Father completed 6 Docetaxel cycle among triplet therapy , Will 3 more cycles beneficial or not ? PSA -2.287

[Helllfire]

Hi everyone , Father , 56 age ,completed 6 docetaxel 3 weekly cycles (dose75mg/m2 , his total dose -135mg ), his blood reports are

HB-8.7 , Platlets - 160, Alkaline Phosphate - 865 ,

PSA - 2.287

All other test like liver ,kidney profile , glucose within normal range .

(Diagnostic PSA-385 , Alk phosphate -6795 ,Hb 9.9.)(PSA before chemo -32).

Diagnosed in August , started with bl orcheidectomy ADT , abiraterone and docetaxel within 3weeks .

Docetaxel chemo and all other simultaneous triplet is well tolerated , apart from fatigue grade 2 no other side effects.

PSA -- Dx -385 , Before 1st chemo -32, After 3rd chemo -9.03, After 6th chemo it is now -2.287

Similarly ALP also has consistent drop .

After going through Internet by reading research on optimal cycles of docetaxel and through HU community, I am of opinion that 3 more cycles will be highly beneficial .

But doctor during initial discussion said 6 cycles is standard . PSA drop till 2 is sufficient , other work will be done by abiraterone.

My father is also willing to go through more cycles of chemo if it benefits.

Please guide me how to go further on number of cycles of docetaxel , should I insist on more cycles or stop chemo cycles here only ?

Please provide any trial research or data regarding 9or 10 cycles is more beneficial if tolerated so that I can convince doctor for more no of cycles.

My appointment with Tata ,Hospital, Mumbai doctor is tomorrow . So please everyone guide me on this .

[GP24]

I agree with your doctor. Abiraterone will be effective, so no further cycles are needed. If required, you can get a rechallenge with Docetaxel or Cabacitaxel in the coming years.

Adding more cycles now will be unnecessary overtreatment causing lasting side effects.

[Helllfire in reply to GP24]

What side effects supposed to be lasting ? He doesn't have any neuropathy problem till now, just have a slightly sensitive skin overall apart from usual fatigue grade 1 or 2 .

[GP24 in reply to Helllfire]

I meant neuropathy. The fact that your father does not suffer from that yet does not mean this side effect will not occur when further cycles are applied. Abiraterone is very effective now, no need for further cycles of chemo.

[Tall_Allen]

I can see that you are understandably excited by his initial response. Docetaxel alone was tested with up to 10 cycles, but the triplet was only tested with 6 cycles. Side effects of chemo may be cumulative-- the more cycles, the more side effects. That's why they like to give the body a break after 6 cycles. I think it is risky to push it when there are no data affirming any extra benefit. But I think it should be his decision.

[Helllfire in reply to Tall_Allen]

As his PSA dropped till 2.287 , not below 1 or 0. something , also ALP at 865 way above normal range . That why I was asking if more chemo will bring PSA level below 1 or 0.

Does this mean his chemo was not that much beneficial if he does not go below 1 like everyone's PSA is going here in forum members?

[Tall_Allen in reply to Helllfire]

Everyone’s situation is different

[slpdvmmd]

Sorry for the slow response regarding my experience with Abiraterone. I have been on it plus either prednisone or dexamethasone since June 2018. I started on it during my last two cycles of docetaxel. In addition I have been on lupron since my diagnosis with the exception of a short initial course of firmagon. I recently turned 71 and have remained physically active, in fact yesterday I just finished a 7 of 9 day stretch of skiing a mix of lift served and backcountry. I think the most important thing regarding activity is you add an endocrinologist to your care team. This seems to be an overlooked specialty in prostate cancer care although clearly many of the medications we are put on affect more than just the target. I have a totally flat cortrosyn response curve and based on recommendations from my endocrinologist I take additional prednisone during times of high and prolonged physical stress in the outdoors.

I think it would be impossible to sort out which component of androgen deprivation accounts the most for decreased physical endurance and strength. But it seems the recommendations by my endocrinologist have been very helpful in me remaining pretty active considering the overall situation.

I have not had any difficulty with hypertension or other reported side effects of abiraterone.

Not sure I really answered your question but hope fully this helps some.