I know two men who had some number of docetaxel infusions. Both men died. Is docetaxel simply a hail mary or does it improve quality of life or longevity?
Statistics only please, no opinions.
(I am not a chemo candidate at this time but this question has been on my mind a lot.)
Thanks
News flash: everyone dies. If you want just stats look up the Stampede trial results. Docetaxel extends life. When you receive it makes a huge difference.
I think he may want know how long it extends life. What's your understanding, and what's been your experience? How long since you used docetaxel. Thanks
I have not had chemo. I was a super responder to Lupron + Zytiga + Prednisone. 56 months now undetectable. See comments below re: extended life. If/when needed, I would not hesitate to try docetaxel.
There have been a number of clinical trials with Docetaxel and prostate cancer. It's best to search for those and look at the data if you want to see the statistics. It's all available online with some Google searches. I agree that looking at the statistics is better than opinions.
I can speak from my personal experience for what that's worth. I did take Docetaxel early on based on trials that proved it added life expectancy. There is no way to know if that helped, but I am over 6 years now from diagnosis. But I can say with certainty that a similar chemo I'm doing now (Cabazitaxel) has improved my quality of life with very reasonable side effects. After Xtandi failed, my cancer seemed like it went into overdrive. My scans quickly got worse and my pain went through the roof. I was maxed out on the pain meds I had, 24/7 couldn't sleep or function without them. I expected some pain relief eventually if the chemo was working. I got my first infusion on August 12 and woke up on August 16 with zero pain. Have not taken a single pain med since then. I'd say that's a major improvement in quality of life and most likely extending my life. Yes, it doesn't always work but when it does it can improve quality of life and quantity as well.
Thank you Ed!
Where did you have a pain? Did you have a liquid biopsy or a tissue biopsy in order to find some actionable mutations? I am happy that the chemo works for you. You could still have a liquid biopsy if your PSA is above 5 or even better 10. Just in case if you need to change to Olaparib, Keytruda etc.
Yes, I am planning to have the next generation genetic sequencing and see if I have any actionable genetic mutations. I had pain in my left side hip mainly. My scan was almost complately clear back sometime in April, then in July there was quite a change along with worsening pain. They got my port placed and first chemo the same day. I felt a little rushed but so glad they got me in fast. Even the day after infusion it was still getting worse, I was in tears that day. But soon after, the pain was gone. Still is so far.
What is your PSA now?
It was around 20 (estimate) when I started chemo, but the doctor doesn't want to check it for a couple cycles to avoid the false positives you can get with dead cancer cells floating around. Fairly sure it''s gone down along with my pain.
You should get the liquid biopsy as soon as possible. Please read this:
pubmed.ncbi.nlm.nih.gov/352...
I asked about it but the oncologist said not now, forget why.
Can you do it by bypassing your oncologist? Find some alternative way. Don't miss that window of opportunity. The results to arrive need some time. It would be better if you find out as much as possible now. You already failed Xtandi. You need to options now.
Where are you treating yourself? Who is your oncologist?
The chemo could fail and without a genetic testing results from the liquid biopsy you would be without options. Better get that results now. It is as simple as a blood draw. I wouldn't wait a day longer.
Go to other oncologist and ask for a liquid biopsy now.
What is your PSA? Did you read a link? Did you fai Xtandi? Did you have first cycle of the chemotherapy? Are you out of options? Sorry, i didn't read your profile. In Australia this test cost 5000A$.
Could you please fill out your profile? It is not possible to say anything without your history.
I'll check again; I thought I did fill out my profile. I was asking a hypothetical question; my PSA has been unmeasureable for two years.
Please read this about liquid biopsy. They recommend to get it if your PSA is above 5 or even better 10,:
Thank you, that's very encouraging.
It was hard for me right before I started the chemo because I was taking all of these pain meds, covering up the worsening situation. Just knowing that I wasn't doing anything to actually solve the problem or at least improve it was depressing.
Based on my increasing pain level, it seemed like the cancer was growing fast. That makes it a great target for chemotherapy. Now I feel like I'm doing something to kill the cancer, instead of just covering up the symptoms. Helps a lot physically and psychologically. Not a perfect solution by any means, but I'm winning again for today.
Brief (maybe) summary, dx 08/19, S4, Gleason 8, mets in lymph nodes, possible met on rib. Bicalutamide, Lupron 1 yr, then 28 rounds of radiation summer 2020 and discontinued bicalutamide. March of 2021, mets in shoulder, added Xtandi, changed Lupron to Orgovyx, 5 rds radiation to shoulder. March of 2022 mets to sternum, ribs, spine and possibly facial bones. Discontinued Xtandi, tried Lynparza as it was indicated due to genetic testing (atm defect.) After it failed docetaxel was initiated. Have now completed 7 rounds at half standard dose of docetaxel. Neuropathy in hands and feet increasingly worsening, extreme fatigue which increase with each treatment, diarrhea now manageable by following BRAT diet and taking immodium. In a 4 week cycle, I have 2 bad weeks and 2 bearable weeks. MO says we keep doing this until side effects become unbearable or PSA goes up. It’s now at its lowest point (1.08) since initial diagnosis. Is it SOC to keep taking infusions or is it advisable to stop. Have not read any comments, here or in other forums, where men are on unending treatment with Docetaxel. Any insight?
Typically, there are two times that chemotherapy is done with advanced prostate cancer. The first is at stage 4 diagnosis along with ADT and now also adding Abiraterone or Darolutamide. Typically 6 cycles would be given at this point although up to 10 can be used. It's been proven there is no benefit above 10.
The second point where chemotherapy is used occurs usually after castrate resistance and failure of an advanced AR drug such as Xtandi or Abiraterone. In this case, chemotherapy is often done until it either stops working or the side effects become too difficult. Some doctors limit the number of cycles to 10 at this point too.
In the case of Docetaxel chemotherapy being used at this point: the patient can also switch to second-line Cabazitaxel chemotherapy if Docetaxel becomes ineffective. It's approved for this purpose. Cabazitaxel also has a different side effect profile, including a significantly lower risk of neuropathy. In general, the other side effects are better too. I would think you would quailfy for it in your situation if you wanted to try.
Something to talk to your doctor about.
Your half doses of Docetaxel at age 91 are probably hitting you like my full doses at the age of 63.
I had a total of 6 and you are past 7.
You switched from Xtandi to Lynparza but I didnt see here if Xtandi stopped working or not.
After this much chemo you have had and your PSA is 1.8 and if your scans look like a nice improvement I dont see why you should continue chemo. You might be able to restart Xtandi due to the "restart" effect of chemo. Or you might be a candidate for Ra-223, maybe Pluvitco.
Im NOT an expert so those are just some things to mention to your dr. What are his/her thoughts.
My PSA only got as low as 5.4 during or after my 6 chemo infusions. For a year it hovered around 8 or 9 and I was on Lupron only. Then a rise in PSA/scans and I started Zytiga.
Now its almost 3 years later and progression on Zytiga and I am about to start chemo Docetaxel again.
Thanks for the reply!
A few quick clarifications, my Father-in-law is 91. I’m “only” 72! 😉 Xtandi failed earlier this year which sent me to Lynparza and ultimately now Docetaxel. The MO doesn’t feel the need for repeat scans. His reasoning is that my PSA has historically been a “good” indicator of my cancers progression and regression.
My wife has asked about Pluvicto but has been told it is another option when the chemo fails. And due to diabetes, I was told Zytiga wasn’t a good option.
Ah got it.
And maybe he gave an endpoint number to the number of infusions?
Since its half dose maybe 10 infusions don't know.
I understood as indefinite.
"When given with prednisone, treatment with docetaxel every three weeks led to superior survival and improved rates of response in terms of pain, serum PSA level, and quality of life, as compared with mitoxantrone plus prednisone."
nejm.org/doi/full/10.1056/N...
Thank you for your always-on-topic and intelligent replies. Very grateful you're among us.
Thanks Allen
Hello mr. Steve J,
ascopubs.org/doi/full/10.12...
You say no opinions but since you anecdotally mentioned 2 guys that died I will mention I am one guy who lived...so far.
Quality of life when dying of PC not good.
Quality of life after chemo kills much PC... good.
Chemo's a bitch, and then you live.
You like so much you're doing it a second time now lol?
BTW a second round of chemo therapy is a possibility for me coming up soon.
I did a summary of my first chemo therapy in a post the other day.
Left out vision side effects, teeth, gums and other stuff I have forgot as the memories affected too by chemo fog are almost like from a dream. Some odd, strange period of time.
healthunlocked.com/advanced...
Glad I'm doing Jevtana on the second round. For me, it's been much easier than Docetaxel. Many others have also reported the same thing. It's an effective chemotherapy too. It does make me a bit more tired than Docetaxel, but the flu-like first week is about 1/2 or less the intensity. And the pain relief was amazing. Ready for my next infusion this coming Thursday.
Just got done with my first this week, tiredness for 3 days but better than the alternative, but decided to retire at the end of September.
Is it easier than Docetaxel for you? For me, it's like 1/2 the overall side effects of Docetaxel, but they last longer and a bit more tired.
The median overall survival in the RCT CHAARTED was 57.6 months.
The results were different for low volume and high volume disease. The median overall survival was not reached at 60 months for low volume disease meanwhile the median overall survival for high volume disease was 49 months.
nejm.org/doi/pdf/10.1056/NE...
Looking at the control trial of the ARASENS trial (ADT plus Docetaxel) the median overall survival was 48.9 months.
High levels of LDH before treatment (or its persistent increase during treatment) is an independent biomarker that predicts decreased survival after Docetaxel.
clinical-genitourinary-canc...
annalsofoncology.org/articl...
ascopubs.org/doi/abs/10.120...
eu-focus.europeanurology.co...
Docetaxel plus prednisone also has no therapeutic benefit for patients with high LDH levels.
ascopubs.org/doi/abs/10.120...
I had high LDH when I started Docetaxel and I'm over 6 years now from diagnosis, past the median survival. Would do it again too, High LDH is not a good reason for anyone who is in a high risk situation like I was to skip a potentially life-extending treatment.
Don't see anything in your profile about your prostate cancer or the treatments you've had. Please share the treatments you've had and how that's worked or not worked for your prostate cancer. Would love to hear!
Thanks for that info on LDH levels, so here are my #s
01/2015 - 169
02/2015 - 150
07/2015 - 212
01/2020 - 130
Also PSA TTN (Time to Nadir) has prognostic value.
Mine was 840.2 in 01/2015 to 0.1 in 07/2017 like 2 & 1/2 years
youtube.com/watch?v=QuKBsJo...
pubmed.ncbi.nlm.nih.gov/307...
I'm so grateful to still be upright, still working as a DDS, hiking, and taking lil staycation trips and posting on the pix on HU
FIGHT ON Ya'll
Randy
Those were "studies" and meta analysis. The actual trials showed otherwise.
Mainly high serum LDH indicates tissue damage.
If you have a high volume of PC and mets you will have tissue damage.
If you have a high volume of PC and mets any treatment has less viability than someone with less disease volume and mets.
Also you mis-stated the summary a bit. You left out the part about DNA mutations and only spoke of the LDH. Also any of us being treated "later in our disease" have poorer responses due to the mutational, and resistant effect of our cancer by that time so studies of these end of life patients show poor treatment results no matter the treatment.
Anyway folks high LDH is not an automatic slam dunk not to have chemo if offered IMHO. Quite the contrary. To say it would not have any benefit I think is a bridge too far.
From a couple of the studies you linked:
High pre-treatment serum LDH coupled with mutations in the DNA repair pathway in primary pre-ADT biopsy correlates with poor docetaxel response and overall survival in the castrate resistant state.
The presence of mutations of the lactate dehydrogenase and DNA repair pathways are associated with aggressive prostate cancer and poor response to chemotherapy later in the disease.
Just coming up to 3 5 years since diagnosis. I am part of the Stampede Trial and had docetaxel straight away. My PSA is currently 0.04 and I am on Abiraterone/Prednisolone. Bit of a struggle some days but hanging on in there
You are asking the wrong question.
Proper Question 1.
If you have cancer, you have a lower life expectancy than all things equal without cancer.
So the question is if you have cancer, and you are among the group of cancer patients for which Docetaxel tends to be prescribed, what effect on life expectancy does it have?
It wouldn't and couldn't be used if it didn't extend those live.
And by the way, the numbers can be deceiving. Perhaps someone else posted the numbers. It wouldn't surprise me if the effect was measured in months. But for those on which it works, its effect is much greater.
Proper Question 2.
You need to ask about the side effects and quality of life issues.
And educate yourself about ways to moderate the side effects. This is a subject that the medical community handles so so so poorly. Even with clinically proven methods, let alone methods that can do no harm, and may work, but no one has the incentive to pay for clinical trials.
With Docetaxel my understanding is that the obsessive use of ice packs is critically important for limiting nerve damage. You really don't want to rely on the obsessive professionalism of the technician or nurse who is attending to your treatment (whose primary concerns are about some petty favoritism the Doc may be showing someone else, or the child's recital right after work) . You just don't.
The data from STAMPEDE and CHAARTED were pretty clear. It’s not a Hail Mary. Diagnosed stage 4 in 2012, 6 cycles of docetaxel in 2017. Stopped ADT after docetaxel. PSA currently 0.5
I had 6x taxotere in 2008, 6x tax plus carbo in 2015, and 3x earlier this year. A 7 year orbit. After having radiation or surgical intervention, or some med such as xtandi; taxotere is like a final rinse. PSA is < .006 now. I can’t say it’s fun but I work out strenuously throughout the cycles, eat well, sleep well and find fun things to do or distract me There are no outcome stats for what we experience as individuals, eventually we all become a sample of one and then die. This is not to say I don’t believe in clinical trials and science, I just extrapolate findings to myself, have a team of supportive medical experts and go on instinct. Good luck to everyone.
What next after Enzalutamide and Docetaxel? 
Life expectancy shock revelation
PSA increase after docetaxel treatment 
After 2 rounds of Docetaxel, PSA is skyrocketing.
How long can docetaxel work after treatment with abiraterone
