What now, coach? (PCa has spread to liver within 3 months of starting Eligard.)

[Skipper238]

Hello all,

I have a dilemma, and I would definitely appreciate any ideas that you might have. The dilemma is, will it be safe for me to start my initial Docetaxel treatments on Monday, 2-28-22, considering the new information I now have showing my PCa has rather dramatically spread to my liver. Below are my elevated liver enzyme levels and the summary of my 2-24-22 PET scan. Thank you! Skipper

Elevated liver enzymes:

Alk Phos [38-161 U/L] 327 U/L

*HI*

(2/11/22 12:15 PM)

AST [16-54 U/L] 108 U/L

*HI*

(2/11/22 12:15 PM)

ALT [6-62 U/L] 149 U/L

*HI*

(2/11/22 12:15 PMy entire PCa story is on my profile: Age 65, low PSA (4.68) but high Gleason (9's and 10's). Original mets to lymph nodes above and below diaphragm. Started Eligard 3 months ago. PET scan results from two days ago show significant spread to liver and other places including spine.

Here is the summary of the 2-24-2022 PET scan:

IMPRESSION:

* Marked interval progression of widespread metastatic disease. Much of the original disease seen on

prior PET/CT has improved in size and FDG avidity. Given the mixed response with the original

disease improving and extensive progression of new disease, consider repeat tissue sampling to

compare pathology.

1. FDG avid lymphadenopathy above and below the diaphragm.

2. Innumerable lesions throughout the liver.

3. Numerous metastatic osseous lesions.

4. Intramuscular deposits within the right iliopsoas musculature.

5. Much of the lymphadenopathy seen on the prior study dated 11/23/2021 has improved in size and

FDG avidity including the left supraclavicular and many retroperitoneal lymph nodes. The prostate

also demonstrates decreased uptake.

6. Unchanged mildly avid 3 cm right adrenal nodule.

[Skipper238]

Sorry. I left out an important part of the situation. I read the "Boxed Warning" on Drugs.com regarding Docetaxel risks associated with extremely poor living circumstances. I seem to meet those circumstances, so I'm wondering if I can safely start chemo using Docetaxel.

drugs.com/pro/docetaxel.htm...

WARNING: TOXIC DEATHS, HEPATOTOXICITY, NEUTROPENIA, HYPERSENSITIVITY REACTIONS, and FLUID RETENTION

Treatment-related mortality associated with Docetaxel is increased in patients with abnormal liver function, in patients receiving higher doses, and in patients with non-small cell lung carcinoma and a history of prior treatment with platinum-based chemotherapy who receive Docetaxel as a single agent at a dose of 100 mg/m2 [see Warnings and Precautions (5.1)].

Avoid the use of Docetaxel Injection in patients with bilirubin > upper limit of normal (ULN), or to patients with AST and/or ALT >1.5 × ULN concomitant with alkaline phosphatase >2.5 × ULN. Patients with elevations of bilirubin or abnormalities of transaminase concurrent with alkaline phosphatase are at increased risk for the development of severe neutropenia, febrile neutropenia, infections, severe thrombocytopenia, severe stomatitis, severe skin toxicity, and toxic death. Patients with isolated elevations of transaminase >1.5 × ULN also had a higher rate of febrile neutropenia. Measure bilirubin, AST or ALT, and alkaline phosphatase prior to each cycle of Docetaxel Injection [see Warnings and Precautions (5.2)].

Do not administer Docetaxel Injection to patients with neutrophil counts of <1500 cells/mm3. Monitor blood counts frequently as neutropenia may be severe and result in infection [see Warnings and Precautions (5.3)].

Do not administer Docetaxel Injection to patients who have a history of severe hypersensitivity reactions to Docetaxel or to other drugs formulated with polysorbate 80 [see Contraindications (4)]. Severe hypersensitivity reactions have been reported in patients despite dexamethasone premedication. Hypersensitivity reactions require immediate discontinuation of the Docetaxel Injection infusion and administration of appropriate therapy [see Warnings and Precautions (5.5)].

Severe fluid retention occurred in 6.5% (6/92) of patients despite use of dexamethasone premedication. It was characterized by one or more of the following events: poorly tolerated peripheral edema, generalized edema, pleural effusion requiring urgent drainage, dyspnea at rest, cardiac tamponade, or pronounced abdominal distention (due to ascites) [see Warnings and Precautions (5.6)].

[GP24]

Docetaxel has significant side effects but it works well against your cancer. Discuss the side effects with your oncologist. Then continue with Zytiga and, according to the new PROpel study, with Olaparib: urotoday.com/conference-hig...

[noirhole]

My MO told me no chemo if bilirubin was elevated above 3.0. I also have liver metastasis with no treatment options. We have contacted hospice. Leasions were discovered about a year ago. Tried to shrink or eradicate them with Gen-Ox combo chemo. Didn't work usually 60 percent effective. Not an easy chemo had to reduce dose by 20 percent for QOL. Good luck!

[Tall_Allen]

Your oncologist will have to make that call. I hope you will be able to use it.

[Shooter1]

Sure worked for me with bone , vein, nerve, and lymph node involvement.... Killed cancer faster than it tried to kill me... Best of luck.. hope your docs get you on something soon.

[Skipper238 in reply to Shooter1]

Thanks, Shooter. I would like to be able to use it, but I don't want to shut down my liver. Is my liver "well" enough to withstand the Docetaxel treatments? Doce provides a big warning about being super cautious with its usage if liver enzymes are very high. Mine are very high.

[Shooter1 in reply to Skipper238]

I can't answer that question for I don't know.. I do know the reduced dose treatments some get still work and are not as hard on a frail body. Hope you can get your liver to accept something for it's mets.