My dad's oncologist plans to do only taxotere for him (he has not received any chemo yet). I see people have been on carboplatin and taxotere. Is there evidence it helps? And is the combo standard for liver/lung metastasis?
Edited - I meant carboplatin
Often, soft tissue metastases such as lung and liver have cancer cells that have neuroendocrine characteristics. For that type of cancer, Carboplatin is useful. Since the cells are mixed with other adenocarcinoma cells, doctors will often combine it with Docetaxel. Another regimen that's used is Cisplatin + Etoposide.
The only way to know for sure whether there is NEPC is to have a biospy. There are also some blood tests such as NSE and Chromogranin A, but they are not reliable enough to be sure there is NEPC cells. This is something to discuss with his doctor.
Thanks I'll ask the doctor about a biopsy.
If they do a biopsy, I would think the liver would be less risky than the lungs. Please let us know what his doctor says. Wishing him the best.
Thanks for your kind words
I spoke to him and he said he wants to start taxotere rather than delay another couple weeks waiting for the biopsy since the cancer is aggressive. If he doesn’t respond we would then do the biopsy.
I think there is a clinical trial for a scan that shows neuroendocrine type prostate cancer. It is being done at Emory in Atlanta and is called Galium Dotatate.
Thanks. Seems like that is not approved for prostate cancer although some doctors use it. I'm doubting Kaiser would recommend it or cover it. Also my dad has lung metastasis so I wonder if it would benefit him without chemo
No, it is not standard to add carboplatin. The only reason to do so is if pathology or germline testing reveals a rare type of prostate cancer not susceptible to taxanes. It may also be true that men with DNA repair defects (like BRCA2) that may benefit from PARP inhibitors, may benefit from carboplatin.
I have the somatic BRCA mutation and did very well with rucaparib (PARP) regarding liver mets. Starting cabazitaxel and wondering about adding carboplatin - When?
cabazitaxel+carboplatin at the same time.
I did carboplatin and taxotere after radiation with ADT (currently Eligard and Zytiga/prednisone). Only had bone Mets (lots of those but no liver yet). Also I’m CHEK2. It was more a precautionary “add on” because he wanted to be as aggressive as possible since everything else was in great shape.
I’m glad to have done this and I can’t personally compare this to any other chemo first hand, but I’ve got to say, rounds 3-6 of that double chemo really knocked me on my ass. Man, that was hard.
I wish you only the best!...I’m still here more than 2.5 years later with a ND PSA and doing all I can to stay healthy.
Did you have RP or RT on the prostate?
Hi there. I had neither. Strangely, my prostate tumor was pretty small considering how it had spread (psa of 500). I was actually asymptomatic down there. I had intense pain and numbness in my arm, neck, and back (due to tumors in my neck/back) and fatigue/appetite loss. Radiation(w lots of steroids) was to neck and spine tumors for pain and paralysis mitigation...it was a judgment call but I think the right one.
Thanks for the details. I was curious, cause it's somwhat similar to mine, PSA 500 but I had huge prostate tumor which completely gone after docetaxel and ADT and still not active. But I never achieved ND, my lowest was 0.5. Few months later, in spring I had three bone mets became active. Had to treat them with radiation, all markers went down with pain. Now is getting ready for double chemo Jevtana + carboplatinum). I haven't had second line anti-adrogens yet.
Interesting. It’s worth noting that I had about 9 months of a really low PSA (0.1-0.2) before it dropped to ND one year ago. My bone NM scan in 8/18 that showed no visible tumor in my prostate (like you) or bones coincided with my psa when it finally dropped to ND. So that scan (which was a scary Christmas tree in 1/17) that showed nothing visible might have been the case earlier w low psa. God speed on your second round of chemo! Doug
I have lymph node and liver mets. Chemo was Docetaxel/Carboplatin combo for 2 rounds (12 cycles). It worked both times as PSA declined and liver mets became smaller.
Best Wishes. Never Give In.
Mark, Atlanta
Did you have any symptoms prior to the diagnosis of liver Mets? My dad has decreased appetite, fatigue, weight loss the last few months.
I had no symptoms prior to diagnosis of 20+ liver lesions. Had CT guided biopsy of liver to confirm prostate cancer mets rather than straight up liver cancer. Immediately began chemo.
Mark, Atlanta
Carboplatin 
Carboplatin
Docetaxel and Carboplatin
Jevtana and carboplatin
