After Docetaxel + Hormonotherapy?

[JNunes]

Hello,

I would like to ask, what is usual to expect after Docetaxel + Hormonotherapy?

Thanks.

[Cleodman]

Not sure about the question? Do you mean the disease or side effects or something else? What stage and Gleason is your cancer?

[JNunes in reply to Cleodman]

My father was diagnosis of prostate adenocarcinoma, Gleason (3 + 4), initially staged with a T2b N0 M0, last year, at the age of 60.

On May 1, 2019 he underwent radical radiotherapy without hormone therapy. Completed treatment on May 22, 2019. 5 intense sessions. PSA after treatment dropped from 9.3 to 7.6.

However, starting in March 2020, he had biochemical recurrence criteria, underwent examinations and presented bone and ganglionic metastasis with a PSA of 47.5.

It was suggested by his doctor to do hormone therapy with an LHRH analogue and evaluation in Medical Oncology to perform concomitant chemotherapy (docetaxel).

He also started with the treatment (just one session).

[Cleodman in reply to JNunes]

Yikes that is pretty aggressive for a Gleason 7. Yes the current standard of care would be Lupron or similar and chemotherapy for 6 cycles and see how he responds. He should respond pretty well for several years I would think. The side effects are not pleasant but I worked the entire time of chemo except days 7-10 after the infusions.

[JNunes in reply to Cleodman]

I think something is wrong with the diagnosis. I wasn't supposed to be in this situation right now: /

[Cleodman in reply to JNunes]

I’m a little surprised that radiation was used instead of surgery. Was surgery an option?

[JNunes in reply to Cleodman]

I cannot say because I was not at the multidisciplinary consultation.

I think that at least it was not placed as the best chance for his problem. The radiologist say after treatment that everything went well, and said to my father that he doesn't worry about the prostate anymore.

[DarkEnergy in reply to Cleodman]

Why would "surgery" be an option, given the diagnosis, "T2b N0 M0", so wondering your assertion?

This was in a diagnosed curable situation, furthermore, even knowing now that it became spine (ganglion) mestatisis.

[Cleodman in reply to DarkEnergy]

Yeah T2b Gleason 3+4 would be radical prostatectomy all the way for me. Maybe is a Gleason 5 or 6 I would consider radiation but that is just my 2 cents.

[DarkEnergy in reply to JNunes]

So, the prostate biopsy resulted in Gleason 7, what scans were taken to stage the T2b, N0 and M0 findings?

[Hidden]

Sounds like he's on a good treatment plan. I've been through chemo and it was well tolerated for me as it is with most. I sat around a lot for the first 5 days of each cycle, but still able to do light chores around the house and even cooked. I never lost my appetite (I actually gained weight) and never threw up. Had runny eyes and some diarrhea, leg and ankle swelling, but that's about it. It all went away.

He's probably going to see his PSA decline from the combination of the androgen deprivation therapy and chemotherapy. Sometime down the road, hopefully in long time, he will eventually become castrate resistant and need to add another drug like Xtandi or Zytiga. That could be a long time from now so you just have to put one foot in front of the other with this disease. That's what I had to do, especially at the beginning when everything was so overwhelming,

Wishing the best for him and you.

[JNunes in reply to Hidden]

It has been difficult to accept that the disease could have been better controlled at diagnosis. I don't know...

Our family has been very discouraged.

We are afraid, because it looks like a sentence.

[Hidden in reply to JNunes]

I know where you are at from the patients side of it. It's tough to take for sure and scary because you don't what to expect. I went straight to stage 4 with a PSA of 463 at diagnosis. I was in total shock, figured I'd have a year to live at most. Here I am 3 1/2 years later and my life is fantastic, even with cancer.

Do everything I can to fight the cancer, but I'm also determined to have the best life I can have as long as I can.

I do remember how it was in the beginning. I found that just taking one step at time kept me from being overwhelmed. Like: the next step is I have to have a CT done or the next step is I have an appointment with the doctor, etc. and just get through things one step at a time.

Don't be afraid to reach out for help. I got some counseling that really helped me a lot.

[rust in reply to JNunes]

A sense of discouragement is expected but not permanent and not necessary. My father was diagnosed about age 74 with stage 4 and lived until age 83. During this time I was diagnosed at age 44 and my father inlaw now is in stage 4. I suppose in my own way I have accepted that I have disease. I will pursue the best treatment avaialble. I recognize that I am mortal and that I will die. I do the best that I can to not let worry and anxiety of what lay ahead ruin the days that God has given me to live no matter how numbered. Disease and poor health can rob the patient and their loved ones of happiness and time if we dwell too much on it.

[JNunes in reply to rust]

It has proved difficult.

I wake up and always sleep with this problem in my head.

If there is anything else I can do to help him please let me know.

Thanks for your time.

[Magnus1964]

I am surprised he didn't receive an ADT drug before and during radiation.

To answer your question an ADT drug would be the next step. I would start with Lupron then add casodex if needed.

[JNunes in reply to Magnus1964]

I wonder if biopsy would be right.

I don't understand why since September 2019 when the radiologist told him to think about his hypertension, that he didn't have to think about the prostate anymore, they only did tests after 6 months. From the little I've read, biopsies sometimes fail ... :/

[Tall_Allen]

Here's the optimal sequence:

prostatecancer.news/2019/12...

But maybe Xofigo if there are bone metastases, pain and no visceral organs are involved.

[JNunes in reply to Tall_Allen]

Thank you so much again.

[binati]

If it was a truss biopsy it might not have correctly located the full extent of the tumour(s) or lesions. In that case the treatment might have not been adequate for the stage of the disease. That is the only reason I can think that this turned to BCR so quickly.

[JNunes in reply to binati]

Sorry, but what BCR means?

Thank you for your time.

I am open to recommendations that can help my father to better results.

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

Sorry, but what BCR means? YOUR QUESTION, answered by Tall_Allen 11 months ago.

Tall_Allen•

11 months ago

While there is a standard definition of biochemical recurrence (BCR) after prostatectomy (i.e., confirmed PSA ≥ 0.2 ng/ml), there is a confusing array of definitions of biochemical recurrence (BCR) after salvage radiation (SRT). I'm not sure that we're ready for a standardized definition yet. And perhaps the definition of the FIRST BCR bears scrutiny.

pcnrv.blogspot.com/2019/08/...

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 07/09/2020 4:59 PM DST

[Bodysculpture]

Thank god for chemo I say

I was in loads of pain had to quit my job as a result

I had mets all over the place

Sturnum ,shoulders ,pelvis ,spine and ribs

After treatment

Very small residual amount left 7th and 8th rib

Clear everywhere else

Moving on to targeted radiotherapy to the prostrate on the 21st

K would be back to work if not for Covid

I feel 100% better now

It was worth the days of fatigue and hair loss

My PSA is now 1.54

It was 13.5 when diagnosed

My hormone drug is Decapeptyl

My side effects were mild

I trained most days after chemo

I am a bodybuilder

I find resistance training works wonders for restoring energy keeping my appetite and strengthens my body

I am very appreciative of what medicine has done

[JNunes in reply to Bodysculpture]

Thanks for your sharing.

[Hidden]

JNunes, sounds normal. For example, in 2003 at age 56, I had Brachytherapy followed by 25 sessions of IMRT with a PSA of 6.7. I was given a 92% success rate. At 10 months I had two mets. My research medical oncologist told me to not second guess my primary treatment as minute cancer cells had already escaped. This is called micro-metastasis where the unseen cells travel through the lymphatic and vascular systems. Kind like the lick of the draw.

In 2004, I immediately enrolled in a six month chemotherapy plus hormone therapy trial. I was most fortunate to be able to stop Lupron in 2010. Today, at 73, I remain undetectable, <0.1 PSA.

Keep killing the little bastards. Worrying is your enemy. You are on the right track. Should your cancer progress, Tall Allen has shown you a typical progression of magic bullets in case you need them.......

Gourd Dancer

[JNunes in reply to Hidden]

Thank you for sharing your story.

We need hope.

[pwallace in reply to Hidden]

your story really is v inspiring 💫