How quickly should PSA drop after doc... - Advanced Prostate...

Advanced Prostate Cancer
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How quickly should PSA drop after docetaxel (chemo) ??

whatsinaname
whatsinaname

Its been 50 days since I had my first infusion of chemo (docetaxel, taxotere). I have had 3 infusions thus far. The side effects have been negligible. The dosage was 100 mg for the first two cycles and 120 mg for the third.

My PSA has dropped from 8.4 to 5.65 in this period of 50 days. Is this too slow ? What should be my plan of action now ?

Thanks in advance for any help.

46 Replies
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Down is good...There are no set rules..If / when it starts going up, you try something different...(Cabazitaxel)..

No hair loss yet?

Yes, some amount of hair loss happened after the first cycle of chemo, but stabilized amazingly thereafter. I look as if I have just had a haircut rather than had a serious loss of hair. So far, so good.

Thank you, Fairwind, much obliged.

My dad did not lose hair until treatment 6. Its also grown back already. His body hair some of which he never wanted like back hair never came back so theres your upshot as well. Lol good luck and may your treatment be harsh on the cancer cells but gentle on your mind and organs. Never give up, my friend!! Also my dads PSA did not go down immediately and some men drop to nadir, but I dont thibk thetes a hard and fast rule.

Thank you, Daddyishealing.

I have been doing a lot of net searching and I have found a few articles which categorically say that IF the PSA levels do not fall within the first 42 days of docetaxel infusion, chances are that they never really will. Also, the survival chances of such patients fall drastically.

Sooo, it appears, that I am screwed again. Eligard failed within 6 months. Now, it appears docetaxel may also fail.

No sweat, I will continue to live it up till the last. Planning a month long trip to France and Paris in the summer (after chemo is completely over, 12 cycles maybe).

Thanks again, Daddyishealing.

Whatsinaname is not healing :-(

My dads psa did fall from I believe 60s or 90s have to check charts to 4 but not until 6 sessions. So everyone truly is different.

This Paris trip..oh lala..have you been. I never have always been a dream. There is spiritual healing and actually some physical healing in travel and novelty. Keep me posted and I understand your discouragement but admire that attitude packed suitcase and memories left to make.

Warm thoughts,

Erica

"docetaxel may also fail." And it may not so what's the itinerary when it works champ?!!! Postcards from abroad. Well be waiting

Hi Erica,

Yes, I've been to Paris before in 1998 (20 years back), but just for 3 nights. Next year, if health permits, my wife and myself will be doing a 30 day tour of France (15 nights) and Paris(15 nights). We have already started the very enjoyable process of planning the trip. The airline, the hotels, the tours within Paris and France, the restaurants (French gourmet), the museums, etc, etc, etc, etc.

Sure, I'll keep you & others informed.

Thank you for everything, Erica.

mjbach
mjbach
in reply to whatsinaname

Planning is half the fun. I remember spending a month in Paris and the countryside of France. It was before life with pCa and we enjoyed it so much.

whatsinaname
whatsinaname
in reply to mjbach

Absolutely, mjbach :-)

Planning is indeed half the fun, maybe slightly more than half :-) I have thus far not been completely debilitated because of pc and have traveled overseas twice and domestically several times in the last 10 months since I was diagnosed with metastatic prostate cancer. Here, I consider myself to be very fortunate that I am not incontinent & the rest of the crap that pc patients go through.

Cheers, mjbach, chin up !!!

Good man. Accentuate the positive..

Whimpy-p
Whimpy-p
in reply to mjbach

Have you seen The Loire valley ? Wow. Vineyards, Chateaus, and the food... nice..

Bon Voyage..something of a dream..

Hopefully the riots and fires will have petered out my the time you go on your trip.

Paris: The city of lights.... but I don't think they mean lights by flames.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/13/2018 7:51 PM EST

The holiday is scheduled for August-September, 2019. I expect the riots will have petered out long before then. Lets see.

Thank you for your good wishes.

Cheers !!

Up and running ..

Whimpy-p
Whimpy-p
in reply to j-o-h-n

They are a little different from us over there . The French government fears its citizens. In protest...Land of protesters. And fine food..

I read also that Psa will "flare up" after beginning Docetaxel. Mine went from 12 to 36 in maybe 3 weeks, and article I read said that if flare was x 4, or 400%, chances are that survival time is not very long, but if no flare occurs, and Psa nose dives then there's a better chance of longer survival time. Best mean extra time is 20 months. Just as many get more than that as get less than that. But one friend had Psa go from 40 to 2 in 3 months, then right back up in 5 months.

One smart local GP doc said my chemo was not working after 2 chemo shots. Well, not yet it wasn't. So I had another 3 shots, but Psa stayed high and reached 45, and that's when my onco doc referred me to Lu177. He does this with a number of patients, if they want it, and if they can pay for it.

My Pca may have many mutations because its now been going since 2004 ( estimated ). So whatver Docetaxel could kill, it maybe did kill, but maybe many survivors laughed at the chemo sent in to kill it. Same could happen with Lu177, some Pca cells will die, others will not be killed and as time goes by there is nothing that can kill whatever is left. I was told the chemo and the Lu177 might make my Pca sensitive to ADT. But I am having continuing Lucrin injects. But Pca may become sensitive again to Zytiga, the abiraterone blocker drug that interferes with adrenal gland production of testosterone and the tumour production of di-hydro-testosterone. Nobody can really know what might happen in future, and afaik, there is no easy blood test to guide docs on Zytiga or Xtandi following failed chemo or Lu177.

People thinking of France? yeah, but first, can you book me into the Acme Time Machine company to get me back to 1975, a one way trip would be fine, and to France, and with a bit of dough to buy a bicycle, rent a flat, get a job, and find a nice willing sheila to teach me how to speak French, and enjoy my evenings. I'd miss Australia of course, but there's nothing like a challenge :-)

Enjoy while ya can,

Patrick Turner.

Oui, oui, 1975 ...

Don’t hinge your future on that . You can do better.. Don’t sell the farm yet..Are you able to exercise? Travel by all means. The French do not mess around with food or wine ... I can’t ever regret the time I took a Michelin guide and ate at the highest stars I could get into . Which was a memorable culinary dream ... Pray that things continue to go down and stay away.. don’t self predict bad. Either way . Hit the road running and don’t look back. Stay well and heal..I m the king of telling my self that I’m screwed.. say it enough to yourself and you definitely will be. Like the little engine that could.. “I think I can , I think I can.” Realism and being brutally honest with yourself or others has always failed me..

mjbach
mjbach
in reply to Whimpy-p

I did not enjoy the fancy French eateries filled with poodles and cigar smoke. I love Vietnamese food so sought out the numerous Asian restaurants and there Chinatown while in Paris.

whatsinaname
whatsinaname
in reply to mjbach

mjbach,

Things have changed quite a bit as regards smoking. Yes, people in Paris, France still do smoke a lot but unlike 2 decades back, the drop in consumption is huge.

Vietnamese and Chinese food is fine but I am going to concentrate on gourmet French food :-)

Cheers.

mjbach
mjbach
in reply to whatsinaname

I liked how they dated their individual eggs. We found some gourmet level frozen food stores that were bustling with people after work. I don't recall the name but they seemed to be all around Paris and we had some good experiences doing as the locals and bringing them back to cook in the apartment. They were way above the frozen foods in the US stores.

Now you’re talking... go all out for the fromage...

Whimpy-p
Whimpy-p
in reply to mjbach

That s awesome. I’d never thought of Chinese in Paris. I bet it’s great also..

Chinatown's are everywhere these days, Lulu700. Besides, a lot of Vietnamese have settled in Paris and opened their own restaurants, which often do both Vietnamese as well as Chinese.

I’m a fan of all foods...In Frace travel with the Michelin guide and hit the highest stars that you can get into. Costly oui oui, but If you can afford it , you’ll never regret it or forget it. L A has a 5star Chinese scene that is world class and Orange County rules on Vietnamese cuisine . Thailand is my foodie dream...

Whimpy-p
Whimpy-p
in reply to Fairwind

I agree . Down is good.

Not everyone is the same. Mine dropped to 0.1 after 10 cycles but then 7 months later I got an MSCC and was worse off. Are you having ADT?

PSA can become an obsession Its the Gleason grade that concerns me. PSA can be managed up to say a range of 1-8 and concerns start above 10 IMO. So under 10 low gleason then other treatments can help.

Cabazitaxel isnt as strong so thats for later.

Thats my experience anyway

Yes, I have been on Eligard for the last 9 months. Just yesterday, I had my third Eligard 45 mg injection. The first was Eligard 22.5 mg (3 months) on the 12th of March, the second was Eligard 45 mg (6months) on the 12th of June.

My Gleason score was 8 (4+4), 16 core biopsy, cancer found in 14 out of 16 cores, occupying 5% to 80% of each core. Cancer had spread to the L4 vertebrae and was declared metastatic, with a possibility of it being oligometastatic.

However, the PSA doubled and the latest PSMA PET scan done on the 12th of October showed that the mets had spread to the skull, neck, collar bone, lungs, ribs, thighs (both), spine, buttocks. Nice. Not much pain though, if at all. Was then started on Chemo.

My PSA score has never gone above 16.51 approx. Last reading 5.65.

Thank you for responding, paulparry. For sure, we are all different. Cheers !!

WOW 😮

I'm 71. Diagnosed 2009, Gleason 9+9. I had ADT for a long time. This year after ADT failed I had 5 chemo cycles, each 3 weeks, so 105 days or just over 3 months.

Psa went from 12 before to 36, 27, 26, 40, 45, 36, 25 during 105 days and I'd been told by doc it may not work at all, and the expectation is always that Psa is lower after time than it was before beginning a treatment. I have slow growing Pca, and chemo Docetaxdel is supposed to kill fast dividing cells, and I said to my doc, if that's the case, then it may not kill much Pca because it divides slowly, and he said it grows slowly, but cells divide quickly, and the more he said the more it looked like he knew very little, and after all, he is not an expert in cell biology; his function is to dole out the drugs under a well known protocol that is used for everyone. Basically, when you come to chemo after supression of ADT fails, chemo is a compete gamble; I have no idea what % of Pca patients have lower Pca show less Pca lesions on scans.

After my first 3 chemo shots it looked like it was not working, but was told I must give it time to work. I was skeptical, Psa did not reduce. After two more chemo Psa was still high. Doc referred me to Lu177, and 5 weeks after first Lu177 shot I feel good but Psa has not reduced, it was 26 before, is now 25.

I signed up for 4 x Lu177 shots and 4 x 6 week cycles are 24 weeks or nearly 6 months, and Lu177 takes time to work, especially on bone mets. If my Psa may still be high. But doc says the relationship of Psa to amount of Pca becomes blurred when treatment it for bone mets and Psa is generated as Pca cells are killed, so the Lu177 is still regarded as experimental, and there is no Medicare funding for it yet. But trials show 70% of men get a mean extension of life of 14 months. Its very easy to be in the 30% who don't benefit.

But I know a man who had RP 3 years ago, Pca continued on, he had EBRT, Pca continued, ADT gave only 3 months, then many mets showed up, then Cosadex boosted Psa rise, Zytiga and Xtandi seemed to do little, so chemo was tried and after 10 cycles Psa rose fast, so he had DNA of cancer cells analysed and last I heard he be was on chemo drugs for ovarian cancer; everthing had become experimental. One sister of mine died of Oa, another got Bca, but she has survived treatment and seems OK at 74. My fiather's mother died from Oa, and I probably carry the genetic mutations for Bca and Oa and maybe these made me prone to Pca. My dad died at 60 from melanoma but my mum died at 98 from old age, and never getting cancer or a chronic condition. I have no idea how long I'll live, and it sure cannot be forever.

Patrick Turner.

I figure you'll take after your MUM.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/13/2018 7:54 PM EST

My heart says it would like the rest of my body and mind to live on like my mum, but my mind says I won't make it to 98.

The fact is, compared to millions of others with far worse medical problems, I am doing OK for an old man. When a young man tries so hard to overtake me on his bicycle, I ask "what took you so long ?".

There are at least two essential elements for a happy life, A Sense of Humour, and Wonderment.

Patrick Turner.

I'm on your team mate! Keep on pumping...and may all your hills be downhill...

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/13/2018 11:14 PM EST

Thank you, Patrick-Turner for taking the time and trouble to explain things so clearly.

Hope you live a relatively happy life. Longevity is a highly over-rated goal, imho.

Thanks again and all the very best.

Longevity without health and full of pain can make anyone feel negative, and think life is overated. At present I'm OK, but there may be a time when I hope the Fentanyl works.

Meanwhile, I find there is more abundant good will in my world than there is bad will. And when I am on my bike, drivers mostly respect my presence, and every time a driver stops to let me ride across a pedestrian crossing marked with wide white lines on road, I salute the drivers; I thank the world that I am in it.

Patrick Turner.

Me too Patrick ...on all accounts. ✌️

Tragic family history of cancer. How about forever and a day?

Well, living forever would be OK with me, but there is a bad part to adding a day because after youse have come to end of forever, you find the added day is spent having a little chat with Aunty Destiny, and she is a truly horrid bitch, make no mistake. She puts before you a list of all your sins, and of your perpetual procrastinations and asks "Listen carefully, I want acceptable explanations by midnight, or you get sent to another planet where the fleas

of a thousand camels will make you itch, while you will find your arms grow too short to scratch, or to reach out for yet more amd more stuff, including extended holidays with fancy french sheilas."

So afaik, the added day is one for the reckoning.

Anyway, shielas the world over do have fundamental simularities.

What's the least said sentence in any language in the world?

" jus' youse lie down 'ere luvvy, it won't cost yer anyfink "

Methinks there'd be nothing sadder than trudging about in France in my present condition and not being able to realise so many experiences.

But I found an exception where the above sentence seemed to have been said, because I got its meaning. I arrived at the chemo ward at a hospital each 3 weeks, was given a recliner chair to lounge in, and what the dear nurses did didn't cost a cent because Unkel Medicare paid for the lot.

But a nurse did say, "Patrick, if you ain't got a sense of humour, GET OUT"

I replied with "No chance, me whole life 'as been a bit ov a joke, and now I am stuck with youse for a cuppla hours, ya darlin ting :-) "

So maybe as well as wonderment and a smile, we need to sprinkle some love over the mix...... easier said than done.

Patrick Turner.

He yah Patrick!

He He, Ho, Ho, Lulu. Santa is nearly here, and I asked him for a lower Psa. Patrick Turner.

He already showed up here. Gave us a lump of coal. I’m on the naughty list it seams. Take care strong man! 🚴‍♂️ Ride on!

I can’t recall the link or the article off hand, but there are numerous articles that indicate a longer time to PSA nadir (the lowest reading you achieve) is a better predictor of long term survival. The patients in the trials who took 7 months or longer to get that low faired better. So stay optimistic even if it doesn’t come down quick and drastic as you might’ve hoped.

Pray for the best and long life for you!

Thank you, Evans71720. Good advice indeed. I'll wait patiently as long as the PSA levels don't go up drastically. Then something (I have a few ideas) has to be done and quickly.

Thank you again, Evans71720 for your good wishes for a long life. Personally, I'd take another high quality 3/5 years over say 10/15 years of life with repeated doctors/hospital visits and multiple treatments. But, we don't get to choose, do we ?? :-)

I am reading a very interesting book titled "Everything Happens for a Reason" by Kate Bowler. Superbly written. Very touching.

For the record, I put "knowledge" above "prayer" any day, any time. To each their own, however. Whatever works :-)

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