ADT + Abi + Docetaxel for metastatic prostate cancer?

[Shanti1]

Going off of the PEACE-1 trial which showed improved overall survival, and improved radiographic progression-free survival in men given the triple therapy of ADT + Abi + Docetaxel therapy on initial diagnosis of metastatic prostate cancer, we are considering asking my husband's oncologist about this approach.

The difference is, my husband does not have a "de novo" diagnosis. Although he knew that it could lower his overall survival, he has been on intermittent ADT + Abi for the past 5 years. His first medication break lasted 2 years and his second lasted 10 months. He had mets to his lungs, lymph nodes, and bones on initial diagnosis and mets are currently showing in lungs and bone. He just came off the the10-month break (he doesn't plan on trying any more breaks) and we believe the cancer is still hormone sensitive. I'm thinking the triple therapy would be best even though he isn't treatment-nieve like the study group.

Would be grateful to hear people's thoughts on the triple-therapy (ADT+Abi+Docetaxel) in his situation. Thoughts?

(ascopost.com/news/september...

[erjlg3]

Love to you both Shanti♥️

[Shanti1 in reply to erjlg3]

🥰 thank you🥰

[Tall_Allen]

I don't think adding chemo will be useful until his PSA or scans are showing increased activity.

[Shanti1 in reply to Tall_Allen]

Thank you TA. His PSA has gone up to 0.66 from undetectable, while this sounds low, his cancer doesn't produce much. Last time he went back on ADT+Abi at a PSA of 1, his Auxumen PET showed 2 active lesions in the lung and several active in the bone. He has also developed a cough we have come to associate with the lung lesions. Scans are pending, so we can wait to see what they show, but we are assuming increased activity.

[Tall_Allen in reply to Shanti1]

May I suggest tracking changes with an FDG PET scan? With low PSA subtypes, it may be more informative than Axumin. The problem is you don't have baseline data to compare it to.

[Shanti1 in reply to Tall_Allen]

Yes, thank you, we will discuss this with his oncologist, seems worth doing.

[Shanti1 in reply to Tall_Allen]

If I understand you correctly, you are saying that people who have de novo metastatic cancer and start on triple therapy have all three therapies started at the same time while the cancer is fully active.

Even though my husband may have some activity, coming in with chemo in addition to ADT+Abi at this point may not be as effective because his cancer is just waking up, not fully active like in an initial diagnosis situation.

[Tall_Allen in reply to Shanti1]

Right. Chemo only kills actively growing cells. If his cells are not actively growing, he gets all the toxicity, but none of the benefit.

[Shanti1 in reply to Tall_Allen]

10-4 Thank you so much for your expertise❤️

[Concerned-wife in reply to Shanti1]

What TA said is what my husband was advised by his specialist oncologists, too.

[Shanti1 in reply to Concerned-wife]

Thanks for the confirmation

[Hidden]

Chemo has to have something to kill.

[London441]

I’m glad he had the time off with intermittent, if that was his plan. Was it a plan? Some would say he was not nearly aggressive enough early, but what no one knows is if it would have made much difference. As you know, medicine is advancing incredibly but still sometimes seems to be at least three steps behind this insidious disease.

I was Oligometastatic at diagnosis and was very aggressive, RP plus the same triple therapy you referred to- plus radiation. It was either overkill or will fail is how I see it. If PSMA had been available to me at diagnosis (2019) I would at least probably skipped the RP, but there was no way to know pre op exactly what was going on. That surgery brought with it permanent life changing side effects for me, which of course is common.

You should have a better idea of how to proceed when you get that PSMA. Low PSA types are tricky for sure. Great luck to you!

[Shanti1]

Yes, it was planned. While his oncologist advised against it, he also supported my husband in his quest for quality of life. Both times he was off ADT his testosterone returned to >500 ng/dL within 2 months of his ADT wearing off. My husband doesn't regret it even though it is possible that it has shortened his overall survival, which is something we will never know.

My husband had a RP in 2017. Triple therapy wasn't entertained at that time or we probably would have done the same as you with triple therapy as his up-front therapy. I hope that the triple therapy and the radiation therapy give you many, many years.

My husband had a PSMA scan at UCLA in 2019 and it turns out his lung lesions do not express PSMA, so we cant use that as a scan. TA suggested FDG above, which we will probably do.

Best to you in your journey!

[Hidden]

It might help you to understand that chemotherapy is a systemic treatment which attack all cells that are rapidly dividing and multiplying. That includes hair, finger nails, toe nails, and mutant cancer cells.

GD