After I failed with Zytiga, my MO moved me to Docetaxel for 6 sessions starting on November 7th.
My Psa going in was 227, after getting the blood work before starting session 3, it was up to 300.
Is this going to be just one more treatment that is not going to work?
Discuss switching remaining infusions to cabazitaxel+carboplatin.
For what reasons?
Cabazitaxel is approved for when docetaxel doesn't. Adding carboplatin seems to further increase results:
ncbi.nlm.nih.gov/pmc/articl...
Thanks for the information
Is cabazitaxel treatment only approved for when docetaxel doesn't meet some threshold benefit?
Yes. It's only approved for when docetaxel is tried and fails.
I just need to live long enough to get through all the preliminaries, basically the failure of initial AOC therapies. The article you referenced was trialed with a restriction of being castration resistant. Frustrating especially when you can't see the science of why those restrictions are in place. I understand going for the patient population which has the fewest other options but it is driving me nuts to see it out there just out of reach. Looks like docetaxel to start.
Docetaxel rarely fails when given for mHSPC.
Unfortunately I am mCRPC
Sorry I must have hit the enter key by mistake. Another friend died after refusing a new round of chemo. Another friend has been through several rounds and says he does not intend to do it again. He has been miserable after every one for weeks. I know of even others who have hated their chemo (for a variety of cancers). The most common side effect noted in the above study and most others is fatigue. Depending on how bad it is it can directly affect your mood and prevent you from living a "normal" life. An extra 3 months of worthy QOL is a decided barrier to my wanting to do it.
Tall_Allen, thanks for all your help on here. Question - what is the trial result increase in time to death from getting docetaxel when mHSPC? In the article you posted above it looked (these articles are hard to decipher sometimes) like the expected mean or 4+ to a mean of 7+. Whenever a trial comes up with a noticeable improvement they declare it a successs and then the FDA approves whatever. The authors did track the side effects that were reported by the participants. They appeared to be fairly low.
That doesn't track with my, certainly, anecdotal discussions with those who are on chemo for various other cancers. I admit I don't know the specific chemo meds and protocols they follow but they almost all say that they are very sick and unable to do much of their normal activities. Many get really depressed. As you know, I am very sensitive to the effects of depression. I don't see it listed as a side effect often if at all.
I'll get some lumps about my anecdotal "information". My brother has been through multiple chemo treatments for non-hodgkins lymphoma. He seems to be asymptomatic after several years of multiple treatments and basically stopped his normal life. I have another friend who
Different chemos have different side effects. Docetaxel monotherapy is fairly mild. Of course, individuals vary.
It could be a PSA flare
pubmed.ncbi.nlm.nih.gov/189...
This is what my husband was told but I am not sure that certain increases are flares. My husband's PSA was 99 pre chemo and after first infusion 200 and then it kept increasing like that until it was 900+ after 4 Docetaxel and 2 Cabazitaxel infusions. They were only stopped when the scans showed progression along with symptoms. Doctors kept reciting a formula of having to try Docetaxel at least 3 times. The 4th one was given because they had not done the paperwork for Cabazitaxel. In retrospect, I think that chemo that does not work actually causes harm. My husband's PCa accelerated after the failed chemos.
If he has chemo and it fails, he is eligible for LU 177 PSMA treatment which has a compltely different mechanism of action than docetaxel and its efficacy is similar or better than chemo and it has less potential negative side effects.
Tango, what you are reporting here might be very good news for me if it is accurate. Can you reference your sources for indicating that failed chemo can meet the SOC requirements to get any of the Radioisotope-PSMA treatment. My doc says it doesn't. It can be a factor in some treatment approvals if concurrent with failures of other therapies such as ADT.
Run a new genetic test and make sure has mutated to PTEN...that happened to my husband recently and nothing works now! Better to know before putting yourself through the ringer.
I’m sorry, what does PTEN stand for?
there are different somatic (not born with) genetic mutations that cancer will express. Like BRCA can be targeted with PARP inhibitors. But it continues to mutate so good idea to check every year or two. PTEN is when it loses a chromosome and can no longer suppress tumors. It becomes very resilient to many treatments and aggressive. There are a few clinical trials in the works for the PTEN expression but nothing conclusive yet. This info has helped us make choices personally. We are letting my husband go without beating him up anymore on the way out. Friends and family are spending lots of time with him.
Thank you for explanation. I will ask for test, not sure how successful will I be in our system. But I would think they should check this when one becomes castrate resistant. Why torture a person with treatments when it is clear they will not yield results? It is inhuman. My father is all for quality over quantity, epecially if quantity means potentially addional month or two. I hope your husband still has some quality time with family and friends. And that his pain will be successfully managed. I will pray for all of us.
Dude, you are ahead of the curve that I’m on, so I have no applicable experience to share. I’m having my PSA checked today, however. We’ll see if I go to Docetaxel or not. My MO has upped my Estradiol in hopes that my PSA will decrease (1.4 last test).
A PSA flare during chemo especially with castrate resistant PC patients (from my understanding although don't take my words for gospel) is not unusual. While PSA readings are certainly important I would be looking at what chemo is designed to do as the main guiding marker. Stay the course and keep rolling. My best to you.
Bglendi53 ,We are praying for you! 🙏Nvr give up! My husband started his treatments with Docetaxel and did well, took 4 years for castrate resistant, currently on ADT +Pred and Zytiga, hoping it works, time will tell, next PSA and T Jan 5th, his QOL is great
PSMA scan scared the crap out of us. Molecular test showed nothing all indeterminate? 0, not sure what to make of that
Happy New Year to all you warriors, hope 2023 yield better days ahead for all
Before I went on Zytiga I was first put on Xtandi or casodex first for about 3-4 months. When I was put in the hospital my PSA was over 800 . After 5 years now the Zytiga is starting to fail. PSA is still low (1.5) but is no longer undetectable. Sending prayers to you hoping your docs get it right
I had Docetaxel 3 years ago with good results. Due to progression started again a few months ago and determined it was of no benefit after 3 infusions.
Every 3 weeks my PSA kept rising and rising at the same rate/trend it had been prior to starting chemo. PSA didnt seem to have the "bounces" that occur with picking up dead cancer cells. Importantly scans after 3rd infusion showed no shrinkage or resolution of mets ( fortunately no new mets or progression of existing mets).
I think if you could get scans asap it will help in determining if continuing Docetaxel is viable. Moving on to Jevtana as Tall Allen noted above might be an option.
PSA flare following first round of Docetaxel
PSA Went Up After Start of ADT
Next Step Docetaxel after Abiraterone & Xtandi failed. 
PSA going up after docetaxel and zytiga
first PSA test after 3 courses of Docetaxel
