Docetaxel or Xtandi

[robbo262]

Hi folks:

I don't post often and haven't for a long time and want to thank everyone for their thoughts, opinions and prayers. Have had PC for 8 yrs. Gleason 4+4, EBRT initially with good results 3 yrs +, followed by salvage prostatectomy (before you consider doing this contact me), Quick elevation of PSA following surgery followed by quick mets to spine and hip. Zytiga for 18mo, only side effects fatigue. Now new hip tumor plus increasing PSA and alkaline phosphatase.

The options presented to me were either Xtandi followed by Provenge if Xtandi is effective, or Docetaxel followed by Provenge if the Docetaxel is effective. I can see from this thread that Docetaxel has so many side effects for some, but on the other hand I am kinda thinking I want to go with the heavy hitting stuff while I am still fairly strong.

Any thoughts out there? Has anyone been on both Xtandi and Docetaxel at the same time, even if it was a clinical trial?

Cheers

Rob

[Magnus1964]

I would choose docetaxel first. Then have xtandi and other ADT drugs as backup positions.

[Fairwind]

Since the Xtandi or Zytiga both tend to work better than chemo, with far fewer side-effects, I would try them first. Then maybe Radium 223, THEN chemo...For me Cabazitaxel (Jevtana) worked better than Dosetaxel with fewer side-effects....But that's just me......

[The_Don5 in reply to Fairwind]

"Since the Xtandi or Zytiga both tend to work better than chemo,"??

[Fairwind in reply to The_Don5]

Both Zytiga and Xtandi worked better for me than either dosetaxel or Cabazitaxel did. Longer, more complete remission with far fewer side-effects..No dates in the Chemo Lounge every 3 weeks, no sticking Neulasta needles in your belly as part of the post chemo treatment..

[Myhubby58 in reply to Fairwind]

My hubby has tried xtandi and zytiga. and now they want to try Docetaxel

We really hope it works..today we are headed to and Anderson in Houston Texas. Please pray for good results..

[JuanVV in reply to Myhubby58]

Of course I will pray, lots of luck to both of you x

[Tall_Allen]

I suspect that best results are with Provenge immediately followed by either Docetaxel or Xofigo. It makes sense to me to improve the immune system before using an immune-depressing drug, and docetaxel and Xofigo kill off a lot of cancer cells. The antigens from the dead cells activate the dendritic cells from Provenge, which seek-out-and-destroy cancer cells everywhere - it's a synergistic combination.

I agree with you that docetaxel works best if used earlier, and the side effects are less. In a few men, docetaxel restored sensitivity to Zytiga/Xtandi.

[Myhubby58 in reply to Tall_Allen]

Does anything help with the castration part???

[Tall_Allen in reply to Myhubby58]

I don't understand your question - what do you mean by "help with the castration part"?

[Myhubby58 in reply to Tall_Allen]

Well since he been on chemo oral treatments he has not been able to have sex. He has erectile disfunction..And his penis has gotten very small. Is that a normal thing with prostate cancer??

[Tall_Allen in reply to Myhubby58]

There are no oral chemo treatments for prostate cancer - Taxotere and Jevtana are given by infusion only. I think you mean hormone treatments - Casodex is a pill. Casodex doesn't cause ED per se - but it reduces libido, the desire for sex. Penile shrinkage is from lack of use. He may be able to reverse that with a pump, and low dose ED meds to encourage nighttime erections. I know a few men who have maintained libido without testosterone, but it is difficult.

[Myhubby58 in reply to Tall_Allen]

Thanks for that info..but he has been on casodex, xtandi,and zytiga and the dr here in Augusta Ga call it oral chemotherapy..he was allergic to zometa so now he gets xtega shots every 3 weeks and next docetxal is supposed to start August 12 th..

[Tall_Allen in reply to Myhubby58]

Well, it's a chemical and it's a therapy, but I think your doctor gives the wrong impression by calling it a chemotherapy. Chemotherapy usually means a cytotoxic chemical, like docetaxel. I hope he gets a good response to it.

[Myhubby58 in reply to Tall_Allen]

Thank you..God Bless

[robbo262]

Thanks to you guys for your responses!

[tango65]

There are some data suggesting that after failing one of the new anti androgens chemo may offer an advantage vs using another anti androgen.

ncbi.nlm.nih.gov/pubmed/302...

[immunity1 in reply to tango65]

Thanks for ref. R

[The_Don5]

cancerres.aacrjournals.org/...

"Furthermore, the combination of indomethacin and enzalutamide (XTANDI) resulted in significant inhibition of enzalutamide-resistant tumor growth".

[larry_dammit]

I went with Taxotere chemo first with lupron and Xgeva shots monthly. Then on to Xtandi. Been on Xtandi now for 28 months. PSA is <0.05. Since starting. Fight the monster 🙏🙏

[robbo262]

Thanks for your thoughts

[EdBar]

Dr. Myers prescribed both Xtandi and Taxotere at the same time early on in my treatment back in 2015. Taxotere was not easy but apparently effective. PSA is currently undetectable and scans show no active disease. I was originally dx Stage 4, G9. Fight the beast and Pray Hard!

Ed

[Olivia007 in reply to EdBar]

You had chemo may I ask how u handled the side effects and what were they and how old r u? My 81 year old father is possibly going to have it he’s hesitant and so am I. Thank you, Olivia

[EdBar in reply to Olivia007]

I was 55 when I had chemo, and yes it was difficult. It was administered every 3 weeks for 6 sessions and it seemed to get tougher with each treatment. Felt like a really bad flu that would last for about a week then it would gradually improve until it was time for the next treatment.

I experienced the usual chemo side effects - fatigue, headaches, hair loss, finger nail loss, temporary loss of taste, loss of appetite, body aches, mouth sores etc. My immune system took a major hit and I had to be careful about who I came in contact with, being in public, etc.

I rested a lot during the rough days, forced myself to eat and still managed to exercise during chemo - it’s supposed to help with fatigue and make the chemo more effective. It took months to “recover” however I still have some neuropathy, immune system issues etc. On the bright side my PSA has been undetectable for a few years now. Keep in mind that’s my experience, some guys are less affected, but I would say my experience is pretty average.

Ed

[Olivia007 in reply to EdBar]

Thank you for sharing your experience I know every hunan experience is different but my dad is 81 one and having flu like symptoms and living alone because he refuses to move in with me I don’t know how to handle any of this but thank u

[Olivia007 in reply to EdBar]

How long has it been undetectable

[EdBar in reply to Olivia007]

For 4+ years now, given where I started (you can read my profile) I am truly blessed.

[Olivia007 in reply to EdBar]

Wow u r truly blessed and I hope u continue to be blessed

[Myhubby58 in reply to EdBar]

Did you get your sex life back???

[MateoBeach]

I agree with Magnus1964. I had Docetaxel early. Yes it kicked my but and took over a year to get back to full normal energy levels. But it gave me two years of life with near zero PSA and no progression. So that was the gift. Then saving the ADT and advanced anti-androgens for further down the road. (Not burning those matches until needed.)

[j-o-h-n]

Rob tell us more about yourself...

75 years ago today those brave men saved our freedom, now don't let it dwindle away from us.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 06/06/2019 5:27 PM DST

[robbo262]

Thanks so much for everyone's comments. Turns out the question is moot anyway as my Dana Farber doc recommenced Apalutamide instead of X-tandi. I have decided I will do either X-tandi or the Apalutamide and wait til the anti-androgens stop working to do chemo.

I truly appreciate hearing the many stories and know that there are so many variables in all of our hard decisions. You gather the evidence, talk to your personal advisors, try to make the best possible decision you can and then ride that pony til the end without regrets if it doesn't work out. Keep fighting and asking questions even if your doctors become annoyed

Rob

[Cheerr in reply to robbo262]

Hi Rob,

What have you chosen? Xtandi or apalutamide?

And what made you choose one of these over Chemo?

(I will soon have to make a similar decision for my dad)

[robbo262 in reply to Cheerr]

Hi I know DF likes Apalutamide over Xtandi, but my MO at DF said they are pretty much equal. I live in central NH and the hassle of going to Boston or maybe Salem is such that at this point I think I will stay with Dartmouth Hitchcock which maintains for my specific case that Apaluatamide is not approved, and therefore I am currently on Xtandi

I find DH is very cautious about this stuff, whereas DF is more liable to bend the rules a bit, which I like. What I don't like is the hassle of going to DF, parking, traffic, the ride to and fro, etc etc. Essentially killing a whole day. People are always super nice to me at DH, in almost every department, and when I have been admitted they fall over themselves being nice to me. The care at DF/Brigham is spotty, I find the ancillary departments can be rude.

My wife and I are good at advocating for my care, and my MO at DF can be reached at a days notice. He is honest about things, though my MO at DH can be a bit defensive about things, haha.

How old is your dad? I am curious and don't take offense but why are you managing his care? I think it is great that you are but I see so often on this website that men are afraid/indifferent/too bravado, etc. to take things in their own hands. Women are so much bolder, curious, etc.

I am not sure how how much longer I will be on the Xtandi as my PSA went up on my last visit, just a tiny amount, but it might be that Docetaxel is in my future....ugh.! I have only been on Xtandi for 6 weeks, without any major side effects, and I suppose my PSA could go down. Remember, every person is completely different and it is very hard to compare patient to patient

Good luck and feel free to stay in touch

Rob