thoughts on virtual second opinions

[Jdhanoa]

Hi all,My dad was diagnosed with stage 4 metastatic prostate cancer about 5 weeks ago. He is 65 years old. His current MO has him on a zoladex injection and next ADT has yet to be added.

I was looking into getting a second opinion at MD Anderson, Mayo and Sloan Kettering. I noticed that all offered virtual second opinions.

I was wondering if these virtual second opinions are worth it or if it’s better to go in person?

Thank you

[Tall_Allen]

No need to go that far afield. You have one of the best in the world nearby. Plus, he knows what is available to you in Canada. I should have also mentioned Celestia Higano, who I understand is in BC now.

[tango65]

There are good options. I have used frequently.

[MateoBeach]

Following your recent posts and decision process and just want to highlight one factor: The substantial improvement in survival with Triplet therapy is from the combination of ADT, with an advanced AR drug AND docetaxel chemotherapy. All started together (or very close to it) at diagnosis. The chemo is most effective on rapidly dividing cells, so needs to be deployed before a significant slowdown from the hormonal drugs.

For this reason I would favor starting the docetaxel promptly to get the maximal benefit. Since he is now on the Zoladex the clock is ticking. If he pursues the Lu-PSMA trial now that would exclude the early triplet with docetaxel benefit. Within 4 months the docetaxel cycles will be complete and he can pursue whatever next-line options as may be recommended. Go to ONE excellent PC oncologist as per T_A’s suggestion, rather than seeking other opinions at this time. Just my considered opinion. Paul

[Jdhanoa in reply to MateoBeach]

Thank you Paul. He did bicalutamide March 20th (one month worth of pills, last pill was April 20). He had his Zoladex injection April 5th. His next MO appointment is tomorrow. We are going to choose to add in chemo, secondary ADT in order start triplet therapy. We are hoping that it is not too late for triplet therapy to be effective? I read somewhere the ideal time is 6 weeks from Zoladex injection however not sure if that is accurate...

[MateoBeach in reply to Jdhanoa]

Delaying the six or so weeks is very common practice. But it makes no sense when Triplet therapy is called for. It just suppresses PC growth very effectively but makes the chemo less effective. On the brighter side, it is probably still okay. Any small sub population of ADT resistant cells won’t be suppressed and the docetaxel will still hit those hard. Have him be vigilant for emerging peripheral neuropathy while going through the chemo cycles, especially the 4th and 5th. Docetaxel should be stopped or replaced with Cabazitaxel then and not continued, as it will likely get worse with subsequent doses. It can be a terrible side effect that is usually permanent hen it occurs. Still worth going through the chemo though. Discuss and plan icing strategies to protect fingers and feet.

[Jdhanoa in reply to MateoBeach]

We had our appointment and his MO wants him to do radiation first which means further delay of chemo and AR drug. Not sure what to do at this point. Can you let me know more information on icing strategies?

[MateoBeach in reply to Jdhanoa]

Delaying triplet therapy while staying on ADT alone waiting for the RT MIGHT be unwise. I would suggest getting a prompt 2nd opinion from an excellent PC urologic oncologist. One would be Celestia Higano at Vancouver Prostate Cancer center at the University of British Columbia in Vancouver. You should be able to find out how to set up a virtual or in person consultation. She will need all history and test results.

Icing of hands and feet is just for while receiving chemo infusions. Infusion center nurses will be able to advise.

[DoubleBlind]

I switched from Kaiser to Fred Hutchinson in Seattle. My first meeting with the team at Fred Hutch could have been done virtually as a matter of fact, I barely get physically examined by my specialists. Between the scans, and the biopsy, and your blood tests and medical history they should have everything they need.