Hello - I'm 53 and have gone through an RP and subsequent radiation without any luck. I was Gleason 7 (3+4), PSA 5.2, aged 49 at onset. Currently my PSADT is three months. My PSA was last measured at 55 in June. I recently underwent a bone scan and a CT which found three probable bone metastatis on my pelvis, L3 vertebrae and fourth rib.
At this point my urologist/oncologist will want to start hormone therapy. He had been holding off until I had evidence of actual cancer. Prior to my appointment next week I received some feedback from an oncologist friend that Docetaxal is sometimes used ahead of the initial hormone treatments. Does anyone have experience with this or know the pros/cons of this approach? Also, I am in the Akron/Cleveland area and if you have a dedicated oncologist you'd like to recommend, I'd love to know. Thanks!
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OhioGuy2
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I went with Docetaxal while using Lupron and Casodex. Very glad I did being it killed most of my cancer. Original psa was 850, 4 mets and numerous lymph mode involvement. Highly recommend the stuff, it isn't half as bad as many people think. If your willing to drive to the Detroit/Ann Arbor area I know two excellent oncologists.
Docetaxel is done together with hormone therapy, not before as far as I know.
I did this after diagnosis and like Fran2020 my side effects were very tolerable.
Some benefits to doing early chemotherapy are: it's been proven to extend life, you get it over in 18 weeks, and it's going after the full spectrum of cancer cells, not just the hormone sensitive ones.
Docetaxel is used together with Lupron, not before. Alternatively, you can use Lupron together with Zytiga, Erleada, or Xtandi. If you do docetaxel + Lupron first, you can move onto the advanced hormone therapies in just 15 weeks.
If Ann Arbor isn't too far away, there's Joshi Alumkal at U of Michigan.
As soon as I was diagnosed with APCa in Dec 2019, age 59, GS 9 and PSA 50, I started Bicalutamide (Casodex) 50mg and two weeks later had my first 3 month implant of Lupron (Eligard). A week later I began Chemo (Docetaxel) with the last shot (no. 9) finishing 3 weeks ago. This week I commenced 20 sessions of VMAT (60 grey) radiation therapy. My understanding is this is the recommended standard sequence for someone in my situation. The ADT works to prevent testosterone feeding the cancer, the Chemo is intended to kill it at the micrscopic level and the Radiation is targeted at the cancer which we can see. My PSA is currently at 0.03, my cancer sites (prostate, bladder and pelvis) have all shrunk and we hope the radiation will finish them off. Fingers crossed🤞 I hope my journey helps you with yours. It's a shitty hand that we've been dealt, but we have to play as the stakes are high. You've got this Ohio, cheers 😎DD.
I did a search of our past posting database and came up with 3 names (and comments) you might want to look into for your treatments. These are NOT my recommendations but were recommended by other members and may be out of date: Keep posting here this is a good site for help....(All 3 in your area?)....
Nima Sharifi, MD
Dr. Ornstein of the Tausig Cancer Center of the Cleveland Clinic.
I see Dr. Moshe Ornstein also at Cleveland Clinic... he has a great office manner....I write down questions and he patiently answers them when we meet...friendly...
Thanks for the recommendations. I currently see Dr. Jayram Krishnan at the CC (who I really like) but he is primarily a urologist who does oncology expertise. I'm thinking about adding a FT oncologist to my team.
In 2004, with mets to T-3 and L-2, I immediately underwent a Chemotherapy with Hormone therapy trial. It worked for me. Stayed on Lupron for another six years...... my guy was a research medical oncologist specializing in genitourlogic cancers - kidney, bladder, and prostate cancer, I found him in academia at a major medical school. He was a professor and researcher.
Good luck. And kill those little bastards while your body is strong and the tumor burden minimal.
My MO told me a few years ago that a small percentage of men go immediately to chemo in the case of a BCR if their experience with ADT as an adjuvant to their primary therapy was so horrific that they can't imagine repeating it.
Since then, however, there have been a few developments: bipolar ADT, Relugolix (faster T recovery), and high-dose transdermal estradiol that are much more tolerable than LHRH agonists/antagonists, e.g., Lupron.
TallAllen: What's your take on this, if I may ask?
Completely agree with Exrunner here. The AUA guidelines are great talking points with your MO, e.g. a look at "Metastatic Hormone-Sensitive Prostate Cancer" gives the newly diagnosed metastatic patient some options of ADT + hormonal (e.g. Zytiga) or ADT + chemo. Since my burden was so high 4 years ago (same age as you, Ohioguy), it was my choice for ADT + chemo + radiation to 3 bone tumors. Good luck! - Joe M.
I do not have a name for you but I would get a 2nd opinion at James Cancer Center in Cbus. I saw Dr Jorge Garcia at CC but he moved to Miami. I would think your urologist knows the the top Oncologists at CC.
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