Docetaxel or Erleada.

[palser1]

Hi guys ,

Hope everyone is well today .

So we went to see the oncologist yesterday to have a chat with her and ask some questions about treatment .

It seems her thoughts are still with Erleada and zoladex . She felt that was the best way to go for john . She said there wasn’t that much disease and that she had seen a lot worse and felt that apultimide had the edge on chemo . And that this was a journey and we were at stage 1 .

She is waiting for gene analysis tests and mutation tests which then could make us have a different treatment .

She told me to look up the Titan Trial which I did .

I then looked up the peace trial 1 we really don’t know what treatment we should go for we are just not sure what is the best treatment for him .

So we are going to seek a second opinion and if it differs ask the reasons s why and then try and work out what we think is best . Any help and thoughts would be appreciated .

Thanks carol 😊

[GP24]

I agree with your oncologist. 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."

practiceupdate.com/content/...

[RyderLake2]

Hello, Without knowing your medical history, I would go with the advice of your oncologist. Her advice seems reasonable to me.

[palser1 in reply to RyderLake2]

Hello thank you for replying it’s hard to chose the right option he had a psa of 122 and they put him on casodex straight away in 16 days bought it down to 35. He then had a biopsy Gleason 9 he had a ct scan and mri showed 2 lymph nodes right side and 2 suspion small lesions on spine . He then had a pmsa scan than showed cancer outside the prostate mainly in lymph nodes a line from pelvis to neck the 2 spots on his spine he is 56 active and positive . I have read your bio it’s great it’s all under control gives us hope Thank you

[Tall_Allen]

Docetaxel first, definitely. Better yet, start docetaxel and abiraterone at the same time (as in the PEACE1 trial). Probably it makes no difference between abiraterone or apalutamide, although my impression is that apalutamide has harsher side effects. Or at least start with docetaxel and he can get abiraterone 15 weeks later (at the end of 6 cycles).

If you start with abiraterone, it will most likely be 2-3 years until it fails and you can begin docetaxel. Docetaxel works best if given earlier, and the side effects are fewer if given earlier. The difference in effectiveness and side effects are very dramatic. Also, starting with abiraterone (or apalutamide) puts cancer cells into senescence in which they become invulnerable to docetaxel until the abiraterone fails. The combination prevents senescence and works synergistically.

[palser1 in reply to Tall_Allen]

Well he is on apultimide from Sunday wouldn’t be able to get docetaxel before then so how long does he have to be on apultimide before the cells become invulnerable ? How did it work for you ? Also do you mean just apulutimide and docetaxel or plus zoladex because she said the 3 would be too toxic .

[Christopherg in reply to Tall_Allen]

Tall Allen I would appreciate your advise.

I am still HS

Just started Firmigon because of heart problems

Before was on Lupron

SHOULD I be on DOCETAXEL and a 2nd generation drug NOW instead of just FIrmigon?

I have a 5 week DOUBLING of my PSA.

Restarted firmigon when PSA about 4

Very grateful for your opinion

Sincerely

Chris

[Tall_Allen in reply to Christopherg]

You are in a very different situation because you weren't first diagnosed with metastases.

[palser1 in reply to Tall_Allen]

I know ,I think they were shocked and to be honest they saw 2 nodes in pelvis on mri and ct right side and one spot on t10 and one spot on t12 that said all had to be investigated due to high psa . I’m not confident at all with the oncologist we have. I do nothing but scour the internet but I cannot seem to find one oncologist that specializes in prostate cancer .over here and I’m worried that even if I do get a second opinion from the doctors in France they won’t adhere to it . she was adamant you don’t mix adt with docetaxel and zoladex even though i told her I had read the peace trial 1 in the end I thought I had got it wrong .

I’m just at my wits end to be honest .

But I’m still looking . For that doctor

I’ve got all his results now so I’m making sure I have everything to send them . Do I need images of the scans as well sorry to ask you all this .

[Tall_Allen in reply to palser1]

The radiology report is a good start - if he needs the actual images, he will ask for them.

[Hidden in reply to palser1]

Hi! Whereabouts are you in France? We live close to Agen in SW France, and lucky enough to have a very good Urologist who specialises in PC, who has been treating my husband for PC for the last 9 years. There is a published list in France which lists the top PC Doctors. Our Urologist features in it.

[palser1 in reply to Hidden]

Hi , I’m not in France I’m in Dubai .

[Christopherg in reply to Tall_Allen]

I am metastatic.

WHEN is the time to do chemo?

And how will I know?

My MO isn’t proactive which is a worry.

[Tall_Allen in reply to Christopherg]

Where are your metastases? Did you get them while you were on ADT?

[Christopherg in reply to Tall_Allen]

No before and then as PSA was rising slowly went on Zolodez

This was 11 years ago

I did a PSMA in sept 2019 and it showed 4 small lymph nodes in the medasenal area around the chest area

I then did hypofractionated radiation to that area

I was on Lupron then and stayed on Lupron until November 2020

Stopped to give my heart a break

Restarted Firmigon last week when the PSA was 4

Doubling every 5 weeks

Appreciate your opinion

Thank you

[Tall_Allen in reply to Christopherg]

So you had 4 mediastinal LNs detected only via PSMA PET/CT but they are too small to be identified by CT alone. Although you think of yourself as metastatic (M1a), this would make you "non-metastatic (M0)" as defined in clinical trials so far. There is evidence from two Phase 3 trials that docetaxel would provide no meaningful benefit:

jamanetwork.com/journals/ja...

euoncology.europeanurology....

[Christopherg in reply to Tall_Allen]

Thank you Tall Allen

Good to know🙏🙏

Most grateful

Chris

[Tall_Allen]

It usually takes about 2 months for full effects of apalutamide to kick in. You would always add Zoladex. The PEACE1 trial proved that the combination of docetaxel and abiraterone and Lupron is NOT too toxic.

prostatecancer.news/2021/05...

Can you get a second opinion from Karim Fizazi?

gustaveroussy.fr/en/karim-f...

[palser1 in reply to Tall_Allen]

How do I do that ? He is in Paris I’m in Dubai so I send johns results to his email address and ask his opinion .

[Tall_Allen in reply to palser1]

On that link, click the button on top that says "Appointment/Second Opinion." It takes you to a page for International patients and there is a button that reads "second opinion." Follow directions to create a new account. Then click on the bottom where it says " SCHEDULE AN APPOINTMENT AT GUSTAVE ROUSSY" and fill out the form that asks for your insurance info. They will send instructions to your email within 2 days.

[palser1]

I will certainly try . Thank you .

[Hidden]

renalandurologynews.com/hom...

Apalutamide is a very effective way to go especially during a pandemic since there are no hospital visits required to take it. My oncologist told me that he had a couple of guys go the chemo route instead and it didn't work out well for them. I went with Eligard and apalutamide/Erleada right off and even with the slight side effects, I couldn't be happier with an undetectable PSA (from 113 originally). The Titan trial results speak for themselves. YMMV.

[Chadsdad in reply to Hidden]

I’m 18 months in with Erleada and Eligard. Latest PSA with an ultra sensitive test was 0.014. Testosterone was <2.5. Hot flushes and loss of energy is not much fun, however I think I can live with the se’s another 20 years.