I am looking for information on heavy volume vs low volume advanced pc. My husband was diagnosed with gleason 8, psa 112, in lymph nodes and bones. We thought in bones in3 places based on what doctor said. Not told how many lymph nodes or of any other metastasis. Doctor said our choice to add either zytiga or docetaxal to the ADT in the next few weeks. The only preference she expressed was that the docetaxal was a shorter duration; however she said side effects might be more intense and not necessarily of a shorter duration. She did not seem all that hopeful to us (His psa levels were 31 after a month on Firmagon where they started at 112). So we went home and started reading as much as we could to make a decision. In researching we came across an article that suggests low volume does not respond that well to docetaxal. When we asked the doctor whether he was low or high volume, we were told he is high volume. The outcomes did not look so great for that when I was reading to try to choose which course to go. Maybe it really doesn't matter which one he takes, but maybe it does and I would appreciate any help.
Newly diagnosed zytiga or docetaxal? - Advanced Prostate...
Newly diagnosed zytiga or docetaxal?
Need a little more information. Age, other health problems, general health, etc.
He is just turned 56. He is generally healthy with blood pressure that runs a little (not a lot high) but he takes medicine for it and it has been controlled. He is not overweight and is generally active, not a super athlete; but since the diagnosis he has been exercising at least an hour a day.
Have any of his doctors mentioned radiation therapy? I am not sure about jumping into chemotherapy at this point. Give the ADT therapy a chance then go for RT.
With high volume mets, Docetaxel is generally preferred. One benefit is that chemotherapy kills cancer cells regardless of whether they are sensitive to hormones or not.
It is a shorter duration. You can be on Zytiga for years whereas chemotherapy is only 18 weeks. The side effects are tolerable for most. I went through it and it wasn't that difficult. In fact, I plan on doing again if it will help. I was very active during my chemotherapy treatments. The first week after infusion was a bit difficult and I did spend a lot of time just doing light chores around the house and in a chair quite a bit of the time. But I was never bed ridden, never once threw up and still had a good appetite. I also was noticing my pain was going down and I was feeling better after each cycle.
Good luck with treatments, please keep us posted on what he does and how things are going.
Hi Leaf,
I struggled with this decision - I'm sure most other members did as well. I was freaking out and desperate to get underway with treatment. I initially went with chemo as my doctor wanted to do as gregg57 suggested and hit my "bulky" mets hard. After one infusion I switched doctors and my new MO suggested zytiga. I like to think that I unwittingly made a good choice, but who knows? Best of luck with your decision - wish I could help. Your stress level will start to go way down after you select a course and he starts responding to treatment. He will be able to relax again.
Than you for taking time to respond. Here’s to hoping we can relax eventually 😃
What you are doing now is arranging your treatment to extend your survival as long as possible...Zytiga, now available as a generic, works quickly if it's going to work at all. It's side-effect load is usually very tolerable. When it works well, it can give you 2 good years or more..The chemo (Dosetaxel) on the other hand can have some heavy side-effects, total hair loss, Nuropathy, which can be nasty...For me Dosazitaxel, Jevtana, worked better with fewer side-effects. No Nuropathy or hair loss. But you will need to take Neulasta (pegfilgrastim) to boost WBC and avoid infections..The side effects of that are just as bad as the Dose.....You might look into Radium 223 as an alternative treatment. See if get in to see a Radiation Oncologist and get their treatment viewpoint. MO's and RO's seldom see eye to eye...But you should talk to both..
Keep in mind, Docetaxel and Zytiga are both good upfront treatments that extend life for many people. It's important to remember that both have very similar benefit.
I think she is giving you good advice. Docetaxel, used early, has less side effects than if one waits. In fact, the degree of side effects is similar between Zytiga and docetaxel, although they differ in kind. I also agree that docetaxel is a briefer duration of treatment, so he can have both treatments in less time. And, by the time he finishes docetaxel, there may be two more hormonal agents approved for his situation. "High volume" is based on mets in visceral organs or more than 3 bone mets with at least 1 outside the pelvic area. Here are his options now:
pcnrv.blogspot.com/2017/06/...
Does spread to lymph nodes count as visceral metastasis?
Visceral means any organ other than lymph nodes. In CHAARTED, the trial that set the precedent for subsequent trials, "high-volume disease" was defined as presence of visceral metastases (stage M1c) and/or ≥ four bone metastases (stage M1b) with at least one outside of the vertebral column and pelvis. Pelvic lymph nodes are stage N1. Non-pelvic lymph nodes are stage M1a and are riskier. One can argue that the definition of high volume ought to include stage M1a, but they didn't ask me when they drew that line 
I don’t know what has happened to my posts but I want to say thank you for responding. I also found other posts on your blog to be helpful.
Did you come across this analysis from November?:
ejcancer.com/article/S0959-...
"In conclusion, our analyses showed that AA + P + ADT is at least as effective as DOC + ADT in reducing the risk of death in men with mHSPC, while it is associated with a reduced risk of disease progression and an improved QoL compared with DOC + ADT. Various supplementary analyses including the different populations from LATITUDE [2] resulted in largely consistent findings."
-Patrick
Whichever drug you choose, there's a fair chance that you'll be trying the other some time in the future - hopefully not for a long time but possibly in not too long. It may not be critical which one you try first. And if the first one causes a really bad reaction, you can try switching to the other.
I think it's a good idea to research the side effects of each one and be prepared to combat them. I would want my medical oncologist to be very conversant with the side effects and have ideas for how to prepare and how to avoid the worst of them. Some oncologists prescribe Neulasta to prevent infections due to immunosuppression from chemotherapy. Some use ice cubes in the mouth and ice packs, or baths, or frozen gloves and socks on hands and feet to prevent or reduce peripheral neuropathy. I would research these on the Internet and ask the doctor about them. If a doctor says he doesn't think they're necessary, propose trying them anyway - there are trials that show that they work.
There are anti-nausea drugs that work amazingly well. My primary care physician gave me some (usually used for chemo induced nausea) to take with me on a trip to China. After one particular meal there I went back to my hotel, got increasingly nauseous, and began throwing up. I took a single pill. The nausea and vomiting stopped almost immediately and I was able to go back to sleep. I'd want some in my pocket before I went home from a chemo infusion.
I know less about the side effects of Zytiga but, if that's what I was going to take, I'd want to research them and also be prepared.
We're lucky to have choices like these. Our parents' generation didn't have them and our children will have even better ones. Ain't medical science wonderful?
Best of luck.
Alan
Taking the six treatments of chemo is generally regarded as the better treatment for men that are younger and healthier to start with. I finished my treatments in March and never got sick or suffered neuropathy, thank fully. Never used ice gloves, but I did chew ice during the treatment. The anti nausea meds and prednisone helps a lot. I had a good appetite as well but we handle this crap differently. I didn’t care about losing my hair I wanted what was best for me. I was also on Lupron at the same time and I continue to be on it. I would do the chemo again if needed. I worked through the first three treatments and then took short term disability until April. My hairs back more gray and very soft. 😎 be brave have hope!
I am 67 years old and live in central Florida. I have been on Z+P+L for 10 months. I have mild hot flashes (not a big deal for me) and a total lack of sexual desire. The second is very important until you compare it to life n death. This year I have gone snow skiing in Montana and Colorado, scuba diving in the Cayman Islands, raced my ZO6 Corvette at Sebring, spent 10 days in the Abacos w a 23 foot open fisherman boat, played a bunch of golf, paddle board almost every day and am writing this in Rockport Maine where my wife n I are hiking and enjoying ourselves. My point is that the loss of sexual desire does not mean that your life is not worth living. My wife, she is 10 years younger than me, and I have worked out alternative bedroom activities. Hit the gym, eat a little better, laugh as much as possible and read this blog everyday to absorb some of the most amazing information from some very intelligent and compassionate members! Good luck!
Would you adopt me? You’ve done more this year than I have in a life time.
Never slow down.
Carlo-
My best trip of the year will be in August. One of my sons and 3 other friends, ages of 30,45 and 55, are riding Royal Enfield Himalayan motorcycles for 8 days on the logging roads of the Montana Rockies! Like you said, not slowing down, trying to pick up the pace😬
Happy Trails!
How did you even find out about such a trip? Enjoy!
For what it's worth, I'm getting everything. Diagnosed last October with extensive bone mets. Started lupron immediately, then spot radiation, then docetaxel starting in December, and now abiraterone started just last week.
It's been a rough number of months, but now my condition is improving rapidly.
One advantage of doing docetaxel early is it can be used again after ADT fails, and there's a chance it could resensitize the cancer to ADT. The downside is 4+ months of side effects.
Isn't it incredible that we medical novices have to ultimately make such an important treatment decision for ourselves. So important to do as much research as possible.
When I was diagnosed one year ago, I was also offered the choice of having an initial dose/round of chemo or Zytiga/Prednisone, in addition to ADT Eligard. I chose the latter. Only God will know what the right choice would be.
A monkey wrench for my treatment occurred after I had genetic testing, and found out I was BRCA2+ after several months on Zytiga which failed after 6 months. Now on Olaparib, PARP inhibitor, which is specifically used to treat my diagnosis. Latest PSA = 0.02!
Should you decide on Docetaxel, you might find this post helpful. I've shared the information repeatedly because it was such a Godsend to my husband.
I've had a similar diognoses and have been on Zytiga,Prednisone,Eligard and Xgeva for bone Mets 16 months now PSA 0.1 from first month treatment
I'm presently going for Provenge as of this week. Nevertheless it's working for me hope you and your medical team find what works for you
Never give up never surrender. Leo
I want thank all of you who took time to respond. This has been helpful for us.
As wife to wife it’s a nightmare
But these guys tod me to breathe and helped to calm me. Our trip started in April and it’s been hard we go to Stanford Tues and see what they say. Gleason8 too Prayers to you
Thank you.
I was diagnosed in October 2017. Had RP in December. Visually the Docs said looks like a great result. Pathology results were not as good as the naked eye indicated they would be. PSA started to rise from a nadir of .58 and doubled in about 45 days. Bottom line is that Auximen PET scan indicated 3 lesions, 2 in pubic area and 1 in Spinte at T11. RT produced good results as PSA went all the way back to .6 from a high of 7 and stayed for a while. They told me to monitor every 3 months but I got PSA done every month and more comprehesive labs. All labs have been excellent but PSA started to increase in March. Auximen PET showed a variety of new METS. In between PET scan and consutation at MSK PSA and Testosterone sky rocketed. 5 to 47 and 500 to 987 in 3 weeks. I took Firmagon injection immediately and have a second one schedule for June 6 (4 weeks and 1 day). I am staying on Firmagon rather than switching to Lupron, at my request. I tolerated Firmagon well. We are adding Zytiga as soon ASAP. Dealing with the pharmacy and Prescription Drug Plan has been a bit of an adventure. One month supply of Generic Zytiga at hospital specialty pharmancy is $9331. Brand name Zytiga is 15k per month. It will require a $3820 payment for my first journey into the "donut hole". The second month will be the balance of of the "donut hole" plus 5% of the cost of the treatment. Roughly $1750. Then it will be $466 per month for the rest of the calendar year. I told the person I spoke to at the hospital that my PDP cooperates with CVS and I wondered if the pricing would be the same. She said that all Medicare plans were the same. I called Aetna and after a little bit of talking in circles learned that the same drug and dosage was a little less than half at CVS under their porgram. I did not do the total calculation as I have to finish this on Tuesday but the "Donut hole" payments will be stretched longer and less in the first month. Of course, the monthly copay after "donut hole" is now going to be about $220 instead of $466.
This was one of 3 situations where I had to double check information given by hospital technicians where I was given bad information. I had a nuclear bone scan at a facility within walking distance of my 9 week old granddaughter's house. Since I had to wait 3 hours between injection and scan, I was thrilled at the prospect of visiting my precious little girl. It occurred to me that nuclear medicine radio tracers in my body might not be a problem to expose to the little girl. I called the technician at the place where I was getting my scan and they said no problem. For 3 minutes, I thought great, that is the answer I want. Instinct made me double check. The Doctors office said I should not hold the baby for at least 24 hours and maybe a little more time if it was them. Since I believe an abundance of caution is the right posture I did not go near my granddaughter.
Then, they had asked me when I wanted the injection and scheduled it for 8AM. The confirmation came through with the injection at 8 AM and the scan at 2 PM. I called to check because they said 3 hours and the tidbits I remembered from the half life discussion on the injection seemed to indicate 6 hours was too long. Not to mention hanging at the hospital for that long is a major nuisance. I was right. The problem was the scanning equipment was in use and they should have scheduled the injection around the scanner availablility. 6 hours would have rendered the test useless. I suspect they would have made me sit in the waiting room for 3 hours before giving me the injection and the test would have been given on time.
I consider these anecdotes of small things worthy of sharing to emphasize the need to pay attention and thoroughly understand our individual treatments and orders. I don't think there was anybody malicious in these stories. I do think that busy people who are keeping track of so many patients and procedures should learn that there is no harm in saying I don't know, let's check before giving a definitive answer.
Another lesson I learned is to check with the Prescription Drug Plan administrators directly to find out what the facts are on each decision. There is much to be learned in every conversation. I now consider this forum to be an invluable resource for up to date information, double checking, and triple checking life with cancer.
By the middle of this coming week, I will be on Firmagon and Mylan labs generic version of Zytiga. I hope it reverses what is happening in my system quickly. I remain asymptomatic but Pca appears to have turned into a fireball in my system.
I will run 6 miles today and play golf tomorrow. Most importantly, by this evening (72 hours+) I will go to my daughters house and get some big hugs from my kids and first grandchild. I found the idea of ingesting something too poisonous for my infant to be near me, more depressing than most of the other crap that comes with Pca. I will get over it as soon as I see her.
Not what you're looking for?
You may also like...
Docetaxal - The Honeymoon is Over
Newly diagnosed Prostate Cancer
Docetaxal prior to Hormone Therapy
Newly Diagnosed
Advanced prostate cancer (stage IV) newly diagnosed
Wife of Newly Diagnosed Husband - PSMA questions 
Looking for men who have done docetaxal+prednisone+Lupron+Xgeva
Vacation or Zytiga...Onco says Zytiga...
