My MO is advising Chemotherapy since I am Mcrp. . The MO said that no Adt will work . I have been reading that most people take Adt along with Docataxcel.
I would love to prolong my life. I have concerns about QOL and what are the percentages of this treatment working with and without ADT?
Thank you
That seems to be a common combination, a doublet therapy. Adding darolutamide might be even better:
"Triplet therapy with the oral androgen receptor inhibitor darolutamide plus docetaxel plus androgen-deprivation therapy significantly improved overall survival in patients with metastatic hormone-sensitive prostate cancer vs docetaxel plus androgen-deprivation therapy..."
ADT, testosterone suppression, (Leuprolide, degarelix, etc) is the backbone for almost all advanced cancer treatments. Do not confuse this with 2nd gen ARATs (enza, apa, daro and abi) which eventually stop working and are eventually discontinued for alternative strategies.
Here is a nice video discussing the role of Atd in cancer treatment:
cancernetwork.com/view/adt-...
Thank you very much
You would by all standards remain on Lupron or Eligard. It would be malpractice to take you off those.
Maybe you are progressing on Erleada. In that case you would stop taking it because it is ineffective.
ADT won't "work" in that it will no longer prevent progression as it once used to, but you will certainly continue to take it because now you are more sensitive than ever to even the slightest amount of androgen. In fact, intensifying hormone therapy with ADT+enzalutamide added to docetaxel may prolong the benefit of hormone therapy, as in the PRESIDE trial:
prostatecancer.news/2022/10...
Thank you very much
I think I have been reading that the initiation of the BAT protocol is causing some to become Hormone Sensitive again and thus allowing ADT to be effective.
Thank you for responding
That has never been shown by any BAT trial.
50%-85% depending on trial. They revert to an HSPC phenotype. It is not complete HSPC. It is a phenotype and appears to be temporary. Denmeade is attempting to resensitize repeatedly in the ongoing STEP-UP trial. Prelim results look promising.
RESTORE: "In the RESTORE clinical trial, men with CRPC progressing on either Xtandi or Zytiga were treated with BAT. Once BAT stopped working, the patients received the same drug that failed prior to BAT (Xtandi or Zytiga). Of the patients who progressed on Xtandi and then proceeded to BAT and were rechallenged with Xtandi, 70% had a PSA response to rechallenge with Xtandi. For the patients who progressed on Zytiga and then proceeded to BAT and then were rechallenged with Zytiga, the PSA response was much lower at 17%."
Two men that I am working with have resensitized. One man's MO said, "this is impossible!".
👍 With y'all on another site. Am a castrated GL10 still HS and using Cypionate on-off-on-off-on ... etc. and maintaining a QoL that's pretty good.
Suggest 2nd opinion, many MO's will recommend ADT & newer hormonal drugs, like Zytiga before and subsequent to chemo.
How old are you?How are you feeling within yourself?
How fit and healthy are you.
Are you up for 5-6months of feeling crappy doing chemo????
You'll be finished chemo in time for summer though.
It's all trial and error.
I have no idea if chemo helped me, or will again.
I personally think chemo gave me something real and present to get through and worry about, instead of all the other list of crap!
Thank you for responding. I am 76 with a a lot of health problems. I already have weakness, pain and fatigue to add.
Seems all the more reason to do Abiraterone/Apalutamide/Enzalutamide rather than chemo as the side effects are fewer.
Oops, sorry, just noticed you've taken them
thank you for responding
Well every treatment is different. My oncologist did chemo first with ADT. Then backed it up with Xtandi and adt. Been 7 years so far. Don’t be afraid to ask questions and or a second opinion Keep on fighting warrior 🙏
Thank you
same here. 11 years in 🙃
Morning. Bill had it as PSA didn’t go below 3 after surg. ( 2014). Pet found it in lymph next to spine. Kwon , mayo. I don’t know percentages, but you could search for the PEACE1 study. He had the chemo first. 2 shots firmagon between chemo 3 and 4. After chemo had 6 mo Lupron, zytiga, prednisone, then 37 radiation and meds then meds for a year. Been non detectable no evidence disease 7 years, no cancer meds or treatments 6 years. Our quality of life didn’t change much. Did read others issues, decided to address our own. Some hot flashes, nite sweats, wt gain. Both nerves cut at surgery due to finding it in lymphs etc. no issues with incontinence at all. Did experience hair loss with chemo, but no neuropathy, but worked hard to avoid that. No real fatigue during treatments again worked hard to avoid that. Got a grip on the wt gain together. Moved to Florida in the beginning, heading back north as I write…. Heat, etc etc, less tolerable than side effects, leaving for a better quality of life…
I’m curious, you mention taking Abi in your profile, but not ADT. When Dx, did you receive Lupron (or other) injections? Also, in 2020, were you diagnosed with stage I or II? Seems that your treatment has been somewhat different for someone with mCSPC.
I would follow Tall Allen’s suggestion.
Ty for responding. MO gave one Lupron injection in 2020. I don’t produce Testosterone. That is why MO decided Lupron is not necessary in my case. Diagnosis was Stage 4
Very interesting! As I understand it, males with low testosterone are more likely to get PC than high Testosterone males. Obviously, it brings into question the link between testosterone and PC.
Given youRr unique chemistry, I would think that chemo is a no brainer.
My dad is in the same boat and we have the same questions as you. We’re going ahead with the DORA trial combining rad223 with docetaxel to target specifically bone Mets with the radium. I don’t know what’s next after chemo
Good luck and Thank you for responding
Adding Nubeqa to the mix might help..........
Good Luck, Good Health and Good Humor.
j-o-h-n Tuesday 11/14/2023 10:22 PM EST
I just finished 6 dose chemo went for my Pet scan and I am now NED. After 7 years of Lupron, Abiraterone, which I am still taking, and Zytiga.. my PSA is also less than .01. I didn't like getting a port, it really was painful, I hated the trips to the chemo place, and my immune system was way down, but I persevered. Others will have different results. I even have neuropathy in my feet, but I made it through and it will be 7 years in February. Still doing my normal PC treatment protocol, but office visits will be every 3 months for a year, if I am still like this after a year, it will be every 6 months. Of course blood draws monthly at my local clinic. Hope is the most important commodity.
Thank you for sharing. So glad that you have been successful. You have been through a lot and I feel for you
Zytiga and Lupron 18 months or 24
Is it time to add Abi+Docetaxel to current ADT?
Intermittent ADT/Zytiga? 
PSA Anxiety and Intermittent ADT for Metastatic Prostate Cancer 
