6 or 8 rounds of chemo

Hi all,

My dad has completed 6 rounds of chemo (docetaxel) and his PSA reduced to 0.3 and the prostate size is 27x26x29. Today is 3 weeks after his 6th chemo round, he came to meet his doctor and she suggested him to consider to take 2 more rounds of chemo. She says 8 rounds of chemo often gave the best result and asked him to consider if he wanted to continue.

Could you kindly advise whether my dad should take 2 more rounds of chemo or not based on your experience and knowledge. Considering my dad health, he can take 2 more rounds but he doesn't want. If doing it gives a better result, he will do it. We should reply to the doctor by this week so really appreciate if you guys can share with us your experience.

Thank you in advance,

[spouse21]

This is a hard decision. It's understandable that your dad had an end date in mind, and now the oncologist has another. I don't have a link to a study that found eight rounds gives the best result. Maybe someone here will weigh in with that.

My 76-year old husband was in a similar position after Round 6. Since he had tolerated the chemo "well," he had a full 7th dose. Then he had three more doses at 75% strength. His oncologist said he could stop anytime. He decided to go forward to ten rounds since the chemo stabilized his many, many mets. The chemo did seem to go on forever--close to eight months. During the later rounds, those post-chemo side effects that kick in around Day 3 started to last 4-5 days instead of 2-3. I feel for the both of you since the schedule, the infusions, and the tensions of getting treatment during Covid are so stressful. Other note: during the two "off" weeks, my husband pushed himself really hard to exercise, bicycling 25-30 miles several times a week to strengthen his body for the next round.

So that's my husband's anecdotal experience. Mind you, he got late chemo treatment, after his body was already walloped by six years of Lupron, radiation, Zytiga. Your dad is getting first-line chemo, so presumably he's in better shape to tolerate more chemo. I'm just sharing this experience, not giving advice, since I'm not an oncologist though I sometimes feel like one!

[Hidden in reply to spouse21]

Many thanks Spouse 21 for your sharing! May I ask if you can share your husband's PSA result after the 6th round and his most updated PSA? My dad already experience post-chemo side effects started around Day 3 and lasted 4-5 days. All the best to you and your husband!

[spouse21 in reply to Hidden]

Hi, again, Dawn. I'm going to update my profile, so you can check for my husband's treatment history. But quickly, here are his PSAs from start of chemo until now. (PSA not always tested monthly.) Mind you, he's always had a cancer type that expresses very little PSA though the oncologist did watch for trends. He remains "low" right now and has had good ALP numbers (indicator of bone health), but take it with a grain of salt since everyone is different. He's been on Lupron since July, 2019 and had it from 2014-2017 as well.

PSA HISTORY DURING CHEMO PERIOD 2019-2020:

8/19: 0.64 (this despite many mets discovered while on Zytiga)

10/19: 0.66

11/19:

0.69 (right before starting Docetaxel) #1 infusion

0.77 (#2 infusion)

0.60 (#3 infusion)

0.53 (#4 infusion)

0.39 (#5 infusion)

0.32 (#6 infusion)

0.30 (#7 infusion)

0.37 (#8 infusion 75% dose)

0.36 (#9 infusion 75% dose)

0.38 (#10 infusion 75% dose)

[Hidden in reply to spouse21]

Dear Spouse21, thanks for your reply. Could you kindly help to confirm if the PSA after 10th infusion increased or decrease? I read your profile before and it says PSA of 0.32. Thank you!

[spouse21 in reply to Hidden]

See my response below. DO NOT BASE YOUR DECISION ON ONE PERSON'S EXPERIENCE. I am very sorry I responded by giving you the PSA record. All I wanted to share was my husband's decision to have more chemo infusions. We got that advice from our oncologist, not from Health Unlocked.

Follow your oncologist's advice, or get a second opinion from another oncologist, and listen to your loved one's wishes. The changes in my husband's PSA were tiny and likely meaningless. His own oncologist barely tracks PSA because my husband has an uncommon kind of cancer for which PSA isn't especially helpful. I urge you to get a second opinion from another oncologist, not a random internet stranger like me.

[Hidden in reply to spouse21]

I'm Dwn80's mother, thanks a lot for your sharing. According to what I read in the above briefings, it seems that PSA of your husband from round 7 to round 10 tend to increase? This information is very helpful for our decision to continue or stop chemo bis to #7

[spouse21 in reply to Hidden]

Please do not base your decision about moving forward or stopping chemo based on my husband's PSAs. Dawn asked me for the record, so I provided it as one of many examples on this site. Your oncologist, and only your oncologist's advice, and your loved one's physical condition, should determine whether to stop or continue chemo.

My husband has an uncommon form of prostate cancer. Each case is different. Even with a high Gleason score, my husband had a low PSA at diagnosis (3.32). Later on, with a very low PSA while on Zytiga, his scans showed many mets. My husband's oncologist does not rely very much at all on my husband's PSA. His progression is mainly being monitored by pain symptoms and images, NOT PSA. So his PSA record does not apply to your loved one's case at all. Please listen to your oncologist and your loved one's wishes to decide whether to stop or continue chemo.

PS. Another huge difference between our men's experience is that your loved one's chemo is first-line treatment he is getting at dx. This is very, very different than my husband's chemo which he underwent after five years of other treatment--Lupron, radiation, Zytiga.

[Hidden in reply to spouse21]

Thank spouse21, don’t worry. We know what should do

[Shooter1]

6 cycles weren't to bad, but had added Xtandi after 4 acct rising PSA. Side effects started to pile on to me after #6. I went 9 and had to quit, combo was really pounding me. Continued full dose Xtandi until I was an invalid and then cut dosage, but pounded cancer into remission. Neuropathy in hands and feet a permanent reminder of a tough fight, but I seem to have won the first battle in this war for survival. Gleason 9/10 stage 4.

[Hidden in reply to Shooter1]

Thanks Shooter1 for your sharing and wish you all the best!

[Tall_Allen]

6 rounds is typical, but some patients do up to 10 rounds. The idea is to let the body recover. But taking a break also can let the cancer recover. The PSA response has been excellent. You didn't mention the bone alkaline phosphatase or the radiographic response, but they are probably good as well.

Here's my question: when you graph his PSA over the course of his chemo, does it seem to be leveling off? If so, maybe it's time to hit the cancer from another direction - Xofigo was very effective with a reduced dose of chemo in the following trial - perhaps email the link to his oncologist:

ejcancer.com/article/S0959-...

After that, he can move onto an advanced hormonal agent (Zytiga, Xtandi, or Erleada). He can rechallenge with docetaxel or cabazitaxel when resistance sets in.

[Hidden in reply to Tall_Allen]

Many thanks Allen! Before the chemo, the MRI showed that my dad had some lymph nodes but not now. In my country, they don't check alkaline phosphatase and only checked PSA twice, after 3th round (0.7) and after 6th round (0.3). We are also considering the PSA, imagine result and my dad health when making the decision. Have a nice Friday!

[Hidden]

So far, it's only been proven that there is a benefit for 6 sycles and no benefit after 10 cycles, but I would suspect there is a benefit between 6 and 10.

I would just look at how well he is tolerating it and whether there is continued improvement in PSA response. There is probably a point of diminishing returns somewhere.

[Hidden in reply to Hidden]

Many thanks Gregg57!

[Shooter1]

My PSA dropped though cycle 7 then stagnated through#9. Xtandi alone then pushed it to 0.13 before I was an invalid...slowed but continued drop at half dose. Undetectable after 2 years. Now 0.08-0.00 depending on test lab three and a half years in. .

[MateoBeach]

There may not be much additional improvement or benefit to be gained after six cycles. So he should not feel bad about declining the extra treatments for now if he chooses to. Perhaps his cancer will retain some level of remaining sensitivity to docetaxel that could be of further use down the road? And advanced androgen meds might restore some docetaxel sensitivity. The chemo will not be curative at this point so it is good to take the long view on strategy. May he live long and be happy even while fighting PC. 💪💪💪🙏🏻