Hey guys! I hope someone can provide me with some insight
I posted on here before regarding my dad (66 yo, initial PSA 200+, Mets on pelvis, spine, shoulders, lymph nodes, DVT complications, Kidney complications necessitating bilateral nephrostomy tubes)
Right now he has started ADT (Firmagon) but his chart says that he is not suitable for docetaxel unless his performance status improves (they graded it at ecog =1 or 2 ie does most or 50% of things on his own). I have heard so much about docetaxel being beneficial in combination with ADT and feel like I have seen some people who were in worse shape who were able to do it. I’m just wondering is maybe I am mistaken/ am missing something else that would make him a poor candidate? I want to push for more information from the oncologist in general. Also, are there potentially alternatives to that treatment that could be equally beneficial?
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StayingSTRNG
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If Dad's General health is not good at this time, Docetaxyl can be postponed until he is doing better physically. Lupron +Abiraterone is considered extremely effective and can bring his PSA close to 0. This combo (lupron+Abiraterone) brough my PSA down from 830 to 0.19 within first 10 months. And that was 2 1/2 years ago.
As treatment works, gradually his performance status will be better and at some point he can opt for Docetaxyl ,if needed.
Thank you for your response! Yes, I guess other competitors make it difficult for that treatment. Hopefully he can get stronger and use it if needed. There was no mention of that treatment but maybe we will discuss it at the next appointment, I will ask otherwise
My husband (63yo) was diagnosed with advanced prostate cancer in March, extensive metastases in lymph nodes and “in all his bones”. His journey was complicated by a fractured neck of femur and his oncologist said he was too late for surgery and too poorly for Docetaxyl. (He also had 20% de novo neuroendocrine cells in his bone biopsy which no doubt has a bearing on his treatment plan).
Anyhoo, they started him on Firmagon and a month later added Apalutamide.
The doc said that the Covid pandemic made it easier to prescribe/treat patients with Apalutamide rather than Docetaxyl as there were fewer immunosuppressant risks, and as a result of that they realised how affective Apalutamide was and it therefore was passed by the NHS as suitable for use in metastatic cases in September 2021. Phew, at least one good thing came out of the pandemic!
In the past four months since diagnosis his PSA has dropped from 1120 to 3, and boy does he look and feel better!
They did radiotherapy to his fractured hip to reduce the load, and are starting radiation to his prostate to de-bulk it next month.
I know de-bulking in very advanced disease can be slightly controversial maybe, but our doc is a lead investigator in a number of trials and says opinions change rapidly and these are the latest recommendations.
Of course we are aware of the situation with the de novo neuroendocrine, but we will take what we have got for now simply because he is so much better, and let’s face it, none of us know what today, tomorrow, or any time in the future has in store for us!
What are your Dad’s bloods like? Is this having a bearing on the doc’s opinion on his suitability for Docetaxyl?
Learn All. I was prescribed Enzalutamide (Xtandi) instead of Docetaxyl as it had fewer immunosuppressant risks during Covid. My PSA was 1,311 in May 2020 but is currently 0.04. I also had widespread Mets to bones and Lymph nodes plus DVT complications.
Out of interest Todd, which hospital is your husband at and are you able to confirm your Oncologist name. Debalking the prostate has never been discussed for me and radiation was dismissed due to spread. I'm UK here, in Leicester. Happy if you message me privately.
Abiraterone and Enzalutamide (extandi) are two different animals because they work by entirely different mechanisms. Both can be very effective though.Abiraterone blocks all sources of testosterone production by blocking and enzyme CYP17A ..thus lowering testosterone to very very low levels.
On the other hands, Lutamide drugs like Enzalutamide work by directly blocking Androgen Receptor and this way it does not allow testosterone to work. Lutamides DO NOT lower testosterone.
i have his tests, I’m not sure is there is anything specific that would be an indicator. I know his testosterone is quite low, his hemaglobin is also low but there are lots of other results that I don’t know if they would have a bearing on their choices
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