Today I take my father to his oncologist to discuss treatment options. He is already on Casodex and Lupron from his urologist and the oncologist mentioned chemo treatments but have yet to solidify official treatment plan.
I have created a few beginner questions to go over with oncologist but also wanted to post here in the event any of you can share personal insight.
1) Why has radiation not been discussed? Is it because the cancer has already metastasized. If so, would radiation eventually be an option to alleviate pain?
2) Can he take Metformin with ADT and Chemo or is it only beneficial with ADT only?
3) Is Xofigo only available when cancer stops responding to hormone therapy and becomes castrate resistant?
4) At what point should we try Provenge?
5) Are there significant differences between Zytiga with Prednisone versus Casodex and Lupron?
6) Does fasting before chemo help prevent side effects and what are the effects of chemo on a person who is anemic prior to treatment?
7) Is no pain with multiple bone meets a good sign?
8) Recommendations for diet and exercise?
I also want to know oncologist's general attitude towards trial treatments or unconventional treatment options.
If you guys have anything to add please feel free to share! All these questions are based upon things I've read through other's experiences through this site.
Thank you in advance 🙏
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Here4Dad
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With a starting PSA of 480 with a Gleason score of 9, bone mets on his right hip, rib and T12 vertabrae, and complications of things blocked by enlarged lymph nodes and prostate, the oncologist is probably going to go for "systemic" treatment, instead of radiation to some place or another which will likely only create more trauma instead of a realistic path to cure or longer survival. Some spot radiation might help at some time in the future if a painful bone met starts acting up.
Several men here take Metformin along with all types of concurrent treatments.
Considerations of timing and sequencing of Provenge are discussed here. It may vary by individual and treatment team. Many say earlier is better, and also starting with a lower disease burden is better, too.
When discussing Zytiga, you might want to check-out the level of familiarity with the results of the LATITUDE and STAMPEDE Clinical Trial Results from a little while back.
Blood levels are checked closely both before and during chemo treatments. See the Full Prescribing Information for "the numbers", and any dosage adjustments during treatment.
No pain from bone mets is always a good sign. Many men with multiple bone mets have reported most if not all of the pain from bone mets receding as initial ADT settles things down. With confirmed bone mets, one might also inquire about one or the other of the protective bone agents Zometa (zoledronic acid) or Xgeva (denosumab).
Diet: For starters, "Eat food, not too much, mostly plants."
Exercise: Do it. Put some resistance / endurance in it too, within reason & safety.
I'd also ask the oncologist which advanced prostate cancer expert he/she will refer you to if/when you may desire a second opinion about any treatment decision or the full range of options. The more advanced centers are typically the ones who offer the most in terms of clinical trials, too.
Thank you so much for taking the time to reply. You are amazing and provided a plethora of useful info.
Thanks from both my Father and I!
My suggestion. Hit the bastard with systemic treatment immediately. Rely on the “silver bullets” later. Everybody is different, but it is what I did over 14 years ago and have not looked back since.
I agree with your line of reasoning as well. He is currently self pay so docetaxel is more affordable than zytiga out of pocket. Consequently, we are going to start with docetaxel and check out zytiga once he is on a long term insurance plan.
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