No indication for Docetaxel ?

[CarlosBrasil]

Helo All, thanks in advance for your usual help.

Almost five years in this journey. RP in 2019, followed by SRT plus ADT for 6 mo. First recurrence in 2021, had RT in LN plus ADT for 8mo. Second recurrence in january this year, started ADT again plus Erleada in July. PSA undetectable last month. Zoladex plus Erleada for ever now, more details in my Bio.

I´ve asked my MO about having Chemo now to be more agressive, but she discarded it, claiming that there is no studies proving that this "triplet" would be of any good at my stage. To not confuse as a "naive" PCa.

Does anyone had seen any paper showing differently ? Does anyone had it at a similar situation, after multiple recurrencies, and had a good outcome ?

[Tall_Allen]

She's right. There is no point in using chemo until the Erleada stops working.

[CarlosBrasil in reply to Tall_Allen]

Thank you !

[Leader4077 in reply to CarlosBrasil]

Depending on your MO and you, you can switch back and forth between back and Earleada, ADT, and chemo or just ADT and one of the above……downside to Docataxel besides obvious fatigue is elevated liver enzymes, especially alkaline phosphate(ALP) dropping, Hemoglobin(below10), dropping red and white blood cells, low 20’s Hemocrit. Also, research the meaning of your lymphocytes and neutrophil ratio……..very important on your Chemo dosing and scheduling.

Mike

Seattle

[Leader4077 in reply to Leader4077]

Carlos

Sorry, made a few typos, be wary of RISING ALP and other liver enzymes.

Mike

[ron_bucher in reply to Tall_Allen]

What source(s) lead you to conclude that?

[Tall_Allen in reply to ron_bucher]

This is very basic stuff.

Hormone therapy drives cancer cells into senescence.

ncbi.nlm.nih.gov/pmc/articl...

(and many others)

Docetaxel is only useful when cancer cells are actively replicating. It stabilizes microtubules so that cells cannot undergo mitosis.

access.portico.org/Portico/...

[ron_bucher in reply to Tall_Allen]

Sorry for my ignorance, but does that mean that the docetaxel I had while on Lupron was useless? Two different well regarded oncologists recommended that treatment.

[j-o-h-n in reply to ron_bucher]

ron...... in this Pca world of ours on H.U., there is no such thing as being "sorry for my ignorance" and except for my first marriage, I'm here to prove that...............

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 11/15/2023 10:12 PM EST

[Tall_Allen in reply to ron_bucher]

No. Before there was triplet, there was doublet with ADT+docetaxel.

[ron_bucher in reply to Tall_Allen]

I'm confused.

You stated "Docetaxel is only useful when cancer cells are actively replicating. " and I think you implied that cancer cells do not actively replicate during ADT (until ADT fails).

[Tall_Allen in reply to ron_bucher]

You just don't want to wait a long time if you are newly diagnosed. As long as you start docetaxel within a 1½ to3 months, it's OK. That is what they did in the triplet trials. In ARASENS, they allowed up to 12 weeks. In PEACE1, they allowed up to 6 weeks. In the STAMPEDE trial of docetaxel, ADT could not have continued for more than 12 weeks before docetaxel was started. If you were newly diagnosed with metastases and your MOs waited more than 12 weeks, you may want to ask them why you were treated outside of the SOC.

[ron_bucher in reply to Tall_Allen]

Thanks!

[robert570]

All I can tell you is everyone is different and what works for you might not work for anyone else. I was diagnosed with aggressive prostate cancer and metastatic bone cancer at 52 years old and I'm now 62. Here's what I've been through. I had a prosectomy because my Gleason scrore was a total of 9 and my prostate was 3/4 bad. My PSA was 10.56 and after the surgery fell to around 2. After that I received Lupron shots, the 6 month one. Next I had radiation that concentrated on the pelvic area, the back of my neck and the middle of my spine due to bone mets. Then my oncologist put me on 6 rounds of Doxetel which took care of numerous spots throughout my rib cage and all the bone mets. Nothing had gone to any of my organs. I had the provenge treatment next. Then I was put on Abiterone Acetate with Prednisone which kept me in remission for almost 4 years, my PSA was around .18 but started rising. Next they put me on Xtandi, but that didn't work well as my PSA was slowly rising. Next was Jevtana. I was on that for over a year and it kept my PSA fluctuating around 2.0 for most of the time. My oncologist recommend me to go on Pluvicto because of its high success rate. After 3 rounds my PSA went from 1.56 to 20.83 That was a big mistake. I stopped it after round 3. I'm back on Jevtana along with Carboplatin every 3 weeks. My PSA stabilized around 20 but after 4 rounds it's slowly rising and now stands at 22. Pluvicto messed me up, but it works for most people, but not for me. This is where I'm at now after 10 years. I'm confident they will find something else that works. I'm in pretty good shape and still active.

[CarlosBrasil in reply to robert570]

Thank you for sharing your journey, although ereryone is different, like you said, an individual history always brings some insight. Just your positive attitude had a good effect for me.

Hope you the best.

[dhccpa]

I've been on Lupron only for five years with multiple bone Mets. My MO is against starting AA now, as PSA, while up and back down, has stayed below 1 and shown no clear trend since reaching nadir. He says if I want AA, he'll go along, but I've stayed the course.