In my limited research on chemotherapy for prostate cancer I have come to the conclusion that it best to start such treatment before one becomes castrate resistant. True? How early is too early? How late is too late. Can it be combined with other TIP agents? I want to be as proactive as I can be.
When to say YES to Chemotherapy. Ear... - Advanced Prostate...
When to say YES to Chemotherapy. Earlier? Combined with other RX
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ronton2
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I was about six months into Lupron and Zytiga/Prednisone, PSA <0.01, then started Taxotere. I'm in the mindset along with the Dana-Farber Oncologist is to hit it hard and early. Also, consider, not long ago, Zytiga and Taxotere were only approved for mCRPC patients.
A good read:
grandroundsinurology.com/dr...
Your reply is very helpful. My research shows similar response from clinicians and patients.
This discusses the answers to your questions:
prostatecancer.news/2019/02...
Doesn't really give a lot of hope for docetaxel except in small increments.
I don't understand why you'd say that. I come to the opposite conclusion- docetaxel is certainly one of the best PCa medications.
Maybe, but the success percentages seem small. I haven't used yet but it's next up. I suppose it works well for some.
I don't know why you believe that - what are you looking at? The only problem is that some patients wait too long to use it. By the time they use it, nothing will help very much.
Maybe I'm not fully understanding your point. It happens on these forums. I am metastatic with 3-10 bone mets (some are very small). On Lupron for two years, PSA stable at 0.7-0.8 all that time. Uptake on last Pet Scan in August was noticeably lower in all respects compared to prior two Pet scans.
My point is that docetaxel is the best medicine we have (along with the advanced hormonals) for metastatic PC. Randomized clinical trials have proven their benefit - and that is the only way to prove their benefit. Sadly, some men are lulled into not using them soon enough by thinking short-term ("I feel fine now" "PSA is low now" "PET scans look good now") instead of comprehending the natural history of the disease. Early use has much greater benefit than postponed use.
Yes i understand now. My MO and I are discussing docetaxel. Sounds fairly tolerable from what I'm told.
Really excellent breakdown of so much research. Well done Allen.
I have copied the information and will certainly pursue it. Thanks
It's kind of a crap shoot. Hit the cancer hard early or after castrate resistant. Chemo can reactivate some ADT drugs.
I had little choice, as I was diagnosed at Stage IV. Surgery was ruled out, so that left ADT, Chemo and Radiation. And that's what ended up happening and in that alphabetical order. I started all that 10 months ago and it proved to be a successful treatment regime. I guess you play the hand your dealt and dance to the tune that's playing. For me it was a strange kinda doseydoe..... 😎DD.
My dad was diagnosed almost 6 years ago and it’s metastasized to his bone since the beginning they treat him with shots, pills and a little radiation no chemotherapy he is older so I really don’t know what or how doctors base there treatment good luck
My Oncoligist informed me that early intervention with chemotherapy is proven to be more beneficial...same with Provenge. Do everything you can to monitor and keep the tumor burden as low as possible.
I was diagnosed in May with Stage 4 PCa. They started me the next week on Taxetere and Firmagon. At diagnosis my PSA was in the 800s. It is now 0.6. No new mets. I am trying to talk someone into putting me on Xofigo to address the widespread bone metastases. I am done with chemo and just on ADT now.
I appreciate the urgency of treating you with chemotherapy. Getting targeted MRI's is so important. Glad you a responding so quickly and well to treatment. Tall-Allen's response is one I would heed. You need additional agents working for you.
In 2004, I participated in an early chemotherapy with hormone therapy trail. The following is a quote from my researcher as to the background of the clinical trial:
“The delivery of chemotherapy in a setting of hormone refractory prostate cancer has shown palliative benefit, with substantial PSA decline, strongly suggesting that disease modifying potential exists. Recently, chemotherapy is being reported to show a survival advantage. The stage is set for chemotherapy to be given earlier in men with prostate cancer. As a working hypothesis, transformation from an androgen-dependent to an androgen-independent phenotype is mediated by the expansion of an androgen-independent clone already present at the time of androgen deprivation. If this model is correct, then it would be desirable to bring treatment to bear on the androgen-independent component when the corresponding tumor burden is minimal. We view the androgen-independent component as analogous to “microscopic residual” or micro-metastatic disease for which adjuvant chemotherapy has shown to be effective in other contexts.“
You want to apply a little logic. Which is better, early chemo when the body is strong and the tumor burden minimal to withstand the chemotherapy or the reverse, a body weakened by the ravishes of the disease as the tumor burden grows. Taken with ADT is today a given. For me, a test......
There is something about the synergy of ADT along with chemotherapy. If you read my posts over the years, you will quickly find that I am a proponent of chemotherapy with Lupron/Eligard as a first measure upon the discovery of metastatic lesions. So I am biased. It worked for me.
Good luck,
Gourd Dancer
From the study TA recommended-
"The "sweet spot" for docetaxel seems to be after there are detectable metastases but before castration resistance is fully established. Used earlier, it seems to have no effect in most men; used later, it is still effective, but less so."
Thanks for flagging this V10s. I am keeping a notebook on all responses. I want to be prepared for every eventuality. Will discuss with my oncologist at our next session in Jan.
V10, yes the study shows that; and my mets disappeared and multiple scans show only new bone growth; however, my understanding from my research medical oncologist is that his study showed beside killing the detected mets was the killing of the unseen cancer cells. Those cells which are considered micro-metastasis; floating around in your vascular and lymphatic systems just looking fir a place to grow and colonize. Systemic treatment like chemotherapy is what kills!
GD
After getting diagnosed with Pca, many ppl feel they want to do all they can to kill the Pca, so they seek surgery, and often this does not work to get all Pca so they all have a long fight ahead to stop Pca from killing them sooner rather than later. But I had so much local Pca inside and outside my PG capsule that I was inoperable in 2009, age 62, Psa at 6.
So I had ADT plus RT added, but these didn't kill Pca, just put my Pca to sleep to slow down its growth, and that lasted from 2010 to 2016, and at this time, the standard best treatment for where surgery was not effective was ADT, not chemo. Chemo is well known to not work very well for Pca, and had I began with chemo, it sure would have failed with me, as I found it did in 2018. But if I'd had chemo early, I would have suffered the awful side side effects for many more years than needed. So first the docs gave ADT, then when this fails and Psa begins rapid rise the add-on drugs like Cosadex, Zytiga of Xtandi are used, and these may give another year or two of low Psa and good QOL. I also had some salvation IMRT to PG but this had little effect because it seemed my Pca was resistant to high power X-rays used in EBRT or IMRT. After all known hormone manipulation drugs failed, it was then time to get chemo in mid 2018, which was often thought of last-resort treatment, or a desperate attempt to stop the unstoppable, and my oncologist said chemo probably would not work with me and after 5 doses it didn't lower Psa but Psa quadrupled from 12 to 50.
But I'd read all about Lu177, and this new treatment had become available in Sydney in 2016, so my onco referred me to get Lu177, and Psa was 25 before I began Lu177 in Nov 2018, and now its 7, after 6 doses of Lu177. I am cycling quite fast and doing 200km+ a week on bike, and able to do lots of hard work around house when I need to.
I have quite a few mets in bones to try to get rid of, but chemo just had almost zero effect on any mets. The ADT and add-on drugs did not seem to kill any of my Pca, and only slowed things down. But Lu177 seems to have gotten rid of all soft tissue mets and many bone mets. Five PsMa Ga68 scans have shown what Lu177 has done for me, and also what it has not done, and very small new mets that are now seen in my bones are a big puzzle for docs now because Lu177 is supposed to work on very small mets even if they don't show up in PsMa scans. I had a talk to one doc at Theranostics Australia last Friday, about results of 9th PsMa scan 2 weeks ago, and she's a very clever doctor, but she will talk to two others who manage difficult cases at TA and then exactly what is best will be decided on basis of likely Pca effect and least side effects. So my fight sure ain't over. If new small bone mets keep on showing up in PsMa scans and Lu177 only works on those then it backs up my theory that I may have hundreds of small bone mets, and as they all grow bigger I'd need to continue Lu177 for many years but this may destroy my bone marrow and I get leukemia or have other side effects that are deadly. Nearly all known treatments are only effective for awhile for many with Pca. There are ppl who get weak versions of Pca, and one dose of ADT and one of chemo gives remission, and one dose of immune therapy such as Provenge works, but for many of us, no such remission is ever going to happen so 30% of men diagnosed with Pca die from effects of Pca combined with side effects of treatments. Statistics are often incorrect because cause of death on death certificates is written down as bone cancer, lung cancer, liver cancer, but really it was Pca which had spread and become un-treatable, so I suspect the % of men who die from Pca after diagnosis is much higher. All these men have tried to fight it. Its often slow growing, so it becomes a chronic condition, quite different to say pancreatic ca which can kill in 6 months, and I have known a man who just had no time to think about what might be best treatment, and the little treatment he did get was not effective. Same of ovarian ca which killed a sister of mine at age 60, and same for melanoma which killed my dad at 60yo in 1973 when almost nothing could be done about many cancers if you got diagnosed.
I might have more Lu177 next year, maybe a little Ac225 added, and then run the risk of side effects becoming very bad. So far, I have few side effects after 6 x Lu177 doses, not even a dry mouth, which is main side effect.
I have no idea what docs will tell me in a week or two, but it seems to me they are a good team, and very interested in seeing me well, because their business is to get patients into remission, and they do manage this with some patients. There is nothing that the local Government owned public hospital could offer me after ADT, RT, add-on drugs with ADT, and chemo. So I can only get Lu177 without any Medicare funding so its usd $7,000 per dose of LU177. Although Lu177 is available here in Australia, its not yet approved, so I had to fail with chemo to get Lu177. At least my good team at the local public Canberra Hospital did all they could for me, but knew where to send me when they could do no more.
I may get Provenge, its another huge expense, but also has side effects, and so when I find I've had every potion possible and have bad side side effects, I may have to admit defeat, get my affairs in order, and prepare to die and I hope the low dose fentanyl keeps the pain low while palliative care workers see me out.
Meanwhile, its time to head out on a bike ride,
Patrick Turner.
Patrick, What an ordeal! You have a stalwart attitude. We don't have LU-177 available here. I am collecting information from all who have responded. We each have to make our own decisions. I do think systemic treatment is best. This may mean chemotherapy for me in the future.
I saw your reply to me below also. Your statement “Chemo is well known to not work very well for Pca,” is simply incorrect. The stampede and chaarted trials emphatically showed their benefit when given early. And the side effects of chemo are typically short-lived, which is why some people prefer it over abiraterone.
Lutetium PSMA only works for a small subset of men.
Earlier does seem to be better, based on the stampede and chaarted trials. In the UK docetaxel up front is now standard care. I was “low volume” by the chaarted protocol, but I did it anyway, based on stampede results .That was 4 years after my initial treatment and after a recurrence.
The docetaxel was nearly 4 years ago, and I’ve been off all treatment since. My psa has slowly risen to 0.277 in that time. So it certainly worked for me !
Amazing. So glad you responded so well. The consensus seems to be for earlier/proactive treatment. What a wonder to be free of cancer and off treatments. Hooray for you!
Yes, but even though your Psa is low after chemo, what next? it is possible a mutant form of Pca now is increasing and causing Psa rise, so what will you do when Psa is 2.7 in months ahead?
Men often think they have defeated Pca when Psa noze dives to a low level after some treatment. Often they will see Psa rise and RISE, and they will need a pile of more treatments. The time Chomo is fully successful would be if Psa went < 0.01 and stayed this way for 5 years+ and without any kind of treatment a can only say he's had remission for 5 years. It could still make a return if few live Pca cells manage to survive chemo and grow.
I survived 1 year more with Lu177 with Psa going from 25 to 0.32. But then Psa rose back to same level 1.5 years after I began Lu177. Now with 2 more Lu177 doses, Psa is 7, and flat lining, so docs cannot tell me yet if having more Lu177 will do me any good. They will confer, then tell me soon.
Patrick Turner.
I wish you the best with the LU-177 treatments. Thanks, too, for your cautions about PSA.
What’s next is cabazitaxel and all the other treatments you mention, none of which I’ve had yet.
I had CT and PSMA scans before I started docetaxel to locate and measure the tumors. I had the same scans after 6 sessions which showed a 40% reduction in there size . PSA is one measure, but scans are needed too. Be careful not to treat PSA, it's just an indicator, 😎DD.
I will make sure to consider this before any such treatment. So helpful!
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