Okay, I just finished 6 rounds of Docetaxel. I was initially dx in Jan with advanced prostate cancer w 7 mers. PSA 11.9. Started firmagon in February and finished chemo in August. Latest PSA was 2.5. MRI shows no organ issues and an enlarged lymph node has reduced, uptake of contrast in previously noted Mets.
MO suggest continued firmagon for (though she insists Lupron, would do the same thing) and revisit everything in 6 weeks.
Urologist recommended Xgeva and insisted Firmagon is better, lower cv issues and effects 2 areas of testosterone. What would you do?
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Can you provide more details regarding your known metastases? Urologist's Xgeva recommendation suggests bone tumor(s), but I can't find specifics in this or prior posts. Also prior posts says you don't meet criteria for Zytiga. Clarification of these issues would be helpful for answering your question.
"Similar extent and distribution of scattered foci of osseous sclerotic metastatic disease. The quality of these has changed ;whereas previously these were densely sclerotic, they are less sclerotic and are more lucent currently. This change is of uncertain significance given recently down trending PSA.
"Redemonstrated sclerotic focus in the right sacral ala
and L3" "abnormal tracer uptake persists throughout the cervical, thoracic and lumbar spine, the sacrum, multiple left ribs, the right humeral shaft, and the right femoral neck"
I'm not sure if any of that helps. Mets located in the spine, humorous
I have no general expertise (e.g., as does Tall Allen), so I can only speak from my own experience and limited learning. That said: #1 - Given your spine mets, seems to me you should be on Xgeva. With only one (cervical) spine met, I've been on Xgeva since 2/19. #2 - In a prior post, you indicated that you didn't qualify for Zytiga. Can you or your MO or Uro push harder on this? Many of us are on a agonist, like Lupron or Firmagon, PLUS Zytiga.
You may be a candidate for radiation therapy for the lymph node (and perhaps the surrounding area). Be aware that there’s no clinical evidence of a net benefit from doing so. I agree, please provide us with a bit more information.
I think there is not much difference between Lupron and Firmagon. Your Uro is right about the CV effects, but for most guys it's not an issue, and is surmounted by the convenience of multimonth injections.
I had my 5-cycles (8 weeks each) of chemo-hormonal therapy in late 2010-2011. At the start of it my PSA was around 15, and scan detected L3 met. Chemo consists of Docetaxel, Doxorubicin, Adriamycin, Estramustine, and Ketoconazole, dexamethasone and Lupron. L3 met and PSA was undetectable after the first cycle. PSA and scans stayed that was for 2 years. After that whack-a-mole with Lupron began each time PSA rose and doubled until I reached CRPC in December 2015. First generation ADT (Lupron/Firmagon/Casodex) continue to fail, thus in early 2018 I began to use Zytiga and have undetectable PSA since then. My MO (now RIP), is believer in hit it early and hard with all you got, and I am still alive and enjoying God’s blessings daily. My suggestion, get Zytiga soon. If your PSA did not get to undetectable level after a few cycle of chemo and Lupron, you’ll need the next generation drug(s).
Seeing my MO In the middle of November, urologist insists I start antigen blocker and xgeva, he also advised me to pick on or the other apparently I've started a pissing contest.
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