Latest PSA has come down from 1.35 in April to 0.41 in July. I have multi mets on my backbone and some lymph nodes. Have been on Zytiga + Prednisolone,Lucrin,Zometa for the last 6 months. PSMA and FDG PET/CT showed a lot of improvement. Oncologist is suggesting that I seriously look into doing docetaxel +Lucrin to increase longer overall survival based on New England Journal, August 20th, 2015 . Will need 6 cycles of docetaxel. Please do share your thought if i should go ahead with it. Thank you in advance.
Need advice if I should do Docetaxel/... - Advanced Prostate...
Need advice if I should do Docetaxel/Lucrin even when PSA continues to drop to 0.41
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bellyhappy
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You have done well on your current regimen--I would add Celebrex to your regimen as there is a survival benefit with Celebrex and Zometa, as long as your heart is doing well:
onclive.com/conference-cove...
I would wait on docetaxol for a later date....Consider stereotactic radiation to the mets if in an area safe to radiate--Phase 2 trials by Dr Heron for less than 5 lesions:
astro.org/News-and-Publicat...
There is a trial called SABR-COMET 10 for less than 10 lesions that is going on now:
clinicaltrials.gov/ct2/show...
While the number of drugs continues to grow for PCa from direct research and from what I call "Crossovers"--drugs used for other issues that will be able to be used for PCa, I would try and use a drug until it loses efficacy--right now Zytiga is working well--look at adding the Celebrex to zometa for an increase in survival rate of 22%...If the zytiga starts to falter (PSA trend changes), try switching the prednisone for dexamethasone--see below:
ncbi.nlm.nih.gov/pubmed/300...
This may give you more time and efficacy with Zytiga.
I hope this helps....Good luck....
Don Pescado
As usual, you have so much knowledge that allows me to think of the options. Spoke with the Oncologist on the radiation for the bones. His suggestion that my multi mets as well as I am not feeling any pain at all is not a good option. Thanks again.
As I say to everyone, I am not an MO or RO....just a wannabe....LOL....
Of course, listen to your MD.....I just would not be too quick to stop Zytiga when it is still working....See if the plan is to do Zytiga later again....Good luck, my brother...May this work well for you....
Fish
Thank you. ..God bless you.
I wannabe a wannabe.... do you have to go to school to be a wannabe or do you just have to be a wannabe to be a wannabe? Dolly is driving me crazy... I'm running out of oxygen puffing her up....Pray for me....
Geezamacripe....
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 07/09/2019 9:21 PM DST
School ???? Depends on how much of a wannabe you wannabe.... That Dolly wants to be puffed up.....lots of dollys do.... I'll pray nobody needles Dolly and for you--health....
Take care my humorous friend....
Fish
Docetaxel has a lot of nasty side effects.
Maybe good reason to defer or avoid it unless there is clear and compelling reason to take it.
Thanks for your inputs.
I assume that with Lucrin injections that you are in Australia. Is this correct? Frankly your Medical Oncologist is in the best position to recommend treatment. Each of us are different. What worked for me or others may or may not work for you. However, as you are into this fight less than a year, there is probably an indicator expressing to your Medical Oncologist a solid reason to undergo chemotherapy + hormone therapy at this juncture.
With that said, I am a proponent of early chemotherapy with hormone injections. If you follow your guy’s advice, don’t fear chemo as side effects are manageable. Fifteen years ago I underwent a six month trial consisting of 9 infusions of Taxotere, 9 infusions of Adrimyacin, Ketoconozole, Estrstamine, and Prednisone; plus injections of Lupron.
My Mets at T2 and L3 were resolved and replaced with new bone growth.
Admittedly, I do not know much about Zytiga or any of the new silver bullets. I do know that systemic treatment is needed to give a fighting chance to kill Mets; especially the unseen metastatic cancer cells - micro-metastasis.
Do not fear chemo. Do not let others who have never experienced chemo tell about terrible side effects. Keep kicking the bastard.
Gourd Dancer
bellyhappy in reply to
Thanks Gourd...I am in Asia and you are right ..everyone is different in relation to chemo treatment. I have a close relative that had very painful experience with chemo while a good friend felt that it is not as difficult as most people make it out to be.
I am in my early 60s and in pink of health and the oncologist felt that I should go ahead with the chemo treatment. He would not have recommended it if I was in my late 70s.
So happy to hear your success in your treatment.
My faith in God that He will continue to provide me the protection and wisdom in this journey. God bless
I'm getting a good response from ADT + Prednisone, diagnosed with PCa, about 9 months ago with PSA 1000+, now PSA 0.02, have a great team of doctors from Dana-Farber, which are on board with adding chemo.
Will start Taxotere next week, there's numerous papers regarding benefits, a few:
ncbi.nlm.nih.gov/pubmed/274...
nejm.org/doi/full/10.1056/N...
And there's other studies negating any benefits, so it's up to you. For me, I'm still healthy at age 58 and adding another assault on the cancer is worthwhile.
Here's a great talk about adding to the fight:
grandroundsinurology.com/du...
Thank you for sharing your journey. My oncologist had also suggested that I should seriously consider docetaxel as I am still young at 61. I wish you well...and will pray for you for a complete remission. The info that you have attached are very useful. Do stay in touch as you start your Taxotere next week. If you have any more tips in managing the treatment, do let me know. I am currently thinking of starting the treatment in mid Aug.
We have to get guns. Oh my God....they killed Kenny.
Some good advice in the other replies. The problem is that there is a case to use Docetaxel early, and young, as this has many success stories. But - Docetaxel is a mighty sledgehammer, and right now you only have tacks to hit, not 6 inch nails. The other side of the coin is those who had negative outcomes. Who will benefit and who will not seems to be poorly understood. So you take a chance either way.
My advice would be to stay in the "safe", more gentle options. Once the Zytega stops working for you, you can swap over to Xtandi and get another couple of years with that - and perhaps change back to Zytega again after that. There may be other new options that can be used in a couple of years. Only after that would you consider the sledgehammers - and you may have a better idea if it will be a wise move.
There are lots of things you can do to extend your "safe" zone (and there are some lucky people that work hard at it and escape) - make sure your sugars are always low and your immune system is boosted by natural "killers" and the right diet etc. None of these treatments kill the cancer - they just slow it down. Your immune system has to do 100% of the killing in the "safe" zone. Nearly all the treatments compromise the immune system and gut biome to a greater or lessor extent, so be aware of the negative effects too.
The Celebrex suggestion is a good one if you have niggles and inflammation. Inflammation seems to feed cancer (and/or inhibit natural killing), so is a no-no (the fact that it reduces the PSA seems to confirm this). Celebrex will reduce the inflammation and the niggles that go with it, probably making conventional pain killers unnecessary. With mild niggles, cut the capsules in half (i.e. take 50mg 2 or 3 times a day). No point taking more poisons than you have to! Diclofenac is an alternative.
Sleep well ... you have years ahead of you.
j-o-h-n in reply to
niggles = cause slight but persistent annoyance, discomfort, or anxiety.
Had to look it up, a new word for my list of words that I will probably never use. Thanks...
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 07/09/2019 9:25 PM DST
There are some here who give me niggles. And some who give me naggles and noggles.
With my Manboobs I can give nipples....
Good Luck, Good Health and Good Humor.
j-o-h-n Wednesday 07/10/2019 8:10 PM DST
DarkEnergy in reply to
From DavidHealth post: "My advice would be to stay in the "safe", more gentle options. Once the Zytega stops working for you, you can swap over to Xtandi..."
Understand certain treatment efficacies depends on the state of cancer - for instance, will chemo be effective if PSA is < 0.1? But, actually who knows what's going on when so called "undetectable" and "in remission", obviously males with PCa have a DNA defect.
Or do we all have this DNA defect and some of us male humans and dogs just hit a certain phenotypic zone, obviously we don't know. Prostate Cancer is still based on 1940s discovery of androgen-ablation therapy.
Combination therapies been trending for awhile, adding Zytiga early-on is common these days - why not add Taxotere (Docetaxel) to kill those lurking androgen-independent cells.
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Quote from one of my favorite PCa articles (ncbi.nlm.nih.gov/pmc/articl... :
"prostate cancers are composed of a heterogeneous collection of androgen-dependent and -independent cells. Androgen-ablative therapy, no matter how completely or early it is given, does not eliminate the androgen-independent cell type."
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Quote from Dr William Oh, MD (targetedonc.com/news/doceta...
"This was a bit of a surprise when we found that docetaxel had so much added benefit when used early, and it makes some sense because obviously, we know that there are high-risk metastatic patients who have clones that are going to be resistant to primary hormonal therapy and by using early chemotherapy, we seem to be pushing off the cancer. We’re not curing any of these patients, but we are basically delaying progression enough that there is a significant survival benefit."
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in reply to DarkEnergy
There are problems with some of what you say. First of all, men get prostate cancer because of their life-style, not because of their DNA. The "prime candidate" Pca victim is overweight, has Type 2 Diabetes, high blood pressure, unfit, and eats junk food. That is before you add environmental factors too - Western food is loaded with known carcinogens and sugar. DNA comes way, way down the list of possible causes. The immune system gets overwhelmed - that is why we get cancer of any type. Change in lifestyle is top of the list of "medicines" to take if you want to add survival time.
There are statistics that early use of Docetaxel can add survival times. It can also speed up your end (is this the majority case - even though years may pass?). A common thread in this forum is to use Docetaxel "because it is there". What I have been pressing for in this forum is for real data on who it may benefit, and who it will kill. One would think that after 23 years of use, this selection process would be very precise and the outcome predicable - not a broad "Let us try Docetaxel and see if it helps".
I threw out a challenge a few weeks ago for real data that Docetaxel (or for that matter any of the regular treatments except x-rays) actually kills existing cancer cells. This is a common belief. So far, no real data (mice and petri dishes do not count). Which is why I made the statement that it is only the human immune system that is doing any killing. The medications appear to kill the cancer, but they only slow reproduction down so the immune system can win the battles for a while. Believe me, I would like to be wrong about this, as I too am looking for anything new that actually kills.
Which brings us to a choice that just about NONE of the people on this forum are given. Not even mentioned, even though it is common practice in much of the world. Intravenous VItamin C actually kills cancer cells (no work has been done to see what mutations are more likely to die). You can see it in PSA numbers that drop, and feel it too. Experiment a bit - prove it to yourself if it works for you. Its harmless. Zero side effects. Cheap. Some doctors are happy to prescribe it "for inflammation control". On its own, it can initially kill up to 30% of the cancer cells (this declines to about 10% over a few years), but in combination with regular medications (especially Xtandi), that kill rate can be as high as 80% (and decline from there). Thus the decision many face has false choices with only part of the picture presented. It's tough to decide when to use Docetaxel which partly kills you too while doing its job (you gamble your life on the outcome), or see how long you can survive in the "safe" zone before you need to consider using any drastic measures.
jfoesq in reply to
David- The only point I will disagree with you about for now, is that DNA doesn't play a role. My father, was diagnosed at age 60 ( almost 35 years ago) and had rad-implants. He died 29 years later from heart disease. He did not exercise and was not very athletic, but he didn't have diabetes and wasn't overweight.
I was diagnosed 7 years ago at age 54 (apparently- there is a relationship indicating a son who gets the disease will often get it at an earlier age.) I was athletic, and fairly fit and had no health issues other than elevated cholestoral, that I took statins for- and continue to take. My diagnosis, prompted my 3 older brothers to get checked. 2 out of the 3 of them were diagnosed with localized PC (at 50 yrs. and 61 yrs. respectively). They were, and are, very fit. One of them goes to the gym daily and swims "for real"- he also played tennis for many of his adult yrs,. hiked... I have no doubt that diet and fitness play a part in the disease, as they do with many diseases, but to rule out DNA as also being a factor, in my opinion makes no sense, and I believe is agst the weight of scientific evidence.
Regards
JFOesq
in reply to jfoesq
Thanks for the reply. I didn't rule out DNA. I said it was way down the list. I see guesses by those in the know are that DNA is directly involved in about 5% of cancer patients. I would put it a bit more, as propensity to obesity, diabetes etc. also have genetic links - which is swamped when two thirds of the population are overweight and we all live in a poisoned environment. The point I was making is that most people should blame themselves and not their DNA (and hopefully change their life style or they will never defeat this beast). Your family may well be in that 5%. Glad you mentioned radium needles (the first reference I have seen in this forum) - I have seen that work (with nothing else) for 2 friends who have got 10 good years and counting (and your father got 29 years!) - but this seems to have gone out of fashion. We should ask why? Cash flow? Surely this should be very high on the list of choices if the Pca is caught early?
jfoesq in reply to
David- I should've read your post more clearly. Having said that, my father, who was a dentist and a strong believer in science and Western medicine, felt quite the opposite of you for most cancers and other diseases. While he thought diet and exercise could clearly have a significant impact upon peoples health,or lack thereof, he also was a big believer that if you had genes had a huge impact on our overall health- be it good, or bad. For example, we know smoking causes cancer- but some people (probably not many) can smoke like chimneys their entire life and live to be 100 without ever developing cancer. I don't wish to get political- but just look at our President's diet, weight and lack of exercise. It's surprising to me that he doesn't have numerous health issues (i.e diabetes, heart..... I was heavily influenced by my father and believe genes can have a large impact on our health, both for better and for worse.
regards
JFOesq
Bellyhappy- I can't make a recommendation, but can provide you a bit of info. When I asked my doc about the study indicating patients did better getting docetaxel, she responded by informing me that the study was done on NEWLY diagnosed patients who had FOUR or more mets. Since I had already been on ADT for years, and because I had less than 4 "mets" (she didn't considered my one dirty lymph node- which as removed when I also had my prostate removed, a "met"as defined in the study, because it wasn't in the bone) and said it appeared I only had 3 bone mets, she didn't think the study applied to me. For that reason, along with the fact that the doceraxel (Like many of the drugs PC patients take, has significant side-effects) she chose not to have me take it.
I hope this is helpful.
Best
JFOesq
I do have multiple mets, Gleason was 7, was on ADT and Zytiga for 7 months and PSA is now down to 0.41....and I am in my early 60s..that is why the oncologist suggested to me to consider docetaxel...Thanks for sharing.
Of course. Good luck and let us know how you respond to the docetaxal
The First week after treatment was rough…
-The first few days , the fatigue, poor appetite and sleep were difficult. Everything tasted bland.
-On the 4th and 5th day after the infusion, every single of my bones were aching so badly and your heart was pounding like a drum beat. The headache would not go away. The fatigue was at its worst. I could not even get out of the house for a walk. It was like the “Mother of all flu”
-Loss of 3 Kg in that week.
- The second week was a lot better and but the blood test showed lower white blood cell count. Concern but not serious.
-Appetite was coming back and definitely started to do some walking and feeling stronger.
-Needed to avoid crowded places due to low white blood cell count.
-Going into the Third Week, felt that I am making good recovery and gaining the strength back.
-Lower back started to ache and left eye started to be less sensitive.
-Just came back from the doctor, white blood cells count is back to normal but red blood cell count dropped below standard. Lower backache, eye issue as well as the red blood cell are not serious enough to warrant any intervention.
- PSA went from 0.232 to 0.351
-Doctor happy with the progress and felt that my body is ready for the next infusion on Sept 4th.
Any suggestion about what to expect next as well as the PSA increase would be greatly appreciated.
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