My PET scan results were worse than i could ever imagine with multiple lesions throughout the upper skeletal system. Since then I have seen 2 different MOs who agree on Eligard and Abiraterone, however one is suggesting Chemo as the third leg of treatment while the other feels we should wait until we see the response to the hormonal treatment. I have been taking Casodex and Eligard and today received my first good news that my PSA has gone from 27 to 3.6. Hooray!!
I will admit that as of yet I have not chosen which institution or doctor will treat me, but I am very anxious to make that decision asap, and plan to do that after meeting with an MO from MSK later this week. I also plan on drilling down on the chemo now or later question as maybe the most important piece of this difficult decision. As always, any feedback is greatly appreciated
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Grateful4this
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I'm sorry to hear of your bone metastasis.I'm not a doctor so only going by what I have learned myself so far but chemo plus Zytiga is highly recommended now not later.
Peace-1 trial confirmed it.
PEACE-1 (Abstract LBA4_PR) found that using three drugs upfront leads to better outcomes than just two in men with metastatic prostate cancer—not only to postpone cancer progression, but also to prolong life. When abiraterone acetate plus prednisolone was added to ADT and docetaxel, men experienced an additional 25% reduction in the risk of death compared to ADT and docetaxel alone.
Sure. The link Tall Allen gave you is the one I really wanted to share but I couldn't pull it up quickly. It is a much better read for us laymen and he dissects the trial in a much more understandable way and without any fanfare.By the way I hope the best for you. Treatments have come a long way.
Read your posts and as in a similar place re lighting up a PSMA PET scan of my spine and prostate late 2021 I thought I’d say hi but am very inexperienced wit advanced prostate cancer..
In the uk I was told gold standard of care was Degarelix, Abiraterone and Chemo.
Plus as standard scans like you showed me as ogliometastatic they recommend radiotherapy to the prostate and prostate bed etc per the ‘stampede trial protocol’.
However I was very interested in early use of Lu-177 (not standard of care but coming it appears to worldwide trials to add in early under the PSMAddition clinical trial. This trial was starting too late for me so I travelled to Finland for it offf licence. So my triple plan is Degarelix ( had two months shots) Lu-177 and Abiraterone.
When I am established on HT the plan is to add the direct radiation too. Chemo is an option but the lower side effects of Lu-177 appealed. I have no idea why different ADT injections are used but all my oncos said Degarelix due to spinal mets do not sure why their varies. My PSA of 17.6 dropped to 4.57 two weeks after Degarelix and two weeks later was 1.66 post first Lu- 177 infusion.
No idea what’s doing what with a multi treatment but next PMSA scan in two weeks may inform more.
Due to start Abiraterone mid January after 2nd Lu-177 infusion. Due to see radio onco at start of Feb and third Lu-177 in Feb is pencilled in too.
So sounds a similar path. Chemo is a proven killer with my MO saying it’s use early is definitely SOC in UK but I just wanted to try Lu-177 early instead.
I'm impressed that a doctor you consulted is recommending "triplet" therapy- ADT+abiraterone+docetaxel. It is very new and the results have not yet been officially published. Here's more about it:
It probably does not work the same way sequentially. So you can't start with hormone therapy and "see how it goes." Starting with either abiraterone or docetaxel makes the cancer dormant so that it will not succumb to the other therapy until much later when it wakes up.
I believe sequencing is an important element for triple therapy to be effective. The comparisons are triple vs ADT and chemo but they have not compared triple to ADT and abiraterone. Reading the study again has made more sense to me than it did a week or 2 ago, but I learn everyday, especially that I need to learn more. I know you cited this study to me a earlier and once again I am very grateful for your insight. I will post again within a few days following my next appointments. Thanks TA
The new ARASENS trial is further evidence of the efficacy of triplet therapy.
That is true that PEACE1 did not compare docetaxel+abiraterone to abiraterone. It only compared docetaxel+abiraterone to docetaxel - a 19 month survival advantage.
However, one arm of the STAMPEDE trial randomized men to either ADT+docetaxel or ADT+abiraterone and found no survival difference:
I'm little further down the road less traveled than you. Eighteen months on Lupron and Zytiga, PSA going up. My MO was suggesting Chemo next but I wanted to explore other possibilities. By staying Chemo naive I was able to get into a trial study, LuPSMA627. One step at a time.
Concur with anyone recommending addition of Taxanes. I was offered ADT, Taxanes, abiraterone and radiation in Feb 18. What I would have done different is after completing I would have gotten a PSMA PET/CT even if I need to leave the country. Wish you the best.
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