Currently have a PSA of 840 and rising. I have a meeting with my oncologist tomorrow (Friday 14APR) and need to proceed with either Chemo or RA223.
My oncologist wants to go with Chemo, but will respect my wishes. My thought is to go with RA223 and follow-up with Chemo if that fails.
Looking for people with experience with either.
Frank.
Do both! And you can cut back on docetaxel dose without loss of effectiveness:
ejcancer.com/article/S0959-...
Note that:
• Median PSA progression occurred after 6.6 months in the combination arm vs 4.8 months in the docetaxel-only arm
• PSA declined by ≥ 50% in 61% of the combination arm vs 54% of the docetaxel-only arm
• Median radiographic or clinical progression occurred after 12 months for the combination vs 9 months for docetaxel only
• All 10 treatments were given for the combination, whereas there was a median of 9 of 10 treatments in the docetaxel-only arm
• 12% discontinued treatment in the combination arm vs 23% in the docetaxel-only arm
• Serious adverse events were suffered by 48% in the combination arm vs 62% in the docetaxel arm
• Serious blood disorders were noted more often for docetaxel-only
The combination is available in these clinical trials:
clinicaltrials.gov/ct2/show...
clinicaltrials.gov/ct2/show...
I suggest you email those links to your oncologist and discuss.
This is a small study with 33 patients and it does not indicate that the treatment may prolong life.
"It is unknown whether the combination prolongs overall survival compared with radium-223 or docetaxel alone, thus warranting further investigation."
"In the combination therapy arm, radium-223 and docetaxel administration was delayed in two patients because of TEAEs (cellulitis and osteoporosis), with docetaxel administration delayed in a further five patients (because of back pain, pain in extremity; oral abscess; pneumonia; toothache; diarrhoea, dehydration, pleural effusion, acute respiratory failure and pneumonia). "
If I were in the situation of having to have these treatments and I will not do it simulatneously based on this preliminary study. I would consider the combination when they show it will prolong my life.
That's why there is a link to a Phase 3 randomized clinical trials. The side effect profile of the combination was lower than for docetaxel only. Radiographic/clinical progression-free survival was better for the combination. In the US, the FDA is now accepting that as a surrogate for overall survival because it takes so long to prove an overall survival benefit (another 4 years).
If you can't do both as recommended above, if you have to choose, I'd say start with chemo. It will affect your whole body, not just your bones the way Ra-223 does.
Some people tolerate chemo well. I was fortunate to be one of them.
Some people react very badly to chemo. Better to find out now, while you are at your strongest.
I read your profile. You are doing well. Did you have a PSMA PET scan? Did they find something? Did you radiate your prostate or anything alse? I am just curious. I did finally radiate my prostate and it looks that I can sleep better now without frequent going to the toilet during the night. It improved my quality of life and hope it will stay that way. My last PSA was 0.37 and no visible mets on any scan.
My cancer in my prostate turned into CRPC that was a reason that I did a radiation of my prostate in order to delay more advanced therapies and to kill a CRPC. The hopes are that the other cancer in my body will still not turne to CRPC. We will see.
No PSMA PET scan, they were pretty rare at the time I was diagnosed.
CT scan and bone scan showed many distant lymph node mets and many distant bone mets.
No surgery, no radiation.
Treatments have been: Lupron, docetaxel, abiraterone (+prednisone), and cabazitaxel.
I still take abiraterone (+prednisone) daily. I still get a Lupron injection every three months. So far, so good. The side effects of the ADT are no fun, but the treatment is doing what I need it to do.
When did you have your last scans? Did you have a bone density scan also recently?
I didn't have scans for 4 years but my latest scans didn't find any mets except my prostate had SUV max 14 on the most recent PSMA PET scan. I believe if you don't have pain and with very low PSA you probably don't need scans. I just had them for a piece of mind.
>> When did you have your last scans?
Yesterday, as it turns out. Bone scan reports "...unchanged focus of increased uptake involving the left anterior eighth rib...." and "...persistent mild heterogenous uptake about the thoracolumbar spine, which may represent patient's know osseous metastasis seen on CT." CT scan reports "No significant change in treated retroperitoneal nodal metastases....No significant change in osseous metastases."
PSA < 0.01 for the second time in a row.
The Lupron and Zytiga are doing what I need them to do.
>> Did you have a bone density scan also recently?
No so recent. I still get injections of Xgeva quarterly to treat my osteopenia.
An alternative view, for what it's worth: my husband has completed 3 out of 6 Radium223 treatments, which his doctor notes targets his bone mets, suits his situation as he has no discernable soft tissue mets.
As usual............................... I'm just in time to be too late..........
j-o-h-n <===<<< Senior management is about to spike my spikes....
Good Luck, Good Health and Good Humor.
j-o-h-n Friday 04/14/2023 7:19 PM DST
We don't know much about you.
Did you have chemotherapy before?
I had early docetaxel and I would probably try it again or if it fails I would switch to Jevtana (Cabazitaxel).
I know someone. He did 8 cycles of Jevtana followed by Xofigo.
My MO was not impressed with the combination. He said that chemotherapy fights cancer while Xofigo is only for bone mets. I don't know how many bone mets do you have? What is your ALP? Do you have bone pain?
I would use Xofigo if I would have more than 5 bone mets and bone pain. Actually I would save up Xofigo for bone pain.
Therefore use chemotherapy first and if it is still indicated use Xofigo after that.
Your profile is empty. Could you fill it out?
Xofigo will not lower your PSA. I would definitely try chemo first. Docetaxel and then Cabazitaxel if Docetaxel fails.
Chemo 
Chemo Vs ADT
Oncologist/chemo treatment 
Radiation with Chemo
