Lupron+docetaxel+Abiraterone

[TMcgee]

First time posting. I have stage IVB PC, which was discovered via a hernia procedure in November 2022. I completed 1 month of ADT with no side effects and my PSA dropped to 1.0. Met with my Oncologist today and he proposed changing my treatment to mirror the CHAARTED clinical trial (Lupron+Docetaxel).

According to my Oncologist I am the perfect candidate; but, after researching the trial and comparing it to the Peace-1 trial (Lupron+Docetaxel+Abiraterone), I’m wondering why he would take me off Abiraterone, when the combination of all three treatments offers statistical superior results.

I’m wondering if anyone with stage IV had experience with either of these combinations at the inception of their treatment?

BTW - I have been reading postings here since being diagnosed. Quite a community all of you have developed and I wish you all well.

[Tall_Allen]

I can't imagine why he wouldn't start you off with docetaxel+ (either abiraterone or darolutamide)+ ADT. That is the standard of care now after ARASENS and PEACE1. Maybe you can get a second opinion.

[TMcgee in reply to Tall_Allen]

Thanks for the insight.

[Concerned-wife in reply to TMcgee]

Tall Allen is someone we all respect. The only thing I will profer is that I agree and would definitely question the plan to come off Abi; however, if you have very limited Mets, some experts wonder if the chemo upfront is necessary. You can read the discussions at UroToday. If you go to a local oncologist, many of us feel a second opinion at a leading center is critical.

[TMcgee in reply to Concerned-wife]

I took some time to read a number of Tall Allen’s comments from prior posts over the years. I understand the respect.

I live in Oregon and have been in contact with OHSU for a second opinion. Also, I contacted my Oncologist with the Peace1 trial results. The statistical results are so overwhelming, I can’t imagine an argument against the three treatments.

I have distant lymph and bone metastasis. Given my overall health and activity, my Oncologist seems more excited than me to pursue chemo+ADT. I had to cancel participation in a Pickleball tournament, so the addition of chemo is already affecting my QOL. Lol.

Thanks for the UroToday reference. I will definitely research it. I quickly perused the site and it looks like a wealth of information. Really appreciate it.

[TMcgee in reply to Tall_Allen]

Oncologist texted me today that we will be using the Peace1 treatment. Thank you for your feedback.

[Derf4223]

When one starts out oligometastatic, has a low tumor load left after initial radiation or prostatectomy, and Lupron + Abiraterone has resulted in undetectable PSA, the decision to add docetaxel is IMO a coin toss. I am not a doctor. My coin says no docetaxel for now.

[TMcgee in reply to Derf4223]

I am just learning how to pronounce Abiraterone; now, I have to add Oligometastatic!

Based on my own research and comments from my oncologist, I have been led to believe that there is a window of opportunity early in the treatment cycle, where the three treatments are most effective. Hence the decision to “gang” up after a single treatment.

Your comments highlight one of my major challenges, my initial treatment did not include a discussion about radiation or prostatectomy. My oncologist placed me on Lupron+Abiraterone +xGeva after a 10 minute discussion. I immediately contacted OHSU and Fred Hutch, only to learn that because of staffing issues, they were not offering 2nd opinions at this time.

I checked all the candidate boxes for adding Docetaxel; and if there really is a window of opportunity early in the treatment cycle, what is the downside?