Just had an appt at the Marsden with my dad. (Diagnosed Sept 2014 with adenocarcinoma of the prostate Gleason 9). He has had first line hormone therapy, 10 sessions of docetaxel, and enzalutamide for 2 years. In January he had a procedure to remove some of the prostate tumour that was pushing in to the bladder making it difficult to urinate).
Today we had an appointment with his oncologist who said the biopsy shows neuroendocrine differentiation and they are doing a blood test for small cell. At the moment they are treating it as adenocarcinoma with neuroendocrine differentiation. They are going to do a baseline CT scan and then start docetaxel again.
In reality what does this all mean for my dad and his prognosis? What other options are there if docetaxel fails?
I have been dreading the day that we got this diagnosis. I know the neuroendocrine is the worst
Thanks
Siobhan
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Ssiddy
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I think the small cell Prostate Cancer is the worst. Dr. Eugene Kwon (Mayo Clinic) refers to prostate cancer cells, with apologies to Clint Eastwood, as the Good, the Bad, and the Ugly. Adenocarcinoma PCa cells are the Good because they emit PSA and have PSMA on their surface. Neuroendocrine PCa cells are the Bad and small cell PCa cells are the Ugly because they are difficult to treat and difficult to see.
Hope that helps. Good luck!
Sorry to hear about this diagnosis. PCa can evolve in many ways as a result of successful treatment. In about 20-25% of cases there is a devleopment of neuroendocrine cancer cells. Unfortunately, they lack the androgen receptors so they are not vunerable to reduction in male hormones. So many of these cases go undiagnosed, so it's good that they were able to find it.
Chemotherapy is the right approach for this cancer. Docetaxel, either with or without a platinum-based chemotherapy such as Carboplation is generally prescribed. Some doctors will prescribe them together and some sequentially. Something to discuss with his doctor. Wishing him the best.
About 17% of men with advanced PC have this kind of mixed type. It is usually treated with a mixture of therapies - like docetaxel with carboplatin. Here's an article discussing some options:
After the appointment, the oncologist called back and said that she wasn't sure he was suitable for docetaxel based on the fact that his peripheral neuropathy was still lingering. She would rather he went on cabazitaxel.
We have another appointment tomorrow to go through the paperwork for this. However, before the appointment, I would like to ask your opinion and to find out what questions I should be asking i.e. will we get the same result from cabazitaxel, is this the best drug to consider next or can we do anything privately, can we still use docetaxel at a later date? Will he be on chemo for the rest of his life?
Thank you for the link to the blog. Very interesting and gives some hope. Please God he doesn't actually have small cell though.
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