Thursday 9/9/2021 was D for Decision Day--Locked and Loaded for Chemotherapy

[Philly13]

I met with the oncologist and ran through my agenda efficiently. He was patient and spent a reasonable amount of time answering questions. As time went on, he suggested that the top 2 options, for the moment, were chemotherapy and radium 223. The oncologist said there isn’t a rush to begin, with no evidence of cancer moving forward.

He said I should think about it and get back to him in the next couple of weeks. My response was that I didn’t need more time. Chemotherapy is the right strategy. We talked about Docetaxel and Cabazitaxel. He said he would lobby for Cabazitaxel.

PSA readings have always been volatile, but the last three months seem out of control. ALP and LDH are higher than I would like them to be.

6/2/2021 81.6 Jefferson

6/15/2021 93.7 labcorp

6/29/2021 121.7 Jefferson

7/16/2021 92.4 Jefferson

7/23/2021 113.1 Jefferson

8/19/2021 95.8 Jefferson

8/31/2021 71.7 Quest

9/9/2021 119.1 Jefferson

ALP 25-120 LDH 125-240

6/3/2021 178 H 214

6/10/2021 185 H 298H

6/17/2021 191 H 235

6/24/2021 185 H 351H

6/30/2021 210 H 278H

7/8/2021 252 H 703H

7/15/2021 233 H 237

7/23/2021 290 H 249H

8/19/2021 229 H

9/9/2021 268 H

The last immunotherapy infusion was on 6/24/21.

All other labs are consistently in the normal range, except for RBC, Hgb, Hct. They have been approximately 10-15% below the low end of normal for a long time. WBC, liver, and kidney functions are well within normal ranges all the time.

I am puzzled by large % swings in PSA in short periods of time. Up and Down. Take out the non-hospital labs and it is still a roller coaster ride.

I don't think I share my oncologist's lack of urgency to begin chemotherapy. The first week of October seems like the right target. I have been giving this a lot of thought for 48 hours. I am going to contact him directly to discuss. The more I think about it the more it bothers me.

The journey continues.

Thanks for all the comments earlier this week.

Best,

Philly

[Tall_Allen]

Consider both. In this trial they were able to reduce the Chemo dose by combining them:

ejcancer.com/article/S0959-...

There are a couple of open trials:

clinicaltrials.gov/ct2/show...

clinicaltrials.gov/ct2/show...

[Philly13 in reply to Tall_Allen]

Wow! Thanks. On the first reading this looks very interesting. I will read the links once again more carefully and then start asking questions next week.

[Tall_Allen in reply to Philly13]

Here's an assessment of all Xofigo combos:

prostatecancer.news/2021/02...

[Philly13 in reply to Tall_Allen]

Thanks again. I continue to review the material in the links you provided. I am improving at absorbing the words in these scientific papers, but a long way from understanding everything I read. I will start asking questions next week to the MO and RO I am working with.

[HopingForTheBest1]

Sounds like you're on the right track. One that you have researched, and you are comfortable with your decision. A viable treatment option.

Just make sure to check out Tall Allen's reference links that he sent you.

[tango65]

Consider getting a liquid biopsy before starting the chemo. The cancer may be susceptible to treatment with olaparib, rucaparib or keytruda. If there were NEPC indicators combining Cabazitaxel with carboplatin or similar may be advantageous. You could also get Provenge.

[Philly13 in reply to tango65]

The Guardian liquid biopsy did not provide any information. I had a Foundation One genetic test done with tissue from my prostate. While it did identify mutations, there was nothing to act on in 2018. The EP300-Q767 mutation now has a clinical trial targeting it. called Cell Centric. I decided to try and beat back the systemic progress of Pca at this time.

[Hidden]

Philly , I’m pulling for you to kick pc’s ass in this round. Stay strong hombre! 🤙🏽

[tallguy2]

Best wishes with the chemo. Been there once already. You might ask if the Neulasta on-body injector is right for you. It kept my white blood cell counts up and me out of the hospital the entire time.

Best wishes!

[j-o-h-n]

Win......

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 09/12/2021 10:54 PM DST

[MateoBeach]

Good! Chemo is tolerated early better than later. Deflect the survival curve in your favor for the longer term (rather than just a little at advanced stage down the road. I am inclined to agree with your plan priorities. 👍