Has anyone received Taxotere chemotherapy after post surgery radiation? My son age 50 was diagnosed last summer with PC tertiary 5 pattern. First post surgery PSA was 20. PSMA pet showed some invasion to pelvic lymph nodes no where else. Put on Lupron , generic Zytiga and prednisone and given 6 weeks of IMRT. Has to wait 3 months till June for first PSA. Have read that a follow up to the radiation is now Taxotere or another chemo. Has anyone has this therapy and what were your results? Did it keep the PC from returning or spreading ?Thank you so much.
Re: Taxotere chemo after post surgery... - Advanced Prostate...
Re: Taxotere chemo after post surgery IMRT
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Cactus297
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"Have read that a follow up to the radiation is now Taxotere or another chemo. " I don't know where you read that, but it is wrong.
SOC is now 2 years of abiraterone and 3 years of ADT.
Thank you for your reply.
He’s on ADT and has had six weeks of IMRT radiation, but Dr Kwon at Rochester Mayo has a YouTube video using Taxotere after radiation and I believe Dr Scholz in the San Diego area also mentions it in one of his videos.
The theory is prostate cancer in the past has not been hit as hard as other types of cancers so adding the Taxotere post radiation gives another layer to “wipe out the cancer” to prevent it from returning later on.
My son had some spread to the pelvic lymph node area and is stage three but tertiary pattern 5 high risk. His two month post surgery PSA had jumped to 20.
However the PSMA Pet Scan did not detect spread elsewhere to any of the bones, etc.
So my thinking has been he might be one of the candidates for post radiation chemo probably Taxotere , but we still haven’t had his PSA tested. It will be three months from the end of the radiation mid June when the test is completed.
I was wondering if anyone has experienced that additional layer of post radiation chemo and what their success was. It’s relatively new within the past few years, and not the SOC for every patient.
Thanks so much again.
Videos are a very poor way of learning about medical practice.
Here is what is actually known on this subject. There are links to articles in peer-reviewed journals, rather than to youtube videos.
prostatecancer.news/2019/02...
Chemo is definitely not in the cards for him based on what you wrote.
His surgery was October 24th. When his PSA rose to 20 two months later he received his first Firmagon injection in December . He experienced a very painful reaction. He said the the pain was much worse than than from Robotic prostatectomy so they switched him to Lupron. He’s doing fine on that and they added generic Zytiga and prednisone. He’s tolerating them well or so he tells me. Then they added 6 weeks of IMRT radiation. He tells me he’s doing well since. If his PSA in June is not favorable then what would you think would be the next strategy they would try?
I thought it would be Taxotere but I guess not from what you said.
Thank you again for your knowledge and sorry for the long posts.
As I wrote:"SOC is now 2 years of abiraterone and 3 years of ADT."
everyone I have spoken to says it is two years of ADT and two years of Zytiga. I know that you pull all of your information from clinical trials, which is important. What clinical trial recommends 3 years of ADT....Stampede?
Everyone you spoke to is wrong. Here is what it actually said: "ADT was given for 3 years and combination therapy [ADT with abiraterone and prednisone] for 2 years"
ncbi.nlm.nih.gov/pmc/articl...
Why do you think a study of "non-metastatic" cases is relevant to the subject case?
The OP is "non-metastatic" in the way STAMPEDE defined it - MO and N1.
I wonder often should I get chemo. Thank you TA for showing me my docs are doing the right thing. Do you have the reference for 3 years ADT? Thought STAMPEDE was 2 years of both. That's what my MO is planning. Thank you so much.
My understanding is docetaxel's effectiveness is highest for those with high tumor loads. It also has some toxicity and other SE's. Every PCa case is a bit different.
ncbi.nlm.nih.gov/pmc/articl...
Thank you for all your knowledge. We all appreciate it. Dealing with PC is such a slippery slope because it’s such a sneaky disease.
You were right. His doctor won’t use taxotere unless he sees widespread which he doesn’t see right now. After 6 weeks of IMRT, his PSA has dropped from 20 to .07. He is still taking generic Lupron and generic Zytiga since Dec 2022. The doctor said they will do more testing this summer. I think he means in June.
Is .07 a good score? I still don’t understand all these PSA numbers totally yet
He was diagnosed August 2022 just before his 50th. Had robotic RP on October 24 and then two months later his PSA was 20 (initially it was 4) and his initial biopsy numbers were 3+3 = 6 and 3+4 = 7 nothing beyond prostate suspected. That was changed to 4+3 = 7, level 3 with tertiary pattern five after the surgery. It seems like the biopsy was totally wrong because it showed absolutely no spread outside the prostate. Then in December at his first PSA test that is where we started on the psa’s 20 journey. I haven’t met anybody on line that’s gone from her for 2 to 20 PSA in 2 months after surgery so I’m just guessing that the initial biopsy was totally wrong Maybe they missed something.???
Thanks again for all your knowledge again.
Biopsies can't tell you if it spread outside the prostate. PSA=0.07 is very good.
Thank you so much. I have been so worried. Since radiation was for stage three I am hoping they got all of it and he won’t need further treatment because his doctor will not do chemo like Taxotere unless there’s evidence of spread so the doctor is following the same guidelines that you sent me.I think he’s going to be tested again in June meaning his PSA, and also other tests too.Thank you again .I am so glad that his score of .07 is a good one.
I saw my son today and he told me actually now they’re classifying it is stage 4 not 3 because it was in the pelvic lymph nodes outside of the prostate. I believe that with the IMRT and the ADT that it’s still curable with the PSA now of 0.07. There is no evidence of PC anywhere else. Is it still curable since there is no spread ? or does it change the scenario? It’s still tertiary 5 that hasn’t changed. They have told him that he will need close monitoring basically forever. My sons goal is remission and he has also gone vegan.
Sorry for all the questions. Thank you very much for your answers.
I saw my son today and he told me actually now they’re classifying it is stage 4 not 3 because it was in the pelvic lymph nodes outside of the prostate. I believe that with the IMRT and the ADT that it’s still curable with the PSA now of 0.07. There is no evidence of PC anywhere else. Is it still curable since there is no spread ? or does it change the scenario? It’s still tertiary 5 that hasn’t changed. They have told him that he will need close monitoring basically forever. My sons goal is remission and he has also gone vegan.Sorry for all the questions. Thank you very much for your answers.
The AJCC stages (i, II,III & IV) are really not all that useful for prostate cancer, More useful are the T,N,M stages. Cancer in the pelvic lymph nodes is called stage N1, which is sometimes curable. There is no evidence that going vegan has any effect, although it may psychologically help him feel better that he is doing something.
Thanks so much. That’s how I understood it too. But his oncologist has not given him any hope for a cure even though it’s just in the pelvic lymph node area, and there’s no cancer that has metastasized anywhere else. Perhaps it’s because he has an aggressive form of cancer ( tertiary 5 )but maybe there’s some aggressive PC type that I am unaware of too? (I don’t have access to his records.) I can only hope for the best that the testing this summer will continue to show that it hasn’t spread elsewhere, and that his PSA stays low. My son’s attitude is very positive, and he is still hoping for a complete remission if a cure isn’t possible. He believes that prostate cancer feeds on red meats like breast cancer feeds on sugar, so he’s continuing on the vegan diet. I am not sure if it really helps either, but he’s the one with the PC and if he feels better eating vegan then I am all for it!
Thank you again for your reply. I really appreciate your knowledgeable answers.
Dr Scholz is one of the more agressive MO's and would probably recommend docetaxel in addition to abiraterone/Lupron, especially for stage 3b Gleason (5+5). Back in 2019, for my stage 3bN1M0+SV he was recommending docetaxel as an adjunct for HDR-Brachy/IMRT. I turned it down because I was GL(3+4) and responded well to radiation/ADT and didn't think it was needed as primary tx. I read some studies at the time that showed the benefit increased with more aggressive, higher Gleasons, so I would consider it.
That’s the same jist that I understood from both Dr Scholz and Dr Kwon. I wouldn’t want to use it for a 3+4 either unless it turned out to be more serious. My son’s biopsy showed 3+3 and 3+4, but after surgery, it turned out to be a 4+3+ tertiary five pattern which is aggressive. So they had to take a more aggressive approach. That’s why I’m thinking unless the PSA turns out very well in June they might want to do a round of taxotere or even if the PSA turns out well, because tertiary five is known to be very aggressive. It’s a relatively new pattern of diffuse, aggressive cells that little is known about. I think they only discovered it about 10 years ago.
Thank you for writing back. If there’s one thing I’ve learned about PC it’s that it keeps you on pins and needles from test to test.
I am so happy for you that your treatment turned out so well🙏🏻
Cactus, thanks for the informative post. I didn't know about the tertiary five pattern [I had assumed it was Gleason 5, as in GL (5+5)]. You might go ahead and check PSA now, before the June date. I know there is a often a flare after radiation, but mine dropped each time one month after HDR-BT and IMRT without a flair. There are cheap PSA tests at resellers like ultalabtests.com (tinyurl.com/2ebm5286), and I used that outside of the MO/RO setting to monitor things more closely. Best wishes to your son. Thanks-- Tim
onclive.com/view/dr-sweeney...
urotoday.com/conference-hig...
My son told me today that his PSA was checked last Friday . Down from 20 it’s now .07! Zytiga the generic and prednisone and had six weeks of IMRT radiation. His doctors philosophy he told me is no chemo unless testing shows it’s widespread. they’re going to check him again this summer I believe in June to make sure that there is no spread and to check the PSA again right now we’re feeling very grateful.
That’s wonderful news!
Thank you. I am hoping his June testing will be better not worse. Thank you for welcoming me. You have both been through a great deal with this PC. How do you manage all the worrying. They say to “live In the moment “ but I haven’t been totally successful with that. It seem that we live more from test to test. Thank you again for your replies.
I will say it took us awhile to figure out how to manage the stress and worrying. We are Christian’s and handed it over to the Lord, put our trust in Him, did everything we can do to manage his cancer, and we are enjoying every minute we can with family and friends. There are still those days those, but I think that’s normal. I learned that worrying about our tomorrows just takes away from our todays.
Thank you for the great advice. I’m still working at it but making some progress at living in the moment . We can do our best with the medications but we can’t entirely control the PC. It really is a journey to learn and accept that. Thanks again for your advice and wisdom.🙏🏻
tertiary 5 study:pubmed.ncbi.nlm.nih.gov/166...
His doctor won’t do chemo unless there’s evidence of spread. He’s going to be tested again in June meaning his PSA and other scans too. Yes, I believe that Dr. Scholz and also Dr. Kwon of the Rochester Mayo both recommend a round of Taxotere, but my son’s team or doctor at UCSD at the present time don’t want him to have it. I don’t know the full extent of how much cancer he had in the pelvic lymph node area as I am his mother and I try not to be too invasive, and yet do research so I guess I’m going to trust his team that he’s working with. They know what and how much was inside of him. I don’t know the full extent of what they were treating. I think it was more microscopic, but am not 100% sure. However, I think if they find anything this summer, they will probably do chemo. I hope that’s not the case.
Sholtz flipped to recommending chemo after my PSMA scan showed a positive mesorectal node with SUV near the min detection level of 3.5. At UCSD, Eintz thought it could be a false positive, and could treat it anyway in his IMRT plan. Seems to have been good judgement by Eintz.
My son’s doctor could find no evidence of spread, but he’ll be tested again this summer to make sure. So far we feel the doctor has made the right decision, because the chemotherapy has side effects too.
I think his doctor is hoping that the radiation killed all of the cancer in the pelvic area. My son said maybe there were three areas but it wasn’t one of those cases where it’s five or more. They weren’t microscopic he could see them, but I guess the radiation is pretty powerful. I am just hoping it got it all. It’s so unpredictable.
Sorry to hear about your son. I am the same age and after prostatectomy my PSA was 0.6 with two pelvic lymph nodes identified. For me they put me on ADT for a month and then 6 cycles of chemo which I have completed. Have now started 35 cycles of radiotherapy and also started on Apalutamide. The ADT/Apalutamide will be for 3 years. My onco, who is a teaching professor said that my treatment regime is standard but the chemo was a judgement call based on a number of factors. Best wishes.
My son told me today that his PSA was checked last Friday . Down from 20 it’s now .07! Zytiga the generic and prednisone and had six weeks of IMRT radiation. His doctors philosophy he told me is no chemo unless testing shows it’s widespread. they’re going to check him again this summer I believe in June to make sure that there is no spread and to check the PSA again right now we’re feeling very grateful.
pubmed.ncbi.nlm.nih.gov/166... this is the study on tertiary five I thought you might enjoy reading
I agree with you. I think the chemo in many cases is probably a judgment call by the Doctor Who has the records and knows exactly what is going on. My son’s doctor thus far does not think his case warrants it or I am sure he would give it because my son’s cancer is very aggressive. Hopefully we don’t see it later on but we could. Thank you so much for writing.
I live it Italy so care has been different. But here’s my story. Biopsy of 4+4 in Jan 20. RP Feb 20 with 12/49 nodes positive. Pathology 5+5 after RP. No treatment after RP due to being undetectable. Slow rise in PSA starting July 20. Salvage radiation discussed and dismissed due to unknown location of cancer and RO not wanting to bombard me with unnecessary radiation. Continued slow rise in PSA. PSMA PET scans in Sept and Nov 20 negative. Still no meds at this point so as not to suppress location of cancer. PSMA PET in Feb 21 indicates 1 small met in pelvic area. 3 consecutive days of high dose radiation to met that killed it off. Still no subsequent meds. Continued slow rise in PSA. PSMA PET in Jul 21 indicates 3 small new mets. 1 in lower spine and 2 in right lung. Start monthly ADT, Lupron (still only med), in Aug 21. 6 rounds of Taxotere chemo Sept 21-Jan 22. PSA non detectable since round 5 in Dec 21. Lastest labs, chest x-ray, oncologist visit last week indicated PSA and Testosterone still non detectable, lungs clear, and oncologist happy with where I am at.
I often disagree with the SOC recommendations here. Sure, great place to get info and maybe develop questions for your MO but it’s your body amd your cancer. Find the best MO you can, develop a treatment plan with your care team, and follow that plan. My 2 cents. Best of luck!
My son told me today that his PSA was checked last Friday . Down from 20 it’s now .07! Zytiga the generic and prednisone and had six weeks of IMRT radiation. His doctors philosophy he told me is no chemo unless testing shows it’s widespread. they’re going to check him again this summer I believe in June to make sure that there is no spread and to check the PSA again right now we’re feeling very grateful. Hoping the good news lasts.
My son told me today that his PSA was checked last Friday . Down from 20 it’s now .07! Zytiga the generic and prednisone and had six weeks of IMRT radiation. His doctors philosophy he told me is no chemo unless testing shows it’s widespread. they’re going to check him again this summer I believe in June to make sure that there is no spread and to check the PSA again right now we’re feeling very grateful. Hoping the good news lasts. dealing with PC is such a slippery slope.
pubmed.ncbi.nlm.nih.gov/166... This is the study on tertiary five but I thought you might enjoy reading
I was nearly identical as a 4+3 and tertiary 5. As part of a clinical trial post op I was given Taxotere along with 2 years Lupron, IMRT and abiraterone at a well known center of excellence.
One positive lymph node out of 12 was found, but PSMA pet was yet FDA approved and largely unavailable at that time. As I was not inclined to travel and spend thousands out of pocket for one then, I entered the trial based on what was known. Good thing since at undetectable PSA there would have been nothing visible on a PSMA pet.
The addition of the Taxotere at the time (2019) was experimental, and in my case was probably superfluous. However my post op PSA was undetectable and this is one area where we differ markedly. His PSA was actually 20 post op? That is very high for a first post op PSA.
My son told me today that his PSA was checked last Friday . Down from 20 it’s now .07! Zytiga the generic and prednisone and had six weeks of IMRT radiation. His doctors philosophy he told me is no chemo unless testing shows it’s widespread. they’re going to check him again this summer I believe in June to make sure that there is no spread and to check the PSA again right now we’re feeling very grateful. Hoping the good news lasts. We would have never known that the cancer spread to the lymph nodes without the PSMA Pet scan as none of the other scans showed anything but everyone is different even with similar numbers.
I agree with you the 20 was very high. We were absolutely floored by it. There was nothing to indicate in his biopsy numbers that this would happen. We thought it would possibly be a once and done operation and then two months later they tested his PSA twice and it was 20 both times, I don’t know of anyone that I’ve run across online with a PSA of 22 months after robotic surgery … perhaps it had something to do with his also being tertiary five, which is very aggressive. Then none of the scans showed any spread of the cancer until they gave him a PSM, a pet scan and that showed some spread in the pelvic lymph nodes but nowhere else it’s been a very scary time living with that 20 with no indication beforehand that the spread was beyond the prostate. Today was a relief to learn from my son that his PSA is down to .07 but I hope it stays that way.
you are one of the few people I have run across who also is tertiary five and 4+3. Everything I read on the Internet about tertiary five is that it’s quite aggressive and basically will come back at you.
pubmed.ncbi.nlm.nih.gov/166...
This is the study I found on the Internet when I learned my son was tertiary five. It really needs to be watched carefully.
tertiary five is a relatively new, finding of diffuse highly differentiated cells that are aggressive. Unfortunately not that much is known about it, but from everything I’ve read, they really do need watching carefully.
I caution you against giving too much weight to random internet searches. Tertiary 5 is not a ‘relatively new’ discovery. The article you cite is 17 years old. The field is changing rapidly.
This is not to say Tertiary 5 isn’t serious. However, in studies such as the one referred to here, the data on biochemical recurrence, PSA free survival etc is too old to be of any use. Treatment efficacy is a world apart from what it was in 2006.
Thank you! I just saw your reply right now. I didn’t recall that it was a 2006 study on tertiary 5 and you are so right treatment in 2006 was a world away from treatment today. I have been so worried about it, but your reply actually helped take the worry away. I was putting by far too much emphasis on the tertiary five part. I am surprised that they haven’t done more studies on it since 2006, but the good part is they’ve developed much better medicines to deal with all these different scenarios that can happen. Each person and treatment is just so different even though the disease is prostate cancer. Thanks again!
Age 50 is very young for aggressive prostate cancer. Study data may not be very relevant to his case, since studies rarely if ever look past 10-15 years.
Every case is unique. Instead of looking for cookie cutter solutions from non-professionals, he is best off getting a world class oncologist (or two) who focuses exclusively (or at least mostly) on prostate cancer. That's why I added Mark Scholz to my medical team.
To answer your question more directly, see my profile for my Taxotere results - it might have given me (or at least helped give me) 4+ years of undetectable PSA.
Yes he was diagnosed just before his 50th birthday last August.My son told me today that his PSA was checked last Friday . Down from 20 it’s now .07! Zytiga the generic and prednisone and had six weeks of IMRT radiation. His doctors philosophy he told me is no chemo unless testing shows it’s widespread. they’re going to check him again this summer I believe in June to make sure that there is no spread and to check the PSA again right now we’re feeling very grateful. Hoping the good news lasts, it would be nice not to need chemo. However, it’s great that if she needs it it’s there.
PSA should be undetectable while on ADT. I hope he has oncologists on his medical team who have a LOT of experience with prostate cancer.
He’s being treated at a large university NCCN hospital in Southern California. He has entire team of doctors that specialize in prostate cancer. After finishing 6 rounds of IMRT radiation in March and sti taking Lupron and Zytiga/prednisone his PSA has dropped from 20 to .07. He will be retested probably in June and also have more scans. Is oncologist said there is no evidence of widespread cancer and doesn’t want to do chemo unless he sees that. Hoping the radiation wiped out the small amounts of cancer in his pelvic lymph nodes because the cancer is aggressive .🙏🏻🤞
Sounds like he is in good hands. Best of luck!
I hope and pray so. He went to several specialists in CA and also had a Mayo televisit before having robotic surgery with one of the supposedly two most experienced prostate surgeons in CA…then 2 months later his PSA jumped to 20. We were totally shocked because we were hopeful that his surgery might be a once and done given his pre-surgery numbers. So ever since then we’ve been on this journey chasing pc. We still can’t figure out what went wrong, but hopefully we’re on the right track now. This PC is really tricky. And in previous groups, I’ve met others who have similar things happen. We can only pray, and hope for the best. I hope you’re doing well with your PC too. The men in this group seem to be really knowledgeable and that makes me feel better. I first joined newly diagnosed groups, and none of us really knew that much. Best of luck to you too.🙏🏻🤞
I am wondering if the aggressive cancer at age 50 was due to the tertiary 5… because tertiary five is a rare and aggressive form of PC. One of the doctors told him he will have to be monitored closely basically forever.
Pca tends to be more aggressive in younger men. The tertiary 5 may or may not play a role down the road. What does play a major role is exercise, both cardiovascular and weight training.
Decide on treatment course as you see fit. Beyond that, your odds of ‘keeping it from spreading or returning’ (as well as preventing the co morbidities that Lupron is known to hasten/exacerbate) are increased more by exercise than any other factor.
so before PC instilled exercises now, so I think that’s in his favor. It’s good to know that the tertiary five shouldn’t be that big a deal down the road that is what has had me worried the most. thank you for letting me know.
Sorry for my errors. What I was trying to say is that he exercised before PC and still exercises now so that should help them. I use Siri on my phone and sometimes it doesn’t get it right and I don’t catch it.
The Tertiary 5 may be a 'big deal' yet. But you can rest assured even if it becomes so, it will be significantly less of a big deal than it would have been 17 years ago.
Are you saying that exercise and Lupron makes the cancer more likely to spread or that Lupron and exercise helps the cancer not to spread? My understanding is that exercise is good. Thank you.
The latter. The two metrics that are most significantly associated with longevity are strength and cardiovascular fitness. The association of exercise with quality of life is even more important and continues to increase with age.
Thank you. He enjoys exercising especially outdoors in CA so he’s doing the right thing. He’s also gone vegan and there is some evidence that eliminating red meats fights PC so he’s doing that as an extra protection. It might not cure it, but I don’t think it’s going to hurt either because it’s healthy eating. Thank you again and I hope you’re doing well too.🙏🏻
pubmed.ncbi.nlm.nih.gov/166... on tertiary five I thought you would enjoy reading it
Hi, I’m sorry to hear your son is on this journey. My husband was diagnosed 2/2018 that had already spread to several pelvic lymph nodes (at least 15), bladder neck margins, bladder neck muscles, and seminal nerves. His PSA’s highest was 10.5. After surgery, radiation wasn’t an option as they said it was to widely spread. They put him on Lupron and Casadex that fall and he started taxotere in November. He was only able to get 3 treatments and then his body couldn’t take it. He ended up with a bad blood infection along with other issues. But … by December of 2018, his PSA was down significantly, I want to say 1.8 or so. The combo probably helped accomplish that drop. Hope it helps to hear another’s experience with these medications. Since this time, he tried zytiga and Xtandi. He just can’t handle the side effects and won’t try any further. Best of luck for your son.. I’ve heard many good experiences with the tacotere and hope he benefits from it.
Thank you for writing. I hope your husband is doing well now. Thus far, my son has tolerated the radiation Zytiga and prednisone and Lupron pretty well. He did not tolerate Firmagon… it was too painful …he still is able to exercise and work but he’s only 50 so that probably helps. I wish you both the best. It’s not easy.
Son's Gleason score?
Good Luck, Good Health and Good Humor.
j-o-h-n Monday 05/01/2023 10:19 PM DST
Thank you. And right back to you. His PSA yesterday of .07 looks a lot better than 20 but I realize it’s a beginning not an end.
John, I just read your bio and it’s amazing that you have been dealing with prostate cancer for so long! Wow! Since shortly after 2000! You are a very strong 💪 person. Best wishes.
Pre-surgery scores were 3+3=6 and 3+4=7 showing contained with no seminal invasion. During surgery doctor took some or all (not sure) of the seminal vesicles. Two months later his PSA was 20 whereas before my son said it was 4. None of the test and scan showed any spread until the PSMA Pet Scan that showed some spread to pelvic lymph node area. His score after surgery was changed to 4+3=7 grade 3 with tertiary pattern 5. And the journey I described earlier began.
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