Grumpy, 78 and frail, has been on 5 mg of prednisone while taking half dose of abiraterone along with full dose of darolutamide. He starts Taxotere 3/1 so the doc stopped abiraterone and darolutamide for two weeks before Taxotere.
Doc said to stay on the 5 mg of prednisone but I see the dosage sheet for Taxotere says to use 10 mg of prednisone during treatment.
Can anyone clarify this? Dosing sheet may be outdated.
He has been given a drug for nausea but Neulasta hasn’t been mentioned. Seems that Neulasta may have its own risks. Experiences or comments much appreciated.
I also have some dexamethosone on hand. Is that still recommended a few days before and after chemo?
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Grumpyswife
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I did some research and found that 10mg of prednisone per day was used with Taxotere chemotherapy in the STAMPEDE trial for prostate cancer. It's also prescribed for use on the prescribing label for Taxotere:
10mg daily prednisone seems to be what is standard. They often do a premed of Dexamethasone along with chemo and that gives some additional help for the first 2 days.
He has to take prednisone with chemo - it mitigates some of the worst side effects. Neulasta is especially a good idea during the pandemic - take with an antihistamine. Discuss with the oncologist.
I've looked and can't find anything to confirm if there is a correct dose of prednisone.But it is definitely given. As TA said it negates some of the worse side effects of chemo.
IMHO he may start with 5 mg a day and stay on that course or at some point labs and side effects might warrant increasing to 10mg. I am not a Dr of course.
In my case I had 5 mg Prednisone per day and 10 mg or more of Dexamethasone was given the day before, day of, and day after each infusion ( I have heard of cases where Dex is administered at the time of the chemo infusion). This also helped negate side effects. I learned thru self observation that when the half life of Dexamethasone wore off about 2 days after the infusion is when I had what most refer to as chemo crash...heavy fatigue.
Energy would improve and by the time 3 weeks went by and it was time for next infusion I was usually feeling pretty good. All things considered.
Neulasta is almost mandatory. Chemo is hard on WBC production and so the boost from Neulasta is critical. My Neulasta shots came the day after each chemo infusion.
Well I can't be so sure of that lol. It was mainly in relation to the medication. But thanks for the kind words.
The chemo experience varies between people. Age, fitness level, are only a couple of the things that make it vary. If I summarized the whole experience I would have to make sure that it was understood it was only my experience. Other's experience might be different.
I started a journal when I started chemo. Its buried somewhere and it only covered about the first 4 or 6 weeks. I put it aside as chemo fog and living life were more on my plate than taking time to write.
Yes, I understand nothing is totally predictable. But physical condition, particularly cardiopulmonary and glucose issues, is very good. Age 65. But I can guarantee I look a heck of a lot better than 65s looked in my youth.
Good morning, I took a steroid the day before chemo, they gave me some thru my Port right before chemo, and then for two days afterwards. I had heavy fatigue a couple days after I quit taking it. I never had any nauseous. My first treatment they did not give me neulasta. My WBC went to almost 0. I ran a fever from it and needed to go to an ER. I live like 1.5 hr away from the cancer center so they put an on body injector on my arm and they set it to inject 27 hrs later. It is expensive, but worth it. This was my experience. Thanks.
Well there you are. Another like me where Neulasta was not automatic. It seemed the protocol was to wait and see where the patient ends up after the infusion.I feel for you as you ended up in the ER.
I was lucky that didnt happen but as I was saying after my WBC results were looked at then the Neulasta was given the day after every infusion.
I remember the first time I came in for that I was dragging my butt pretty severely but nonetheless thought I was doing good enough and that that was just the way it had to be and that I just had to suck it up.
The nurse looked at me on that Saturday morning and said "Oh my god, you poor thing".
Here is a card with phone number. Don't hesitate to call. etc. lol.
I was going to ask about neulasta, but forgot the first time. What did not help my situation, is I am self pay. The first price was $25k, then with all the self pay discounts it was $3K per treatment. Till it was all said and done the pharmaceutical company pd for it. Very grateful for that. I would not do another treatment without using neulasta. Every one has their own journey with cancer and chemo. What SE, how we respond and how effective the treatments are. I am so thankful that my PSA has gone down and I am coming out of chemo fatigue. I hope and pray that I can keep the cancer at bay and numbers down for quite a while. I thank God for all he has done for me. My life is in his hands. Best regards. Keith
Although I was already on daily 5 mg prednisone (to accompany Zytiga), when I started chemo I was given dexamethasone for a few days before and after to ward off side effects.. It was great. At the time I didn’t know anything about its potency.
I didn’t sleep much on it, but I did clean the house thoroughly each round. My wife wanted me to get a separate prescription of it just for that. Kidding, but only barely.
No withdrawal problems, I only took it for 3 days every 3 weeks.
It was a good side effect indeed. When I was younger the discovery of dexamethasone might have led to some ill-advised recreational use.
Now that I’m older and wiser (minimally), I value sleep more.😀
Grumpy is in a tough situation. For 21 years he has valiantly fought metastatic prostate cancer with SOC at the time. Before posting, I reviewed every post by you in the last four years, including my comments four years ago. Today he is “frail” by your description. To me that means his body may not be strong enough to handle the rigors of chemotherapy treatment.
In my opinion there can exist an ultra-SOC, SOC, and modified SOC and all are based on the strength of the body and size of the tumor burden. First, ultra-SOC can only be found in academia and research where the treating physician has the ability to go beyond the normal palliative treatment in an effort to find a cure. Those guys are few and far apart. I can’t help but believe that the disparity between private money raised for breast cancer as to prostate cancer research is a major factor. Both are hormonal cancer based and closely related. In fact, my treatment regime is used today at Baylor College of Medicine for initial treatment of metastatic breast cancer........ my guy was a Professor and Researcher at Baylor before he moved to the McGovern Medical School at the University of Texas.
The latter, modified SOC, is the position which Grumpy finds himself today with three MO’s disagreeing with any chemotherapy; and one who is willing to extend life by trying. It’s a crap shoot, but damn he is fighting......
Your question is in the appropriate dosage of Prednisone. Your treating physician has determined that a half dosage is most appropriate. Go with it.
You can not compare to me nor anyone else with metastatic lesions. I make no bones about my treatment -Essentially, Taxotere alternated with Adrimyacin infusions on a weekly basis for six weeks in three cycles over six months. Plus Ketokonazole and Erustamine paired with each chemo drug. And, continuation of Lupron. Take note that I took 50 (fifty) mg of Prednisone daily for the six month period.
I remember there were those in the infusion center where treatment was either delayed or stopped. Mainly for low WBC or major side effects where the body rejected anymore poison infused into the body, Luckily I was not in that group.
With Brachytherapy plus IMRT in 2003 and this trial in 2004, at 75 years of age, I would not change a thing. Luckily, I had a strong body not withstanding a double by-pass in late 2002 for an aortic aneurism. I have been on medication treating hypertension since. However my journey is vastly different than almost all with metastatic prostate cancer. I am still a proponent of chemotherapy with Lupron/Eligard as an initial treatment for metastatic prostate cancer after failure of primary treatment while the body is strong and the tumor burden minimal. Anything else is best termed as palliative treatment to extend life.
One statistic I remember from when Grumpy and I started our journey, with metastatic prostate cancer the average life expectancy was 3 to 4 years, maybe five. A lot of “silver bullets” have been developed since then. Take heart that Grumpy continues to fight the ravages of this terrible disease for twenty-one years. Celebrate that your life partner is still fighting. My mother who passed at 101 in 2019 lost my father in 1979 to complications colon cancer surgery - most probably brought about by metastatic prostate cancer.
I sincerely believe that when the Lord decides to call home, the fight will be over. Until then, Grump continues to have “more good work to do”.
Right it was. Given the advice by my two ROs, I took that approach. Unfortunately Doctor Amato died of Gioblastoma, and no one has picked the research as far as I am aware. Credentials has a large part to do with it, as I have been told.
I appreciate your response here. Especially your recognition of Grumpy. I too looked at his bio. What a journey. I have looked at yours's as well a few times these past couple years. A journey for you as well. I appreciate your contributions to us here !
I've been receiving elegard injections every 3 months as well as taking abiraterone with prednisone every day for 16 months and my psa and metastases are undetectable.
Thank you so much. I had just read your bio again last night or early this am—pretty amazing. My neighbor who’s a nurse and knows Grumpy’s health tells me that I need to tell all the docs that Grumpy has a lot more life to live. There's no doubt the end may be nearing but I think he should go out swinging.
Thank you all for informing me of what we are *possibly* heading into. I wish there could be one place on here where a list of things to ask about and to have on hand specific to prostate cancer chemo. It would help many as I have read the same questions over the years.
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