My Dad is currently on Bicalutamide and gets his first Lupron shot next week. These were both prescribed by his urologist. Additionally, his oncologist recommended starting chemo as soon as his kidneys stabilized which they now are.
Because he was just diagnosed with advanced metastatic prostate cancer, is there any benefit to postponing chemo and relying on hormone therapy alone? I'm his health advocate and want to ensure that we choose the best option in regards to initial treatment.
Thank you!
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Here4Dad
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No it was not. He has multiple bone mets and both his ureters and urethra are blocked by enlarged lymph nodes and prostate. As a result, he has catheters directly in both kidneys and urethra to allow kidney and bladder to fully void. I'm wondering if they want to do the chemo bc his cancer is so aggressive with Gleason score 9.
The side effects of early Zytiga are similar in degree to the side effects of early chemo - they are different in kind. For a man with multiple mets, early chemo may have an advantage.
zytiga never was a problem with my the lupron/eliguard shots were a big pain just to reduce my testosterone a bit. make me weak and sleep alot. now on PROVENGE tx and where your antibiotics fight the cancer not pills and shots
Tall_Allen they are giving my Dad a higher dosage of Lupron once every six months instead of monthly as he is paying out of pocket. Is there any downside to one large dose every 6 months as opposed to smaller monthly dosages?
your right in one case. the proveng3e builds up ones immunity and does some lowing of his psa. going with the lupron shots helps a bit but i found that zytiga helped me a'lot just is hard finding it is my problem.
I think Tall Alan is right. Lupron plus Zytiga/Prednizone will deal with cancer cells that are hormone sensitive. I've read, as PC goes metastatic it also becomes more hormone independent. The Docetaxel treatment will treat all cancer cells. He can go on Lupron/Zytiga after the chemo.
ADT + Early Chemo provided an increased mean Overall Survival time in the CHAARTED Clinical Trial, particularly for those with more extensive metastatic disease. Some overview details are here:
You may also want to review this Docetaxel Prescribing Information documentation, while weighing his current kidney, blood work, liver function, and other factors before making a final decision. Note particularly the dosage adjustment notes for Docetaxel if his blood/lab test numbers may start to be slow to recover between each of the 6 Docetaxel cycles.
depends on what his psa is, and how spr4ad his mets are in his body that will be a choice to wait or go forward. remember very few men live once they have advanced mets, and high psa it takes it time and the age of the person. i've been without zytiga for 5 months and that bosted my psa from 28-60. not worried its been 10 years and i have other options to follow. myself if and when it becomes a waste of time then i will stop and enjoy the time i have and quick putting poison back into my body just to live a few months more.
His PSA is 480 and is he 63 years old. We do a PET scan on Monday for a fully comprehensive view of where the cancer is. Currently we know it's in his lymph nodes, rib, vertabrae, and right hip.
He is willing to fight it now as he was just diagnosed last week. His family of course wants him to fight it as well, however, if treatment ever makes him too sick to enjoy his quality of life I would respect if he did wish to stop. For the time being though, we are gonna fight.
My dads mets are minimal. We got him on lupron and zytiga but I regret not having him do docetaxel first. He could have handled it and it is early-ish. Should have had him do it and then go to zytiga after. Uhg. I shouldnt have had to make that call for my dad by myself. go for the chemo now....
Thank you for sharing. That would weigh heavy on my heart as well but try not to beat yourself up.
As caregivers we are doing the absolute best we can and we won't always know the right answer at any given time. Despite this, the choices we do make are always coming from a place of great love and concern for our Fathers.
I'm sure he is thankful for you to be there during this difficult journey.
I was given Zytiga,Prednisone and Eligard as my first line of treatments. I am now going on no months of undetectable PSA side effects are now subsiding but everlasting none the less. Leo
I was hesitant too at first but after reading the data from recent trials like the CHAARTED trial which shows a substantial overall survival advantage to early chemo I went ahead and had chemo. It wasn't easy but I'd do it again in a heartbeat given where I am today. I recommend reviewing the data from CHAARTED, it should help with your decision.
Yes. This is my opinion and I’m not a doctor however I’ve spent many months reading scientific literature and posts from sites like lupronvictimshub and hormonesmatter where complaints re lupron are registered. There is evidence that a whole-food, plant-based, no added oil, diet can reverse some (many) cancers, including prostate. My husband is daily, hourly, suffering from lupron.... can’t sleep well...wakes up every hour (occasionally 2 if he’s lucky) with hot flashes, bad mood...angry or morbid or discouraged, has had fainting spells so can’t drive ... or swim. POSTPONE! Is my opinion. Best wishes to you.
Early chemo works and it works better while cancer is weak and still responding to hormone therapy. The weaker the cancer the better result with any treatment. Don't wait until cancer gains momentum. Hormone therapy alone will work until it doesn't and then cancer has the upper hand.
Good day i am 60 years young I was dx in January several Mets out and around my body PSA 1790 Gleason 8/9 on all 12 biopsy cores just had chemo 9 and going for 12 or so treatments, yes standard is 6 but most say to hit hard early so we are kicking butt now as long as I am doing so well with treatments, seems everyone has a little different reactions to chemo but you won’t know until you try it, for me it has been ok a little fatigue , a little bit of mouth soreness, hot flashes and a few other annoying issues but overall I would be glad to do this for 20 years nonstop as it is today .
My situation is quite similar. Diagnosed late in June with advanced prostate CA with numerous bone metastases. Began bicalutamide and Lupron in July with good response of PSA from 148 then, down now to 1.67. Just began chemo with docetaxel (Taxotere) this week. My understanding is that the studies on docetaxel (Stampede trial and Chaarted trial) showed significant benefit with increased survival by about a year compared to androgen deprivation therapy (ADT) alone, if begun within 120 days of beginning ADT with Lupron, especially with high burden metastasis (more than 4 to bone, or any to another organ). I had a detailed discussion of this with my medical oncologist. I think the same is true for the alternative, ie abiraterone (Zytiga) which showed similar benefit (the Latitude trial). Those 2 drugs are different but results are similar. There is no evidence yet which is better, if either one is. I hope that helps. Good luck.
If you click on her name it will take you back so you can see an original post when her dad was diagnosed. It gives that information. I was wondering as well and found it there.
Hit it hard, hit it early. PSA 52 scans clear, prostatectomy, PSA climbed to 62 in 6 weeks. Lupron for a month PSA 6.5 scans showed mets in lymph nodes and bones. Chemo for 9 cycles. Added Xtandi after #5 as PSA rising again. Side effect put me down at cycle 9. 4 1/2 mo later I was an invalid on just Xtandi..excess toxicity was killing me. Cut dosage, got better . Cut again, got better yet. third cut and started to heal. Got back to work and pushed aPC into remission. Now planing to retire middle of next mo. at 68. PSA steady in 0.130 range. Xtandi now at 90 mg daily. (two pills for 3 days, 3 pills one day).
Best of luck to you. Concurrent treatment may be better then consecutive treatments, hard battle, but worked for me. .
I have read all the posts and you have some excellent input from the crew. That said, at some point, we have to let go and I am not suggesting quitting but with the reality that most on this site will die of PC or related issues, one has to look at quality of life as well as accept that there is no cure at present and some just do not want to keep battling-and this is ok in my view, as I have seen far too many suffer endlessly and needlessly.
When a persons says enough, that should be respected and not have the world keep him alive and in great pain.
I am trying to say that it is ok to stop, it is ok to say I have reached the end and to let go, and I hope that those watching us loved ones, can understand that for the pressure to linger on is many times due to the family not the patient's wants.
I understand your point of view. My Dad was just diagnosed last week having had no prior issues. His life went from nothing wrong to advanced cancer. Because of this, we are relatively new to treatments, side effects thereof, and quality of life versus quantity of life.
Luckily there is no pain and my Dad is willing and wanting to fight to prolong his life. I will continue to fight alongside him until he tells me no more. I love him enough to respect his decision.
To Here4Dad, Sounds like they want to hit it hard now... The best chance to knock it down initially..
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go for the chemo now....
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