Is chemo an effective treatment for PCa?

[babychi]

My online research indicates chemotherapy is not an effective treatment for all cancers. I’m wondering if anyone can direct me to information supporting chemotherapy as a life extending treatment for Prostate Cancer. Thank you in advance.

[henukit]

The effectiveness depends on many factors: disease type, stage, agressiveness, patient age and its general health state, comorbidities, other types of treatments used in parallel, etc.

There have been a few pivotal clinical trials that showed early chemotherpay prolonged survival for high-risk prostate cancer patients. You can look up on CHAARTED clinical trial results.

Plenty of people got out of some serious problems via chemo and some got into long remissions. Some of them here, you can use search and find a lot of them sharing experience. I'm for one used early chemotherapy for aggressive (GS9) prostate cancer with bulky tumor protruding through the gland and with initial PSA 500. Six cycles of docetaxel cobined with ADT (Lupron) completely rid my prostate from the huge tumor and dropped PSA to 0.41.

I just started a second course of combination therpay: cabazitaxel + carboplatin. Carboplatin works well in patients with DNA repair defects like BRCA which I have.

[babychi in reply to henukit]

Thank you for your input. Much appreciated. Great outcomes to you.

[Hidden]

It is what saved my Stage 4 metastatic life . henikit comments are very accurate. It depends on many factors. Most important: when the tumor burden is minimal and the body still strong. Research the great works of Dr. Robert Amato. There are others. I participated in this trial:

Trial of chemotherapy plus hormonal therapy as initial treatment for unresectable or metastatic adenocarcinoma of the prostate

Robert Amato and Haby Henary

“DOI: Published May 2005

Proc Amer Assoc Cancer Res, Volume 46, 2005

Abstract

5748

Background: The delivery of chemotherapy in a setting of hormone refractory prostate cancer has shown palliative benefit, with substantial PSA decline, strongly suggesting that disease modifying potential exists. Recently, chemotherapy is being reported to show a survival advantage. The stage is set for chemotherapy to be given earlier in men with prostate cancer. As a working hypothesis, transformation from an androgen-dependent to an androgen-independent phenotype is mediated by the expansion of an androgen-independent clone already present at the time of androgen deprivation. If this model is correct, then it would be desirable to bring treatment to bear on the androgen-independent component when the corresponding tumor burden is minimal. We view the androgen-independent component as analogous to “microscopic residual” or micro-metastatic disease for which adjuvant chemotherapy has shown to be effective in other contexts. Methods: Each course of chemotherapy lasts for 8 weeks (6 on/2 off). Patients were treated on weeks 1, 3, and 5 with adriamycin 20 mg/m2 as a 24-hour intravenous infusion on the first day of every week in combination with ketoconazole 400 mg orally 3 times a day, daily for 7 days. On weeks 2, 4, and 6, treatment consisted of docetaxel 35 mg/m2 intravenously over 1 hour on the first day of every week in combination with estramustine 280 mg orally 3 times a day, daily for 7 days. Hormone therapy, GnRH antagonist, is initiated within the 3 months of initiating chemotherapy. After the completion of 3 courses of chemotherapy, the addition of casodex occurs. Hormone management continues for a total of 24 months. At the completion of 24 months of hormone therapy, then discontinued. Men are then followed every 12 weeks with a serum PSA, including testosterone level. For those men who have a PSA recurrence, hormone therapy will be reinitiated. Results: Nineteen men have been enrolled, to date, with a median age of 63 (range 48-76) years. Fifty percent of the men had no prior local therapy, while the other 50% either failed surgery, radiation therapy, or surgery plus radiation therapy. Fifty-nine percent of the men had Gleason 7, 12%/8, 24%/9, and 5%/10. Thirty-five percent of the men presented with bone metastasis and 50% presented with nodal involvement. The median PSA reduction to date has been 96% with associated nodal and bone scan improvement. Conclusion: Enrollment is ongoing. Further information regarding PSA response with associated radiographic response and toxicity will be presented.

* American Association for Cancer Research

Cancer Chemother Pharmacol. 2013 Jun;71(6):1629-34. doi: 10.1007/s00280-013-2163-4. Epub 2013 Apr 21.

A phase II trial of androgen deprivation therapy (ADT) plus chemotherapy as initial treatment for local failures or advanced prostate cancer.

Amato R1, Stepankiw M, Gonzales P.

Author information

1

Division of Oncology, Department of Internal Medicine, University of Texas Health Science Center at Houston (Medical School)/Memorial Hermann Cancer Center, 6410 Fannin St., Suite 830, Houston, TX 77030, USA. [e-mail]

Abstract

PURPOSE:

Long-term hormonal ablation in prostate cancer is associated with decreased overall health and quality of life. Few reports emphasized the role of chemotherapy in the management of early stage prostate cancer. This study analyzed the safety and efficacy of androgen deprivation therapy (ADT) plus chemotherapy as initial treatment for patients identified as local failures or not eligible for prostatectomy or radiation therapy due to advanced disease presentation.

METHODS:

Enrolled patients received ADT in the form of leuprolide every 12 weeks for 24 months with bicalutamide initiating after the completion of chemotherapy. Chemotherapy consisted of ketoconazole and doxorubicin for weeks 1, 3, and 5 and estramustine and docetaxel and for weeks 2, 4 and 6. During weeks 7 and 8, no treatment was received.

RESULTS:

Forty-six patients were enrolled, and forty-five patients were evaluable. Median progression-free survival (PFS) was 23.4 months. Median overall survival (OS) was 53.7 months. Out of 45 patients with measurable disease, 22 patients had an objective response: 9 patients achieved a complete response; 2 patients achieved a partial response; 10 patients achieved stable disease. Frequent grade 3 adverse events included elevated ALT (17 %), hypokalemia (13 %), and hypophosphatemia (13 %). Grade 4 adverse events were rare and included low bicarbonate (2 %), hypokalemia (2 %), leukocytopenia (2 %), and neutropenia (2 %).

CONCLUSIONS:

The treatment demonstrated clinical benefit in all patient subsets with minimal reversible treatment-related adverse events. Subgroup analysis suggests that having prior local therapy resulted in greater PFS and OS.”

Gourd Dancer

[DarkEnergy in reply to Hidden]

GD,

It's beyond belief, that today, combinational therapies is still a niche!

When tell folks, that I've added Taxotere while on ADT and Zytiga with current PSA <0.02, they think I'm nuts!

Here, it's often to read: "I'm delaying chemo..."

[Hidden in reply to DarkEnergy]

Dark, there is no doubt that chemo and adt together plus other drugs have shown to provide enough synergy to cure. Me, I would rather try to cure first and failing a cure to delay the onset of death. Current SOC is a delaying tactic only. It will always be delaying tactic until there is a shift in paradigm. I’ll never forget Dr. A’s words to me, “We found out how to cure cancer in 1978. The problem was that the cure killed the patient along with the cancer. I think I have solved killing the patient part under certain circumstances.” From a personal perspective, there is a vast difference between the methodology of the community oncologist and the research and academia oncologist.

I hope your combination is successful.

I wish all the best of luck.

GD

[Muffin2019]

All I know is that it stopped the Mets and healing is happening, stopped any soft tissue invasion, everything went back to normal but still have to have ADT the rest of my life. I expect to be here for many more years, goal of 30 years, I was in great shape before and age of 66 so I was young as the oncologist said so the chemo went very well with hardly no side effects. I figure a bonus was that if I did have any other cancers starting like lung or colon cancers they were zapped also.

[j-o-h-n in reply to Muffin2019]

99? Why not shoot for 100.....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 09/18/2019 5:20 PM DST

[monte1111 in reply to j-o-h-n]

Am I missing something? New math. 96? Why not shoot for 97..... Good luck Muffin.

[j-o-h-n in reply to monte1111]

Damn calculator keeps making mistakes............

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 09/19/2019 5:05 PM DST

[babychi]

Thank you all for the input. It’s much appreciated. 🌺

[Tall_Allen]

It's true that chemotherapy is not effective for every type of cancer. Thankfully, taxanes are very effective for prostate cancer.

[babychi in reply to Tall_Allen]

Thank you for your response. Anecdotally and unfortunately, chemo hasn’t prolonged life in my circle. In fact, my buddy with PCa has made huge lifestyle changes, eating less meat and more organic food, cutting out alcohol and increasing exercise that we are hopeful he will not be facing chemo. Once again, I much appreciate the responses kindly offered here.🌺

[Tall_Allen in reply to babychi]

" chemo hasn’t prolonged life in my circle" - how could you know that? The only way to know if a therapy prolongs life is through a randomized trial. And even then, you know it for the population but never for the individual.

[babychi in reply to Tall_Allen]

I used the word “anecdotally.” The results of chemo treatment in my family (father with oesophageal cancer) and close friends (breast cancer) as a final treatment have not been positive.

[Tall_Allen]

First, it is a mistake to equate different cancers. Secondly, chemos for different cancers are vastly different in effectiveness and side effects. Try to think of your cancer differently. Docetaxel adds significantly to life AND quality of life for most men taking it for prostate cancer.

[babychi]

My buddy has the same gene as his mother and aunt. They both died of breast cancer related disease. Chemo did not work for them. Nor did it give them a better quality of life. I’m glad if it works for some. I am not anti chemo. I just hope we don’t need to use it. Thank you for your input. I’ve been provided with all I needed in the great responses above.