Based on my appointment with Duke on Friday I am going to proceed with GemOx Chemo. Platinum based chemo component will better treat my liver metastasis. Hopefully I can get the chemo at home with follow-through appointments and scans at Duke. That is if my home clinic will agree to the infusions. Since we are 3.5 hours away from Duke 5 hour infusions every 2 weeks will be easier at home. 12 week scans can be done with one day turnaround or an overnight.
With no current genetic mutations this may be my best bet on buying time.
The chemo recommended is more specifically- gemcitabine/oxaliplatin (GemOx) based on the report of a phase II trial by JL Lee et al (Br J Cancer. 2014 May 13;110(10):2472-8). PSA response rate was 55% (95% CI, 38-72) and radiologic response rate was 82% (9 out of 11). With a median follow-up duration of 20.5 months, the median time to PSA progression was 5.8 months (95% CI, 4.4-7.2) and the median overall survival was 17.6 months (95% CI, 12.6-22.6). The most frequently observed grade 3 or 4 toxicities were neutropenia (13%) and thrombocytopenia (13%).