I was told after diagnosis and RP that Lupron was SOC and not a candidate for chemo or RAD. After all their high dollar stuff quit, then my MO starts me on docetaxel. Question if I may, did you do anything with the docetaxel? It would seem you have had a better response than most I have read about, or what the drug claimed to do.
I did Docetaxel chemotherapy plus 10mg Prednisone along with ADT at diagnosis. I didn't do anything additional.
After a year, my PSA started rising quickly, doubling every 3 weeks so I was wondering if doing chemotherapy had any effect. My doctor said he often sees this with patients who do early chemotherapy. Now I'm wondering if the benefit is longer-term since I started Zytiga 3 years ago and have had an undetectable PSA for almost that entire time.
There's been an update to the CHAARTED trial and they are still seeing a long- term benefit in overall survival for high-volume patients that did early chemotherapy, but not for low-volume.
At median follow-up of 53.7 months, median overall survival was 57.6 months in the docetaxel group vs 47.2 months in the ADT alone group (HR = 0.72, P = .0018). Among 513 patients with high-volume disease, median overall survival was 51.2 months vs 34.4 months (HR = 0.63, P < .001). Among 277 with low-volume disease, median overall survival was 63.5 months vs not reached (HR = 1.04, P = .86).
My husband has low burden mets or however you say it...single suspicious bone spot and several lymphnodes. He is G9.
His MO is at UCSF. I asked her if adding chemo to Jim's case is relevant (he's on Lupron, Abiraterone, and prednisone)She said the data didn't support chemo for my husband at this time. She gave no further explanation.
There hasn't been a proven benefit for patients with a low disease burden. It's also harder to prove a benefit with patients that will probably live for quite a long time anyway. Those of us with a high disease burden are often the ones that benefit from adding additional treatments.
I wonder if part of the reason could be that SOC is in part driven by third-party-payer dynamics... do insurers pay for early chemo more reluctantly than for later chemo? Docs need to fight insurers on things as cheap, simple and logical as DEXA scans, after all, so that wouldn't surprise me.
Some docs, like Bob Liebowitz (of Compassionate Oncology), have promoted the early use of chemo along with ADT for several decades now for nearly all PC patients. Although still a minority approach, the science increasingly seems to back this approach, so far as I can tell.
Appears to me that you do certainly have remaining cancer ( micro-metastasis) and are now becoming castrate resistant. So you need to change up treatment. That could be either adding abiraterone to ADT, or going to chemotherapy (docetaxel is first line) followed by going on to ADT with abiraterone plus prednisone. Either seems reasonable to me and I see no fault in your reasoning. Good luck amigo.
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