Is it best to start triplet therapy first before trying other treatments for stage 4 ?
My uncle is stage 4 with spread to nearby lymph nodes and seminal vescile invasion, but no bone spread.
They are starting him on Casodex and lupron shots.
Can he actually do tripley therapy right away or have to wait to see how he does on casodex and lupon before switching to triplet therapy ?
One can argue that this is not metastatic. This are just "affected nodes". Instead of ADT I would get surgery with extended lymph node disection. Surgery will remove the seminal vesicles as standard.
I would absolutely not get surgery if I were him and consider radiation a much better choice in his condition. I had surgery and it is my only regret; the consequences are well documented and could have been avoided in my case and many others.
This is why you get opinions from the best oncologists you can find. We are merely patient advocates. Suggestions from us will range from dietary changes and supplements to triplet therapy and more. Everyone responds differently to treatments but data and high level evidence are your best guides.
While triplet therapy is only used at the beginning, your uncle is not a candidate. It is only used when there are bone metastases.
He should be talking to a radiation oncologist for potentially curative treatment. He should consider the following clinical trial:
I agree with Tall_Allen . My husband just completed triplet therapy. He is 48 with Gleason 9, spread to pelvis, regional and distant lymph node metastasis. While his tumor load was considered “low” his team here in Israel decided to not only go for triplet therapy but to add Carboplatin right away due to the amount of cancer in his family. Here’s what we’ve done. May 2022: Firmagon. June 2022 six sessions of Doxcetel + Carboplatin all while taking Zytiga (in morning 4 tablets ) and 5mg prednisone. He’s a strong as nails Israeli soldier but that chemo combo was beyond brutal. He just finished 38 radiation treatments to his prostate and pelvis. Side effects were quite severe starting the second week including severe diarrhea, nausea and urinary symptoms (unable to empty his bladder and very weak stream). He could NOT drive to radiation himself. He’s getting stronger by the day but like anything it takes time and he’s not a patient man. That said he’s never been one to exercise much since the army, preferring to work at the computer most of the day. He’s a thinker and not the most active of men. That is where he will hold himself back as one important strategy that men here will agree on is that you must get moving as much as possible to counter side effects from ALL treatment especially hormone treatments.
“A body in motion stays in motion. “
Since your uncle isn’t a candidate similar to another member here who I will try to find and tag, go and find the best radiation oncologist you can for advice. One of the best oncologist in the world for prostate cancer is Karim Fizazi out of Paris. As a mother to a child with a severe heart defect, when she was born I emailed the best surgeons in the world asking for advice and to my surprise they ALL wrote me back. If these surgeons who are just as busy can write me back personally, I believe you should email all the oncologists you can to get some advice. Thanks to the pediatric cardio thoracic surgeons who responded , I was able to make sound decisions about my infant daughters surgery and care. With that, good luck and feel free to message me privately.
thank you so much, very helpful feedback! Appreciate it
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