My father has been resistant to castration (mCRPC). His PSA (May 2020) is 5.683 ng/ml with new left pelvis and inguinal lymph nodes. I read articles of treatment steps on HeathUnlocked and understand that chemotherapy should be taken before zytiga, shouldn’t it? I understand that chemicals from chemotherapy will be released through passing urine. However, the problem is he has urinary retention at night (not during the day). He passes urine about 8 – 10 times from 10.30pm to 7am. In this case (having urinary retention), can my dad take chemotherapy? Is there a way to make urination easier at night (e.g. medicine, exercise, etc.)? All comments are highly appreciated.
I'm not understanding the problem. Are you concerned that docetaxel will be excreted before it is finished working? If so, no worries on that account - it won't be excreted before it is finished working and it has been metabolized.
Hopefully, the chemo will improve his urinary retention. If not, he can discuss palliative radiation, or TURP to help with that.
I broke down and kept gator aid bottle at bed side so I could just set up and pee at night. Not the most looked for answer but it works. After chemo and prostatectomy I can get from 1100 pm till 7am without a problem. Just another part of living with this insidious condition. Best of luck to you on your journey.
"understand that chemotherapy should be taken before zytiga, shouldn’t it? "
There are different thoughts on Zytiga first or Docetaxel first... some say it's better to do chemo first since it's a relatively short cycle (6 x3 = 18 weeks) versus Zytiga (18 mos).
Check out the studies linked on TA's blog (I searched on Docetaxel for this link) and read up on the Stampede trial...
Hi Timotur, my dad is metastatic and had orchidectomy. I read the studies in the link share by you, I understand that chemo increases the survival in his case. Is my understanding correct?
"CHAARTED showed that the survival increase attributable to docetaxel in recently-diagnosed, metastatic men was only observed among men with a high volume of metastases, but not among men with a low volume of metastases. "High volume" was defined as visceral metastases or 4 or more bone mets with at least one beyond the pelvis or vertebrae. However, a STAMPEDE update showed no difference in overall survival or failure-free survival between the two subgroups. The STAMPEDE authors point to their larger trial and that their analysis applies more to newly diagnosed men, whereas the CHAARTED groups had more previously treated men."
Dawn: yes, if your Dad falls into the "high-volume" group, then, yes, he would benefit from Docetaxel (or Cabaxetaxel). Since he has already had oriechtomy, it would not make sense to do Zytiga first anyway.
Hi Dawn, I was DX in Dec 19, with Stage 4, GS9, PSA 50, with 3 mets on my pelvis and a bladder tumour. I was put on Casodex and Eligard and began 6 x 3 week Docetaxel shots. I have responded well and my last PSA was 0.39. My last CT scan (after 3 chemo shots) showed that my prostrate mass had shrunk by more than 30%, pelvic mets and bladder mass showed only scars. So the ADT and Chemo is working for me, it could very well work for you guys too. I completed my chemo two weeks ago and have a PSMA PET scan coming up soon to see how it all looks now, fingers crossed 🤞🤞All the best, 😎DD.
Hi DD, my dad's doctor asked him to take some tests before providing suggestion of next treatment steps. We are also thinking about chemo. Have you got any side effects from chemo? Thank you and wish you all the best too!
Hi Dawn, yes I experienced the standard side effects. Hair loss, loss of appetite, lethergy and general flu like symptoms. The docetaxel is cumulative and it took me longer after each dose to feel better. After the last shot I developed Neuropenia and am currently receiving Filgrastim injections to get my white blood cell count back up. I have learnt that this is all quite normal with chemo. So I just take it in my stride. What else can you do, its a means to an end and at the end of the day, the chemo is killing the cancer cells. I see chemo as putting the fire out, ADT as the sentry keeping it down and the PSA tests as the smoke alarm. Kind regards, DD 😎.
Not a dr. I discovered Ibuprofen an hour before bed helped with ability to pee. I switched to acetaminophen before chemo as ibuprofen not allowed. Within a week after the first chemo, almost all discomfort was gone. No more agonizing. I still was up maybe 12 times a night. Bedtime lasted many hours. No more Ibuprofen or Acetaminophen needed after chemo started. After 3 years, I'm down to about 3 times a night. (the 1st 2 times are usually snack times, also, a habit from chemo to keep weight up, etc.). Timed podcasts are very good at putting me to sleep. I'm sure your doctor knows best. Best of wishes.
While you mentioned a drug to help your father urinate (Xatral) due to an enlarged prostate, I suspect there is a limit as to how long you would tolerate that condition before taking a more decisive step like a TURP, which is surgical procedure to re-open the passageway. I would hope that that subject has been discussed (TURP) as a potential plan IF / when it is apparent that the current treatment isn't working.
I had acute urinary retention, resulting in a catheter and multiple visits to an emergency ward. Acute urinary retention has the potential to be fatal if left untreated.
I might be wrong in my assessment (hopefully, I am) but I hope that you are aware of it as a possible solution.
Dear Ronny, thank you for your advice. My dad has difficulty in passing urine during night and it's normal in daylight. Anyway, I will carefully monitor his condition. Thank you again and all the best to you!
My radiation oncologist, Dr. Demanes at UCLA, told me under no circumstances should I have a TURP performed after my HDR Brachytherapy and IMRT. I never stated that Dawn's dad shouldn't consider it. They should broach the subject with their healthcare professionals though. Notice that I used the words "can" and "if" in my post.
In your particular case, you state that your TURP was performed before radiation, so it's not even applicable to my statement.
Like you I also ended up in the ER due to retention, was catheterized, and self cathed for months, so I also speak from experience unfortunately.
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