I would still do the chemo if it was my choice right now. My reasoning is: I had a considerable tumor burden, chemo gets all the cancer cells equally, not just the hormone sensitive ones and doing chemo at a younger age is generally more tolerable than doing it later.
Abiraterone works really well if taken at the start of ADT, preventing CRPC. I posted a graphic on this site last week showing its efficacy. It is less useful once you become CRPC, whereas Docetaxel still works. So, in my opinion, I would take Zytiga now, saving docetaxel for later.
I’ve not had any chemo, just Zytiga from dx. PSA 571, 7 major bone Mets, dropped to immeasurable after 12 weeks where it’s stayed for approaching 7 years.
Good luck with your journey, stay positive.
Tommy-
I reread your post about being on Zytiga for SEVEN years! It gives me hope that I can do the same! Are you on Lupron and Prednisone as well ? Any other changes, supplements etc that you would recommend? I am just 6 months into the battle. PSA down from 10 to 0.07 w L,Z and P.
Congratulations on beating the odds for so long! Wishing you continued good health!
Hi
I've not changed anything. No supplements or dietary changes. Enjoying a few beers twice a week, and staying really positive. Not easy at first, especially with the hormonal effects. They've dissipated now, so I'm a happy man.
I've not been able to exercise much as my femurs are damaged from the Mets, along with the big Met in my pelvis which can antagonize my sciatic nerve. No point in aggravating things at this stage.
I'm pain free 99% of the time, at times the signs of old age can be confusing and worrysome as the first thing that crosses your mind is another met! I've got one met in a rib at the back which rubs against a muscle if I'm leaning forward doing something repetitive. Kind of like dull toothache!
Still working a little to keep my mind alert, helps to distract me from the 'elephant in the room' too.
Anyway, Good Luck with your treatment, I hope you're as successful as I've been.
Cheers
Martin
Also trying zytiga first and when it fails can be rechallenged after chemo so zytega to chemo and back to zytega. Rocco
Ok I’ll throw in my two cents guys. As I’ve posted before dr scholz and the other oncologists in his office are recommending all 3. Zytega, lupron and chemo. And why not. All the recent studies keep proving that hitting pc early seems to work better than later with a combination of drugs. That’s how they finally figured out how to stop HIV from killing people. Use a drug cocktail. For the most part saving PC drugs in the bullpen for use in the ninth-inning has often been proven very wrong. I brought the idea to ucla to get a second opinion and they said that logically it made sense but that they could never recommend it because no study had yet been done to prove it. However they did say they would sure like a study on it cause it made logical sense based upon other recent studies showing lupton early with Zytega and lupron early with chemo increased survival by huge chunks. And they said nothing in the chemical make up of the three drugs would seem to have any effect that should make the other drugs not work as well. They are getting great results so far and my personal PSA is down to .02 for the last couple of months. I tolerated all three pretty well. And it was no problem getting my insurance to pay for all three. Just sayin.....
Schwah
would you care- I hope yes- to share which ins covered all three, PM if you prefer - we are not well covered for Zytiga- so can't do now- but at new enrollment we can switch- so to add it- we have medicare-covering Lupron and will cover Xgeva when our wait after dental repair wait time is over-to prevent/reduce chances of jaw necrosis
I’m on blue shield of California.
Medicare covers Zytiga. I paid $2800 the first month and $580 a month copay after that. Most medical centers have a staff person whose job it is to help patients find ways to pay for expensive therapies. Also, in some cases where patients can’t afford full doses of Zytiga, some docs are apparently giving consideration to the one pill and light breakfast regimen that showed favorable results in a University of Chicago study. Given the
potential savings, I’m surprised that Medicare and other insurers aren’t clamoring for more studies.
our medicare rx supplement will cover Zytiga for about a month and a hole - then we hit the "donut hole" - we applied to J&J but they denied for reasons we have RX coverage, trying to find out if we can reapply after we hit the donut hole- up til now we rarely used RX meds so for several years we had our current RX supplement and never ever hit our deductible max- but this year of course is vastly different- will be looking at other RX supplements come time
but medicare does cover the Lupron and will cover xgeva when he can start after the wait from dental work that was done to avoid needing to do in future.
ty for sharing
I was treated with Zytiga,Prednisone,Eligard, and Xgeva for bone Mets as my first line of treatments and couldn't be happier wth the results. I had a PSA of 14.7 and in one month dropped to undetectable with minimal side effects. You will have to get used to a loss of libido and muscle mass but both can be addressed with keeping active and E.D. medication I'd needed. Best if luck with your decision mine was an easy one I just trusted in my Doctors. Leo
May I ask why you are getting radiation to your spine?
Are you having pain?
The m d Anderson trained r.o. Would not touch me with my 3 Mets to my ilium and immediately sent me to a m.o who has had me on aap and lupron with great results for a year. Psa undetectable..
Good luck
I had three bond Mets too. Very small and no pain but I had radiation to all three with my Zytega ,lupron and chemo. The kitchen sink approach. Lol
Schwah
Most meta studies show an equivalence between Abi and Doc. I would suggest if you are deciding on the chemo, get your genomic profiling done first. You may benefit more from a platinum based chemo.
Newly dx with high risk locally advanced prostate cancer..bewildered 
Chemo #4 Docetaxel, for prostate cancer
Optimal Management of a Man With Recurrent Prostate Cancer
Is my cancer still hormone sensitive?
Enzalutamide Extends Radiographic PFS in Metastatic Hormone-Sensitive Prostate Cancer
