Father diagnosed stage 4 June 2019, mets to pelvic bone, liver and lungs

[lsteacke]

Hey everyone,

Looking for some information and advice about my fathers diagnosis. It seems very atypical as he never had an elevated PSA that sounded the alarm to doctors, I think the highest it ever got was 4. Never the less by the time scans happened it had already spread. Step one was firmagon to reduce test levels. He started chemo shortly after diagnosis, 6 infusions of taxotere. Saw reduction in tumor count and size. Took 3 months off and now starting another round of taxotere and carboplatin.

Can anyone comment if they have seen the treatment protocol before? I understand carboplatin is generally used for ovarian cancer and breast cancer. I've always been interested in immunotherapy, does that happen after chemo?

[Tall_Allen]

I'm sorry to hear about your father's diagnosis. Those low PSA-type prostate cancers tend to be very virulent. Combining docetaxel or cabazitaxel and carboplatin is certainly the best approach. I'm sure his oncologist will monitor his liver enzymes and other toxicity biomarkers closely. Because PSA is an inadequate biomarker for him, CT scans must be used to monitor progression.

If possible, a biopsy of his liver metastases may be useful. Firstly, a morphological analysis may reveal if there is a neuroendocrine complication. Second, IHC staining for PSMA, SSTR2, AR, and PSA may guide treatment options and clinical trials. Third, a genomic analysis may reveal if it has microsatellite instability (MSI-hi) or deficient mismatch repair (dMMR), or a BRCA mutation, which would make it treatable with Keytruda or a PARP inhibitor, respectively. This is very rare with prostate cancer but is worth looking at.

Immunotherapies have been disappointing for prostate cancer, except in the rare cases of MSI-hi/dMMR. It is possible that it may be more useful as a part of a combined therapy.

Let me know what his biopsy findings are.

[Hidden]

It’s a pleasure to welcome loving children here. Good looking out for dad. The chemo can work. He needs to keep active and healthy while he’s being diminished. Not easy to here. Treatments take recovery time. Stripping him of male hormones is one goal . This is new for us fellows. My advice is love him much . That’s the best medicine. The drs will figure out his plan .. Be strong and support him . That’s priceless. 🙏🏼

[Hidden]

He might also get blood tests for neuroendocrine markers such as chromogranin A, synaptophysin, neuron specific enolase (NSE), and CD56. These may be useful in the future as tumor markers to help determine if there is progression since PSA will not be useful for him.

[vandy69]

I have had 18 infusions of Docetaxel/Carboplatin chemo combo (2 rounds of 6 cycles, and in middle of 2nd round of 4 cycles).

For me, Docetaxel is for lymph node mets and Carboplatin is for liver mets. So far, all this chemo is still working, as I have had every drug and proton beam radiation. Have never been cautioned about the sun.

I use Biotene products for mouth care.

Best Wishes. Never Give In.

Mark, Atlanta

[j-o-h-n]

Give us more info about your Dad..... age, when diagnosed, location, treatment center(s), doctor's name(s)? This into helps of us help him and helps us too. All infor voluntary. Thank you.

Besides my Pca I also have a LUNG melanoma being treated with Keytruda (immunotherapy) and it's working.

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 03/11/2020 11:37 PM DST