Reaching the end of treatment, suggestions beyond Docetaxel and Carboplatin.

[docbulldog]

1st Docetaxel in ‘21 held psa down to 8, but further treatments have been with no success. I read once that the steroid to use with chemo could be Dexamethasone 1 mg rather than prednisone 5 mg. Is there a clinical reason why?

What next?

[Tall_Allen]

It has to be stronger to counteract the side effects of chemo (Dex 1 mg is stronger than pred 5 mg).

Have you tried Xofigo+Provenge?

[docbulldog in reply to Tall_Allen]

Provenge, yes back in 2019, then Xtandi and Zytiga. Xofigo would still be an option, but would have to travel 100 mi north.

[docbulldog in reply to Tall_Allen]

Are the extra side effects of 1 mg of dexamethasone worth the attempt to counteract the side effects of the combination chemo? I guess I have a concern about the adrenal gland being affected a lot. I have been on 5 mg of prednisone almost continually since I got off my last chemo treatments in 2022.

I might add that on the day of fusion they give me 12 mg of dexamethasone and then the next three days 8 mg. After that I take 4 mg for two days and then 2 mg for two days. Then I’m back just to the 5 mg of prednisone that I am taking continuously.

Sorry to put too much detail, but I really appreciate your input.

[Tall_Allen in reply to docbulldog]

That is typical, from what I've heard - a big dose of dexa at the infusion, and low dose pred as maintenance. Important to slowly come off them afterwards, to avoid high BP.

[wagscure259 in reply to Tall_Allen]

Exactly my current protocol at MSK. Your breath of knowledge is amazing.

[Mrtroxely in reply to docbulldog]

HiWhy do you still take presidlone steriods

[Fightinghard in reply to Mrtroxely]

the low dose prednisone helps slow cancer growth plus reduces pain

[Magnus1964]

Have you been on any ADT drugs?

[docbulldog in reply to Magnus1964]

I started with Lupron in 2016, later Xtandi the Zytiga. Xtandi worked for about 2 years, Zytiga did not control psa. Also have been receiving Zytiga shots every 3 months along with the Lupron.

[dhccpa in reply to docbulldog]

Didn't know Zytiga came in a shot. Will Medicare cover that (if you're in USA)?

[docbulldog in reply to dhccpa]

Oops, Xgeva….every 3 months

[dhccpa in reply to docbulldog]

Got it thanks

[tallguy2]

you might consider Lu-177.

Pluvicto.com

I will be traveling 360 miles round trip to start this treatment on 2/27.

[docbulldog in reply to tallguy2]

I just completed 4 treatment of LU-177 with little results and was dropped out of the program in January. I thought the PSMA CT scans taken the second day of the program were showing progress but my PSA continued to skyrocket up to 764.

Definitely hoping this combination of chemo will get some good positive results. I’m just hoping I can keep my strength up and not lose so much weight.

[tallguy2 in reply to docbulldog]

I am sorry to hear it didn’t work for you. That is my fear as well. I will only have cabazitaxel/carboplatin left, if my body can take it.

I have lost 25% of my body weight. This has resulted in my back pain per my RO. It never ends.

Best wishes.

[docbulldog in reply to tallguy2]

I think I’m in the same situation as far as losing body weight. Used to weigh around 210 now down to 160. Always wondered if old guys ever get back to their high school weight. I guess one thing is, I won’t have to worry about acting like an 18 yr old again. 🤣

[EdBacon in reply to docbulldog]

Did you get any benefit from the first and/or second infusions of Pluvicto?

I'm really wondering if it's going to work for me. I've pretty much exhausted chemotherapy as an option, think I would just be wasting my time with it. I still don't have much of an appetite, but it's only been a week with Pluvicto so far.

[docbulldog in reply to EdBacon]

Since I am now on chemo, my chemo brain is not working the best, but as I recall the first couple sessions seemed to eliminate any small pain I did have, which were very few. I did seem to have a lot of knee pain for some reason. After I was eliminated from the Pluvicto, I haven’t had that knee pain.

Not a lot of help there, best of luck to you.

[joeguy]

Which chemo drug did youo find easier to tolerate? I recently started Docetaxel, and for a chemo that is said to be "fairly tolerable", I found it to be pretty nasty

[docbulldog in reply to joeguy]

My first round with Docetaxel wasn’t too bad except after 10 infusions I was pretty worn down. Biggest concern there was it gave me some pretty nasty neuropathy. I have only had one infusion of the combination chemo, and I feel pretty worn down but I am working through it.

The best to you and your challenge!

[joeguy in reply to docbulldog]

you too, thanks

[cesanon]

Have you investigated the option of Bipolar Angrogen Therapy?

[docbulldog in reply to cesanon]

My oncologist is not onboard with BAT but has mentioned an oncologist in Spokane, WA that had interest. With my psa in the 700s there may be concern.

I’d definitely like a vacation from all.

[cesanon in reply to docbulldog]

No harm in scheduling some second opinions. The folks here can make some recommendations.

But you will need to get prepared to do some flying.

[Docker53]

Have you talked to your Oncologist about Radium? This is what she is suggesting for my hubby who just finished 10 sessions of Chemo. His PSA before Chemo was 26 and now it's 14.9. She wants to give him a break for a month or so before 2nd round of Chemo or the Radium

[TeleGuy]

I see that you were on Zytiga for a time which means you must have been on prednisone then. Did you try switching to dexamethasone to see if you could get any more life out of the Zytiga? My PSA went from 3.8 to 0.6 in less than a month when I switched.

I ask this because it seems that you are still on prednisone, and over time the androgen receptor can get what it needs from the glucocorticoid receptor and thus prednisone ends up stimulating the cancer. Dexamethasone is chemically different enough that it disrupts this outcome. If you have to be on a steroid, I wonder if switching to dexamethasone would help with your PSA rise?

[docbulldog in reply to TeleGuy]

I have never heard that before, but will definitely check this out. I am about to switch from prednisone to dexamethasone during my current chemo treatments. I will pass this on to my oncologist. Thank you for making me aware of this, is there some references I can refer to before I talk to my doctor?

[TeleGuy in reply to docbulldog]

Here's a post were I cite references. No idea whether this might work outside of the abiraterone context.

healthunlocked.com/advanced...

[docbulldog in reply to TeleGuy]

Thank you very much for your time on this, I will take this into my oncologist next week. Also I’m going to talk to my onc about my neuropathy and hopefully get on Lyrica, and not the generic Pre-Gabalin.