My dad was diagnosed with stage 4 metastatic prostate cancer PSA at diagnosis was 200. He was on bicalutamide for one month and he has also received his first Zoladex injection (April 5). His last PSA test showed that his PSA is down to 56.
We met with radiation oncologist on April 11th and I followed up today again for an appointment. However, they are saying he most likely won't start radiation for another 4 weeks!! I was shocked at the timeframe given - has anyone else experienced this? He is getting treated at BC Cancer (Fraser Valley).
We are not sure what to do in this situation, is getting it out of the province a possibility or a different location of BC Cancer?
Our treatment plan to tackle his cancer is triplet therapy. However his MO said he should do his radiation first and then triplet therapy after. Our main concern is waiting so long for radiation will diminish benefits of triplet therapy (early chemo).
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Jdhanoa
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I did ask his MO about doing chemo first, that unfortunately also has a 4 week wait. However his MO was adamant of him having the radiation done and to not postpone that. In regard to Zytiga, for triplet therapy was it not darolutamide + chemo?
Thank you for confirming. Do you think we should push to have the Chemo done before radiation then? I wonder why the MO is wanting radiation first. MO says since we are choosing to do triplet therapy darolutamide will be delayed until we start chemo as well (which makes sense). I guess my worry is just the timing of things. The only treatment he has had thus far is casodex pills and zoladex injection
All subjects must receive an ADT of the Investigator’s choice (LHRH agonist/antagonists or orchiectomy) as standard therapy started ≤12 weeks before randomization (if combined with a first-generation anti-androgen, such as bicalutamide, flutamide, nilutamide, or cyproterone acetate, it must be stopped before randomization). For subjects receiving LHRH agonists, treatment in combination with a first generation anti-androgen for at least 4 weeks prior to randomization is recommended. First-generation antiandrogen therapy was discontinued before randomization.
Six cycles of docetaxel will be administered after randomization. The first cycle of docetaxel should be administered within 6 weeks after randomization.
Docetaxel is given with prednisone or prednisolone administered at the in- vestigator’s discretion The recommended pre- medication to prevent docetaxel-related hypersensitivity reactions and fluid retention was oral dexamethasone, administered at a dose of 8 mg at 12 hours, 3 hours, and 1 hour before infusion.
Patients were randomly assigned in a 1:1 ratio to receive either darolutamide (at a dose of 600 mg [two 300-mg tablets] twice daily with food) or matched placebo... Patients continued to receive darolutamide or placebo until symptomatic disease progression, a change in antineoplastic therapy, unacceptable toxic effects, patient or physician decision, death, or nonadherence.
Exclusion Criteria:
1. Prior treatment with:
a. LHRH agonist/antagonist started more than 12 weeks before randomization...
2. Treatment with radiotherapy (external-beam radiation therapy, brachytherapy, or radiopharmaceuticals) within 2 weeks before randomization
In the similar PEACE1 trial (using abiraterone instead of darolutamide) they specified: Patients assigned to receive radiotherapy (74 Gy in 37 fractions administered over 7–8 weeks) were planned to start radiotherapy at least 3 weeks after docetaxel completion (but no more than 8 weeks after completion).
Thank you for all the info TA. We had another meeting with his MO's and he now is saying to wait on radiation as almost all of my dads pain symptoms subsided when starting ADT. I think before because he was in so much pain they wanted to radiate first. However, now radiation is being put on the back burner. He started bicalutmide pill from March 20th to April 20th and had his 3 month zoladex injection April 5th. He will in two weeks begin darolutamide pills and then hopefully chemo a couple of weeks after. There is a delay in getting a chair for chemo in BC which is unfortunate so doesnt look like first treatment of chemo will be within 6 weeks of zoladex injection. Fingers crossed that this will be still be okay and still the right course of action
yes this what I’ve heard as well. Unfortunately by the time he gets chemo it’ll be more than 6 weeks as he had his zoladex injection April 5th more likely closer to 8-10 weeks
8 weeks is also ok. Could you please read the document from Fred Saad? Ones he is deeply castrated he can get a chemotherapy. The link is above. So please read it.
For your convenience I copied and pasted a relevant information from Fred Saad document:
"Compared with the castration-resistant state, HSPC is associated with significant increases in docetaxel absorption10 and risk of neutropenic fever.5,8,9 Thus, it’s important never to start docetaxel before patients are adequately castrated. I recommend at least 1 month and preferably 2-3 months of hormonal therapy before starting docetaxel. Peripheral neuropathy is another risk of chemotherapy, and it is potentially irreversible.11 If patients report warning signs and symptoms, it is recommended to reduce the dose of docetaxel to 60 mg/m2.12 If symptoms persist, further reduce the dose to 45 mg or stop treatment."
Funny, my RO shot me up with Lupron, sent me back to MO to debulk with Zytiga and Prednisone. Now that PSA is undetectable for 6 months, and lymph node is 1/4 size and SUV, Im going to WPEBRT. So different doctors have different ways!!
It's not different ways - you are in a different situation from the OP (There's nothing in your profile.) It sounds like you are N1 and have no distant metastases. That is not what "debulking" means, and triplet is inappropriate for your situation.
I received SBRT to my prostate 4.5 years after my diagnosis.
The best would be to do the triplets first with darolutamide. I would not rush with the radiation if it is not absolutely necessary as it can effect his immune system and that would not be good for the cancer.
I would only do radiation if he has pain or something maybe in his neck, otherwise no.
Could you please name the spots where the cancer is and the symptoms?
Ad TA said radiation is not really a standard of care except (I believe) if they have some other very good reasons.
Hi Seasid we had another meeting with his MO's and he now is saying to wait on radiation as almost all of my dads pain symptoms subsided when starting ADT. I think before because he was in so much pain they wanted to radiate first. However, now radiation is being put on the back burner. He started bicalutmide pill from March 20th to April 20th and had his 3 month zoladex injection April 5th. He will in two weeks begin darolutamide pills and then hopefully chemo a couple of weeks after. There is a delay in getting a chair for chemo in BC which is unfortunate so doesnt look like first treatment of chemo will be within 6 weeks of zoladex injection. Fingers crossed that this will be still be okay and still the right course of action
I certainly understand your concerns about the seeming "delay" in treatment. However, this type of delay in treatment is common, particularly with radiation where the excuse is that they need 4-6 weeks to develop the treatment plan after the simulation. This clearly is not the case as Mayo took three days for me recently after being told the 6 weeks in my prior trips to the LINAC at two other institutions. While people will say this delay means nothing, the truth is know one knows what day significant metastasis occurs despite what anyone says. The basis for saying this or that cancer undergoes spread slowly is not a valid excuse for delay. But I again say this approach is open to criticism because NO ONE in truth knows a particular cancers growth, mutation, or metastasis "schedule". I totally empathize with you having been down this road myself but I sadly think the sense of urgency felt by the cancer patient (or any patient) will ever equate with the sense of urgency determined by the medical industrial complex.
I am also being treated by BC Cancer. As we all tend to have different circumstances, my situation was/is - post 2015 January prostatectomy my PSA began to rise rapidly - April started Zoladex (bicalutamide caused pulmonary emboli so stopped it) - June, started radiation. Two reasons why the ‘delay’ in starting radiation. First, they wanted to slow/stop the post prostatectomy PSA rise and second, my radiation oncologist wanted to ensure that my anastomosis was completely healed. Thirty-two radiation treatments landed me in the hospital with, as my GP pointed out, a bad sunburn on my lower intestines. Gotta have a sense of humour. Ultimately, was the radiation of any real value? Possibly not, as my PSA began to rise after two years on Zoladex. Since then, I’ve had eight months of Degarelix and am now on continuous ADT until I become castrate resistant and who knows what will happen then.
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doc says 9-12 months more for my dad
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Is this castrate resistance?
No Longer Undetectable
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