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[Kentucky1]

Newly diagnosed in March as Stage 4, T4,N+ (suspected), M1a. I have multiple metastasis to the pelvis and ribs. I have started Lupron and need to make the decision on the next step of additional therapy. MO wants to do docetaxel. I am very risk averse and from what I gather from the STAMPEDE trial data, Zytiga appears to be equally effective. MO says she "likes" docetaxel because it's a shorter duration of therapy. She seems unconcerned about any side effects. I also have longstanding MS and after 19 years it has moved to the progressive phase. Educated as a pharmacist, with over 30 years of community and clinical experience. My gut says to go with the Zytiga. Any insight from you guys would be greatly appreciated.

[GP24]

The choice is yours. This study reports that the results are the same for these treatments:

ncbi.nlm.nih.gov/pmc/articl...

Conclusions:

This direct, randomised comparative analysis of two new treatment standards for hormone-naïve prostate cancer showed no evidence of a difference in overall or prostate cancer-specific survival, nor in other important outcomes such as symptomatic skeletal events. Worst toxicity grade over entire time on trial was similar but comprised different toxicities in line with the known properties of the drugs.

[Scorpio99 in reply to GP24]

I can only respond here by saying that I started my prostate cancer treatment with a PSA of 21 (anything at 4 or above is considered potentially a "serious problem"), which my biopsy confirmed was the result of prostate cancer. After I had my prostate removed my score was still 4.2, meaning the cancer cells had spread beyond it. After 2 years of Lupron injections and 38 radiation treatments, which need to be done together for the desired results, my PSA score is now .01 and I've been declared "cancer free". I hope my story might those who read it. Good luck.

[Hidden]

Welcome Kentucky 1, My dx was like yours except 4 yrs almost exactly. Except I didn’t have the rib involvement .. Mt treatment was double adt and RT. Worked well so far . No visible signs for 31/2 yrs now . I’m tested tri monthly for life.. Psa undetectable .. I don’t have your medical background . I have however read these pages for over two years. I think you’ll receive well informed advice . If it were I, I would go with the chemo first to knock it out .... Personally I’d take the drs advice. Being a pharmacist you know more than I . Typical for the Dr not to be concerned with side effects . They are immune to the suffering. Some guys have had a not too bad time with chemo and it has worked well for many. I am interested to see others reply’s . As a pharmacist do you believe in any natural or alternative remedies or nutrients . ? I do . I ve done a lot thru my naturalpathic Dr. ... Peace in Kentucky .

[Kentucky1 in reply to Hidden]

I have an appointment with a naturopath later this week. He is also a practitioner of traditional chinese medicine. Mainly going to him for acupuncture therapy to help with pain issues. My years spent in the pharmacy world have shown me there is more than one way to skin a cat. I plan on attacking this setback from as many angles as possible. I have also joined COC program which is using a 4 drug protocol ( metformin, atorvastatin, doxycycline, and mebendazole ) to disrupt the metabolic pattern of the cancer cells.

[Hidden in reply to Kentucky1]

Glad to have you aboard this leaky ship . I like that “ There is more than one way to skin a cat”. Western med is limited .. the COC program is promising . Keep active and live well . Take care , Scott 🌵

[pjoshea13]

You should check out the CHAARTED study. The benefit of early Docetaxel (added to ADT, versus ADT only) was only seen in "high-volume disease". You have multiple mets, but here is the CHAARTED definition of high-volume:

"visceral metastases and/or ≥4 bone metastases with at least one metastasis beyond the pelvis or vertebral column."

"The clinical benefit from chemohormonal therapy in prolonging OS was confirmed for patients with high-volume disease; however, for patients with low-volume disease, no OS benefit was discerned."

ascopubs.org/doi/full/10.12...

-Patrick

[BarronS]

It seems there is more pedigree and research indicating the benefits of early use of docetaxel. I'm not a doctor, but the way I look at it, is when you use docetaxel you also kill the cancer cells that might not be susceptible to hormone therapy.

The earlier the better.

[softwaremom00]

My husband survived his chemo. He had Taxotere and Carboplatin. His neuropathy from the chemo causes him pain a lot of the time. One of the problems with chemo is that it also kills the good cells. I am happy my sweetie is alive.. he had/has a very aggressive form of prostate cancer.. neuroendocrine … and we needed a Nuclear Warhead to kill his cancer and that is what we got. I am not sure which of the chemo drugs caused the neuropathy.

Currently he is still on Zytiga.. he has been weaning off the prednisone. I think it tolerates it ok but he is tired a lot.

Which ever treatment you pick, try to eat healthy. Lots of fruit and vegetables. Try to relax more, have more fun, and spend time with people you love!

Hugs,prayers and love!

Softwaremom

[Hidden in reply to softwaremom00]

Good advice. Nice to here from you softwaremom00.

[tango65]

There is not difference in outcome between docetaxel and abiraterone +prednisone treatments in your situation.

ncbi.nlm.nih.gov/pubmed/295...

If you have MS you should consult with a neurologist since chemo with docetaxel could cause neuropathy which could affect small andl arge fibers.

ncbi.nlm.nih.gov/pmc/articl...

[Kentucky1 in reply to tango65]

Another reason I'm not leaning towards chemo. Many years ago my neuro suggested that Novantrone( mitoxantrone) would be the best for me when I was just a few years into my MS journey. I declined at that time and history has shown that was a good choice. Novantrone never got traction in MS therapy and thankfully equally effective and less toxic medications came along shortly thereafter. I know that's comparing apples to oranges, but I still can't quite embrace the basis of chemotherapy, i.e. let's kill the cancer cells and hope we don't kill the host in the process. It's a hard decision.

[tango65 in reply to Kentucky1]

I have a small fiber peripheral neuropathy and the neuologists I have consulted told me not to have chemo with taxanes So talk with your neurologist, since taxanes can affect small and large fibers.

[kenner in reply to Kentucky1]

Chemo is a game of Russian Roulet.

[NPfisherman]

Welcome Kentucky1....to the forum that no one wanted to be a part of but all are treated as brothers....read your info.. some feel that if A+B is good, then A+B+C is better....I would chose A+B+C+D in your case....ADT +docetaxol initially, then put on abiraterone and consider enrolling in this trial for stereotactic radiation along the way to hit those mets really hard...:

cancer.gov/about-cancer/tre...

Many feel that it is better to hit it hard early before the cancer really takes off... I am of that philosophical bent, and I am guessing that you still have your prostate and maybe you should take a look at Hifu or something else to take out the "Mothership"--initial tumor site in prostate...

Best of luck in whatever you choose....

Don Pescado

[Costarica1961]

Welcome.

Its speaks volumes with your background your reluctant to go with chemo. I am on zytiga and lupron. One year. Its been good for me few side effects and PSA 0.007. Good luck.

[lincolnj8]

Welcome to the group Kentucky1. I was diagnosed with stage 4, 15 months ago. Mets in bones, lymph nodes and organs. Zytiga, prednisone and Lupron plus monthly zometa infusions for the bones is what my MO put me on the second month till now. Also Oscal twice a day also and a b-12 shot every visit. Took about 6 months to get the psa under 1. It was at 800. Holding steady so far. This is a great site for information and advice.

[larry_dammit]

Welcome fellow monster fighter. I was diagnosed August of 16. My doctor gave me the choice of the pills or Chemo. I went with 6 rounds of Taxotere with lupron and Xgeva shots monthly. PSA has been <0.05 for the last 32 months. Oh. I have been on Xtandi since finishing the chemo. Good luck with the monster 🙏🙏🙏🙏

[leo2634]

I've been on Zytiga for 13 months now and very little in side effects. I also received Eligard injection every six months and Xgeva monthly for bone Mets. It has been my Doctors choice from the very beginning as first line of treatments. My PSA has been at 0.1 since first month. It's definitely a life style changer but the key word there is " Life" . Leo

[Magnus1964]

My wife has MS so I know how careful you have to be. I would do all the research I could on the affects of chemotherapy on MS and be prepared to ask the hard questions. Doctors sometimes are short sighted and only concentrate on their field.

[Hidden]

Hi Kentucky1 and welcome. I really struggled with the chemo/zytiga decision. Ultimately I went with chemo, but after only one infusion I switched doctors and switched to zytiga. Two different doctors, two different philosophies. I guess we all wish the right choice was more straightforward. Good luck with your decision.

[jrodrig]

Hello, Kentucky1

I was diagnosed 3 years ago as stage 4, with some mets. I was put on CHARTEED trial, so with Lupron + docetaxel (6 dosis). As my immuno system was attacked by docetaxel I had some issues at the 2 fists sessions. Then my doctor decided to give me shot after each session of some medicine (I don't remember the name) that increased my immuno system very quick I didn't have any more issues.

From the treatment my levels of PSA are very low (0.02) and I hope to be there many years.

[Kevinski65]

If you could go on Xtandi you could avoid the steroid. Steroids cause osteoporosis, among other things. Many men do go on zytiga...

[j-o-h-n]

Greetings Kentucky1,

The only thing I can add is "IT WILL BE READY IN 30 MINUTES"....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 04/16/2019 5:51 PM DST

[Walkingwell]

Everyone is different. The research is on big groups and leaves a lot of questions for the individual. I went for Lupron injection + bicalutamide/Casodex tablets + docetaxel because a couple of big research results gave positive results. BUT - I reacted so badly to first docetaxel (damage to liver/kidney, white blood cell count 1,200, sickness, rashes, etc) that doctor would not continue. Side effects not worth damage - in my case. Everyone is different but 'my gut says' may be very important. Whatever you choose, best wishes. BTW - Stage 4 Gleason 9 mets to bones including spine, age 56 at diagnosis.

[Tall_Allen]

I'm with your MO. Although the side effects of Zytiga and docetaxel are different in kind, they are similar in degree among newly diagnosed men. This is discussed in this article:

pcnrv.blogspot.com/2017/06/...

I also agree with her that the shorter duration means you can get to both docetaxel and Zytiga quicker than if you start with Zytiga.

Your "gut" is probably reacting to the bad rep that chemo gets when used late and in other kinds of cancers.