I am 72 years old living in Germany and still teaching out of existential needs. My wife is bedridden with heart insufficiency and in constant pain, with rheumatism We have a brilliant 11-year-old son to care for who is entering 11 grade.
I have recently been diagnosed with aggressive prostate cancer Gleason 8 with metastasis in lymph nodes and cervical spinal column.
I have been advised to begin: ADT ( GnRH Antagonist) in combination with Apalutamid or Enzalutamide or Abiraterone /Prednisolon or Docetaxel.
My questions are which of the suggested medications/therapies should I choose if at all (...perhaps do nothing and just let it alone)?
Have you had experience with it? What are the side effects experienced?
THANK YOU!
Shiva
Written by
Rudradas
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Docetaxel is a Chemo which has more side effects than the other drugs. The other drugs work well and there is no good data to show that one is better than the other. I would choose Apalutamide simply because it is newer than Abiraterone and Enzalutamide.
The first chapter of this review discusses your situation:
The findings from the phase 3 PEACE-1 study (NCT01957436) showed that adding abiraterone/prednisone to standard docetaxel/ADT was associated with an approximately 2.5-year absolute benefit in median rPFS in this patient population.
If you are otherwise in good health, hit the cancer hard by adding abiraterone and docetaxel to basic ADT, such as Lupron. The side effects of abiraterone and Lupron are basically hot flashes, fatigue and loss of muscle mass. These are the direct result of taking your testosterone down as low as possible. These side effects can be mitigated by regular, weight bearing exercise.
The side effects of docetaxel are easily managed by most men. You will get an infusion every 3 weeks (for 6 cycles), and you will likely feel lousy for three or four days in the first week. There is a lot of information here about that.
I think Prof. Sator is right when he states regarding the PEACE 1 trial: "We do not have data to show that docetaxel adds further value to those patients being treated with ADT plus abiraterone."
Hey Shiva! I too was gl 8. Over six years ago. I’m now 60. I did Lupron with a tak -700 test drug similar to zytiga stopping adrenal production of t . Also I did 8 weeks imrt instead of chemo. I did orchioectomy 2017 allowing me to drop the Lupron shots. I ve had 3 t for this entire time. I am sorry that you have this dx . I Don’t think that you should turn away from treatments. Unless you’re ready for a brutal ending now. End stage isn’t pretty . Your treatments are standard of care . Go for it. Hold tightly on to what you love in this life. Without t you will be diminished . Strength and stamina take a hit. Walk daily if you can ? Good luck Sir! 🍀🙏
Oh yah doc! I am the only on on Hu … I ve always had to be different.🧐😷
Congratulations on having an 11 year old doing school work of a 17 year old. I think you need to hang around long enough to see how that blossoms so I hope you take this advice to heart and do your best to follow the standard of care. Some men do not have bad reactions to ADT. You may be one. Germany is known for having some of the best treatment centers. There is also the possibility of LU-177 that helps some, but not others.
Hi from Australia. We are Gleason 8/9 diagnosed at 71. Zoladex implant 96 weeks and 39 radiation sessions as he has quite high blood pressure so Enzalutamide was not deemed suitable. Chemo was not advised or indicated for his cancer. There are clinics in Germany such as Klinic Marinus Am Stein who might be able to provide alternatives for you. Great outcomes to you and your family.
I'm 70 y/o diagnosed with Gleason 9 (4+5) in Fall 2015. Had prostate removed, but cancer also found in lymph nodes, where it remains and continues to spread slowly. I follow the treatment regiment, which included 40 rounds of radiation, and ongoing injections of 22.5 mg. Eligard (quarterly), 30 mg. Prolia (semi-annually). It's slowed the progression of the disease. My advice is do not become an internet doctor for yourself. Seek treatment with the best doctors in your area, stick to the treatment regiment prescribed, pray, and exercise. You're going to be ok.
Sorry to hear about your circumstances. Aggressive cancer needs urgent aggressive treatment. Your Medical Oncologist is the expert for advising on a treatment plan. As a non- expert I suggest hormone deprivation treatment to cut down the testosterone available to the cancer, plus zytiga to cut out the rest. Also, depending on the spread seen on a Pet Scan, doxetaxal.
Agree with Poowater. ADT plus abiraterone (zytiga) plus prednisone. That leaves apalutamide and enzalutamide for later. Docetaxel may be a good option now (with abi), earlier the better. Best wishes mate.
My husband began with Lupron, which was very effective immediately, and then traveled to St Georg Klinik in Bad Aibling near Munich for hyperthermic treatment and low-dose chemo to compliment the conventional treatment. We are very happy with the treatment he received there.
I prefer to think in terms of the multiple effects of pharmaceuticals rather than the traditional “side” effects. All meds have multiple effects. I too was diagnosed in Germany (Gleason 9 with lymph mets) at age 69 and after some initial reservations I followed Herr Doktor’s instructions. The results are that I am now 73 and looking forward to a few more years. When my scans were read it was also discovered that I have pulmonary fibrosis, which seems to be advancing faster than the cancer. In my case I could no longer urinate when chemo began. After three rounds of Doxy I was no longer catheter dependent and I continue to function today without assistance. That result alone is worth the discomforts of treatment. All my treatment decisions were made by an interdisciplinary board at the Klinikum, which prevented discipline bias, which I think is often a problem in the US approach. In short, I am grateful for the various treatments, even considering the rigors. Life is good and I look forward to a few more years before nature prevails as it always does, overcoming whatever interventions we deploy. Mut, mein Freund, Mut!
If you were younger I would advise the chemo followed by zytiga but given your family predicament I would choose the ADT + Zytiga and get radiation to the prostate and pelvic lymph nodes.
I believe the Stampede trial showed better results for low burden metastases.
I'm now ending my 2 years of my ADT + zytiga course...the SEs were very manageable. If you don't drink coffee in the morning, you will now...I needed three cups to get moving. Coffee is good for you amyway..so that is a plus.
hi Shiva ... sorry that you are experiencing multiple challenges ... here are two websites that you might consider checking-out ... drgeo.com ... envita.com ... best wishes ... Nous
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