Docetaxel forever?

[Shepard]

Received consult with my chemo Doc 3-17-20. I have completed 6 Docetaxel infusions and am "enjoying" a week off. My lab numbers are within tolerance. I asked him a question about the Extandi that I have been taking (I was instructed to continue with it during chemo by my Oncologist/Urologist who has been managing me for almost ten years.) Chemo Doc says stop Xtandi - its not working - (note it was on the Rx list I provided during intake.) My memory is many on this site have continued with the oral along with infusion chemo - correct? He also said that I would be on Docetaxel for years, not months. Further, he said that going to another oral chemo, e.g. Zytiga is not an option. Infusion chemo is my last ride! Comment?

[spouse21]

Hi, there, Shepard. I asked a question similar to yours on behalf of my 75-year old husband--except for the forever part :(--a few weeks ago. Here's the link to the responses. You've had a very different treatment plan than my guy's had. (Lupron, IMRT, Zytiga (failed in 4 mos.) Docetaxel + Lupron again. )

Here's the link to all the answers: healthunlocked.com/advanced... I hope that helps.

My husband underwent the standard of care 6 full-dose infusions every three weeks. Since the follow-up scans showed his mets "were reasonably stable," the MO asked if he wanted to keep going a bit. So he got #7 the day of the consult since we were there. We'll need to talk with the oncologist about a possible #8. That number seems to be recommended as balancing stable results with quality of life. Since my husband is getting some neuropathy, #8 is scheduled though not locked in until we see the MO. Thing is his hospital is reporting Covid-19, and even though some people on this board say don't panic, it's overblown, etc. that's yet another factor to consider if we follow our usual no-panic-but prudent course.

Do you know what your chemo regime would be, i.e. what's the drug, how often, and what dosage? I've come across the phrase "maintenance chemo" but haven't looked into that yet. Maybe that's what your MO is talking about. Right now I'd like to have maintenance wine, chocolate, and steak. I hope the link helps.

[Tall_Allen]

There seems to be some confusion over the term "chemo." Chemo is usually taken to mean cytotoxic chemo, which for prostate cancer means 6 infusions of docetaxel 3 weeks apart. It is never taken for more than 10 infusions at a time. When docetaxel stops working, another kind of chemo, Jevtana, may still work.

Lupron, Xtandi, Zytiga, and the like are hormone therapies - they prevent the androgen receptor on the surface of the cancer cell from getting activated. They may be taken for years. Lupron is taken permanently, the others only until the cancer becomes resistant to their actions.

[Shepard in reply to Tall_Allen]

When I first met with my "infusion" doctor. I asked him about doing a Genotype. He said he would do that. During the last two meetings, when I ask about results - he avoids an answer. This week he did say that - "you do not have small cell!" He seemed to be somewhat stressed out so I did not press it. I can not travel long distances and need to return to the farm each day so I will have to make this work. I had asked the question about number of infusions because Summer is approaching and plans need to be made for the farm.

[Tall_Allen in reply to Shepard]

Why would you be concerned that you have small cell (it is rare)? Have you had a biopsy of any of your metastases (not your prostate)?

[Magnus1964]

Tall-Allen has given a good overview of treatment protocols. Can you give history of PSA readings? It might help with further explanations.

[Shepard in reply to Magnus1964]

My PSA range has been 9.96 in 2011 at the time of radical prostatectomy , then it wavered in the single digits thru IMRT. I was then given Lupron once every six months and Bicalutamide (8-2014). PSA then fell to less than one for almost four years.

Suddenly it rose to a peak of 166.96 (6-2018) I began Xtandi along with Provenge, it dropped to 34.5 and was then given six months of Xofigo for bone mets. (8-2019) PSA fell to 21.4 I continued on with Xandi and Lupron. 1-7-20 PSA rose to 96.4. After three treatments of Docetaxel (one per week for three weeks then one week off) PSA was 109. So at present: no Xtandi. Lupron every three months and Xgeva monthly. Blood values are all within range. Thank you for responding.

[vandy69]

I have had 19 infusions of Docetaxel/Carboplatin chemo combo over the past 2 1/2 years (2 rounds of 6 cycles and 2 rounds of 4 cycles). We have used Xtandi as a rechallenge between rounds 1 and 2, but have used Xtandi PLUS chemo for the most recent 2 rounds.

This treatment plan continues to work for me, as I have mets in lymph nodes and liver. PSA currently .8, down from .9, 3 weeks ago. MRI of liver in April will give us status of lesions.

Best Wishes. Never Give In.

Mark, Atlanta

[j-o-h-n]

What a bitch.... to have to work a farm and to treat your Pca.... Farmers have a tough life... So I pray that somehow someone can watch the farm while you travel to see a new and better oncologist. Keep on Keeping on....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 03/19/2020 5:29 PM DST

[Shepard]

I do have another option which is the VA. Visited with the oncologist there in 2019 before beginning Docetaxel. He said he would assign a similar treatment plan. 3-17-20, my PSA regestered at 90. I know this is not a perfect tracker, but there was some comfort in seeing it go down. While I am limited in travel with a working farm, I think the farm has been an asset in this journey which began in 2010. Certain tasks must be completed each day and there are no excuses. I have a reason for being here today and tomorrow. Sometimes it is fun to find the work-arounds that I must use due to loss of muscle mass. Fresh air and exercise are part of the therapy. A couple of years ago, I considered moving to a assisted living facility. Today, with this virus, I feel much safer alone on the farm with my six dogs and livestock.

[Shepard in reply to Shepard]

Update: After 12 infusions of Taxotere, Doctor halted it because PSA has stalled at 90. Doctor reported tumors in abdominal area had grown. I ask about Jevtana and he said he would have to study scans. Also said he may want to needle biopsy abdominal tumor. He did not say what he expects to learn from the biopsy. In the past, he has resisted Genotype tests. I ask him about a "rechallenge" with Xtandi; he did not think it would do anything. So now I am wondering what next? Is there a next? Bone scan showed little change from six months ago. There are lung mets, but he did not seem interested in these at this time. I will be consulting with a Urologist that I have been seeing for the last ten years in about two weeks.