Update on my dad-PSA not budging on Taxotere

Update on my dad.........just got labs back before getting his 3rd round of Taxotere. His Alkaline Phosphotase went from 1250 to 600!!! I was so happy about that but his PSA went from 20 to 21. His PSA was 20 before he started chemo. It’s not budging. Is this bad? Isn’t it a really good indication that the Alk Phos went down so much? I’m a little confused. I would expect the PSA to decrease if the Alk Phos made such an improvement. Any insight is appreciated!

[Hidden]

This makes me really worried. I sure hope it hasn’t evolved to Neuroendocrine Prostate Cancer. He started on the BIRM 7x concentrate about 10 days ago. I pray it helps. I was hoping since his alkaline phosphotase declined so much in 3wks going from 1250 to 600 that the PSA was just a little slower to catch up.

[Tall_Allen in reply to Hidden]

Neuroendocrine is an uncommon occurrence -- 17% of heavily-treated men with metastases develop neuroendocrine disease of the mixed type. Even if it's mixed, the normal therapies can hold it back. If his bone mets showed up on a bone scan and confirmed as overgrown by CT, you need not worry.

[Dan59 in reply to Tall_Allen]

I thought small cell made up 2% of all PC.

[Tall_Allen in reply to Dan59]

That's correct for all PC. Researchers at UCSF recently found that the number goes up to 17% for heavily pre-treated men. For 1 in 6 men, it is part of the evolution of their cancer.

[Hidden in reply to Tall_Allen]

What does confirmed as overgrown mean Tall_Allen?

[Tall_Allen in reply to Hidden]

There are 2 types of bone mets - lytic or blastic (or a combination of the two). "Lytic" means that the bone is eaten away by the cancer. It is characteristic of neuroendocrine cancers and many other kinds of cancer (e.g., many lung cancers). "Blastic" means that the cancer causes the bone to get overgrown. It is characteristic of normal acinar prostate cancer and most breast cancer. Whether the bone is eaten away or overgrown can be detected on a CT. Certain biomarkers and other imaging, like bone alkaline phosphatase, bone scans and sodium fluoride PET scans also only detect bone overgrowth.

[Hidden]

Isn’t that a particularly lethal type of prostate cancer? If it turns out that it is can he have the Lu-177 or other treatments? Or is it too late for anything once the cancer becomes that type?

[Tall_Allen in reply to Hidden]

Take it as it comes, otherwise you'll drive yourself crazy.

[Dan59]

How long did it take for alk phos to go from 1250 to 600? Stable is always good. Do not worry about small cell before you get results of chromagranin a lab.Lets hope the alk phos comes down a lot more in next few cycles

[Hidden in reply to Dan59]

It came down from 1250 to 600 in 3wks. Between 2nd and start of 3rd chemo infusion. But PSA started at 20 and was 21 today before 3rd infusion. I am so confused. I thought this was good??

[Dan59 in reply to Hidden]

IMO alk phos dropping 650 in 3 weeks is remarkable, and a fantastic response, the psa going from 20 to 21 in same time is insignificant and basically stable, stable is always good, and we hope for the alk p to have another significant drop along with psa remaining stable or preferably dropping,but stable is always good.

[Hidden in reply to Dan59]

Thank you Dan59. I’m a bit confused because I feel like after posting this it wasn’t a positive thing due to the many comments that seemed concerning to me.

[Sgtan]

20 to 21 is within testing error so it's basically unchanged as regards PSA level

[Ldb01]

On Taxotere my hubby’s PSA dropped alot. Suddenly it rose from 11 to 16 then 20. They stopped the chemo. Suggested we find another doctor. He has now completed 2 cycles of Jevtana and PSA is at 29 ! The dr who was standing in, told us to stop the JEVTANA and consider Xtandi. Our dr is back on Monday so we are waiting for him to confirm. Hubby has bone mets. The liver enzyme was also higher. So we hit a panic yesterday but nothing we can do until we see the Oncologist again.

[Hidden in reply to Ldb01]

I’m so sorry the chemo didn’t work for him. My dad did very well on Zytiga but Xtandi didn’t work. He had Lupron and Zytiga first then Xtandi and now on chemo.

[Shooter1]

When my PSA stopped dropping and rose between cycles 4 and 5, added Xtandi to mix and PSA started dropping 25% per cycle again..... After ending Taxotere, the Xtandi 160 mg dose proved to be to toxic for me. Made me an invalid all by it self/ Cut dose and got side effects under control.... Now on 100 mg dose daily. ( 2 pills one day, 3 the next) PSA still dropping 9 mo. after end of Taxotere.

[Hidden in reply to Shooter1]

I’m so happy you are doing well on Xtandi. Zytiga worked for a short time about 7 months for my dad then switched to Xtandi and didn’t work at all. PSA was doubling every 3wks and he had horrible side effects. Then started taxotere.

[Hidden]

I not sure what I can offer at this point other than The Texas Medical Center complex in Houston. The top three in my opinion is Memorial Hermann, Methodist Research Institute, and MD Anderson. All three have outstanding Medical Oncologists specializing in Genitourologic Cancers in an academia and research setting.

Case in point over the past 14 years I turned down employment promotions; one my dream job. Only because it would take me away from treatment in Houston. Academia and research facilities have greater flexibilities than standard of care protocols in the treatment of metastatic PCa. It may help; it may not. However, it is certainly worthy of an inquiry.

Gourd Dancer

[Hidden in reply to Hidden]

So in your opinion the Taxotere is failing? His alkaline Phos went from 1250 to 600 in 3wks and his PSA went from. 20 to 21. I though the rapid decline in Alk Phos was a very good sign so I’m confused by many of these posts.

[Hidden]

No not at all. I would continue with Taxotere. I took Taxotere along with another infusion drug, Adriamycin; alternated every week for six weeks. Then. Two week break, and then repeated for two more cycles lasting a total of six months, but my circumstances were different in that I started this chemo regime under trial and very early on after the appearances of metestates disease. I also took Ketoconzale and Erustamine alternated and paired with an infusion drug. Plus 30 mg of Prednisone daily for 180 days.

However, this was only available through a research and academic trial and not standard of care through countess Medical Oncologists across the Nation. I have posted the protocol and early results based on several papers here and other groups. It’s not 100% effective for all, but it worked for me and several others. Because of my experiences, I recommend a research and academia as a possible solution. You will find this type of program associated with medical schools associated with major facilities. In my case, the Texas Medical Center complex. There are others around the Country. OKC is about a seven hour drive from Houston.

Research the faculty of medical schools looking for Doctors with a speciality of Prostate Cancer research is an alternative. This is my global suggestion. My understanding is chemotherapy is the best way to kill systemic disease leading to longevity and or cure.

I am only writing to you about what treatment option I was given after posing this question to both of my Radiation Oncologists in 2004. “Doc, if you were in my shoes with the onset of metastatic PCa disease, what would you do?” The follow up question, “Do you know one?”

I wish the best in fighting this terrible disease.

Gourd Dancer

[Patrick-Turner]

All us men may have a different response to Doctaxel. I am 71. I just had 5 cycles over 15 weeks and Psa went from 12 to 26, 27, 36, 45, 35 and alk phos went up a bit.

My oncologist said my chemo response was a failure, and he referred me to another doc who specializes in nuclear radiation and I had my first dose of Lutetium177 last thursday, one month after the last dose of Docetaxel. I have countless bone mets. I won't know if the Lu177 is doing anything good until blood tests are done in about a month.

So you and your doc need to know when its time to quit Docetaxel and try something else, and my hospital offers Cabazitaxel, Carboplatin, and one other chemo drug I don't know about. These drugs can cause long lasting horrid side effects, and each time you hop from one chemo drug to the next, the side effects get worse.

My doc told me in 2013 that there was no cure for my Pca. I was diagnosed in late 2009. Surgery had been abandoned in 2010 after cutting me open because cancer had come out of capsule and covered nerves which could not be severed.

Psa at diagnosis was just over 5.0, and I had "high risk" Gleason 9, with 9 / 9 positive biopsy samples. I had ADT, then EBRT, but it has been impossible to keep Pca permanently suppressed by ADT, Cosadex or Zytiga. I have a long expensive fight ahead of me. I cycled 20km today, swam a bit, talked to friends at cafe for lunch, and it is a nice day.

Patrick Turner.

[RICH22]

saw elsewhere you asked about thalidomide - i was on lenalidomide, which is probably the same or very close drug. was taking it for MDS bone marrow cancer. it worked beautifully, to raise my HGB but not my RBC... but still alleviated the anemia i was suffering from. then i developed a body-wide rash which itched like crazy. stopped til the rash was mostly gone, then began taking it again, but rash returned in force. stopped it almost a month ago, still have itch all over but hardly any rash. praying the itch goes away. hope this is helpful info.