At age 70, Diagnosed with Pca in 2015 after seeing initial PSA as ~ 270.
Got the surgery done in December 2015 - Bilateral sub-capsular Orchidectomy. PSA reduced to 1 and eventually gone down to 0.05 etc…
He was on BICALUTAMIDE medicine for about 4 years and PSA was well under 4 for quite sometime.
PSA started rising in 2019. His doctor didn’t change any medication but straight away went to Radiation. Later we realized that’s mistake and change doctor in 2020 June. He was then given Zytiga (Aberiterone)… it worke well for about 8 months and got the PSA under 1.
In 2021 June PSA started to rise again ~20. He started docetaxel on October 2021, His PSA was ~ 20 in October 2021, now today’s (3-Dec-2021) PSA test shows it is 98. This is after 4 infusions. Does this mean Docetaxel is ineffective? Or do we have to give it more time before we see good results?
Please help.
Thanks.
Written by
Vishwa1890
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Hi Tall_Allen , spoke with MO. He is saying to wait for some more time to use cabazitaxel+carboplatin, as that’s a last resort. Btw, PSA still increased further with Docetaxel usage, and it is 105 currently. MO is saying to increase the dose and continue on Docetaxel for some more time. Do you think waiting is a bad option.
MO’s thought process is, if we give cabazitaxel+carboplatin now itself, and if Ca still grows, then we will not have any last option. So, he wants to increase docetaxel dose and see if that does any benefit, before switching to cab+car.
Also, could you please advise on this?
Is Erleada (apalutamide) an alternative to Abiraterone? Also, your thoughts about combined usage of Abiraterone and docetaxel (I read one of your posts that they are more effective when used together).
The problem with his "logic" is that earlier use increases survival more than later use, and the combo is more effective than either taxane alone in setting back the cancer. If you let the cancer progress, it will have much less benefit.
Let's say there are 2 patients, A&B. A is given docetaxel for 6 infusions (about 4 months). After 3 months recovery, he is given cabazitaxel+carboplatin for 6 infusions and he survives for 3 months after that. Total survival=4+3+4+3=14 months.
Patient B is given cabazitaxel+carboplatin for 6 infusions.He needs no further treatment for 12 months. Then he will repeat it. Total survival=4+12+4+2=22 months.
Also, your father's ability to tolerate the side effects of chemo is better now than it will be later.
It is ALWAYS a bad idea to save a good therapy as a last resort.
Thank you so much for the great rationale. I will talk with MO again.
One thing that worries me is that, based on the examples you gave, is the maximum survival anything between 1-2 years? Or would there be any remote chance to prolong it?
My opinion doesn't change. Cabazitaxel was designed for cases where docetaxel doesn't work. PEACE1 is only for starting triplet therapy at the same time - too late now.
Hi Vishwa, my husband is age 60. He is trying taxotere for the 2nd time and it's not working. It did not work the first time. His MO is doing the same as your MO. Cabazitaxel (Jevtana is next in line) We will find out if he starts in January. We are close to the end of treatments and hope LU177 is available soon. Tall Allen has great advise! Don't wait and go to Cabazitaxel now.
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looking for advice. 
Is this a PSA flare caused by chemo?
Docetaxel
Docetaxel re-challenge not going so well
PSA is increasing after 11 cycle of Docetaxel, what should we do now ?
