Chemo for an 86-year-old with stage 4 PC.

[Poollover]

Started all this at 86, stage 4. 3 months on Orgovyx brought PSA from 72 to 1.8; next week I'm adding Zytiga, and if that helps and I can deal with this drug I'm going to press the MO to start me on Chemo. Do you think I'm setting myself up way too much?

[Tall_Allen]

You can't do chemo after Zytiga helps. You have to start them at around the same time (called "triplet therapy"). The reason is that cancer cells that are not killed by Zytiga go into an impervious state called senescence. Chemo only kills rapidly duplicating cells.

[skiingfiend in reply to Tall_Allen]

Are you aware of any credible evidence or work being done in Senotherapy and Senolytics?

[Tall_Allen in reply to skiingfiend]

I do not think that senescence caused by cancer medicines is the same phenomenon that senolytic advocates are addressing. It is confusing because they both use the same word to describe different phenomena. The senotherapy advocates don't address senescence caused by cancer medicines.

[Azores1 in reply to Tall_Allen]

Tall Allen-does the same theory apply to Lupron? If Lupron is started months before chemo, are cancer cells scenescent? Thank you.

[Tall_Allen in reply to Azores1]

A few months of Lupron doesn't seem to drive it as much, but I wouldn't wait much longer. If cells aren't rapidly dividing, chemo is ineffective.

[Azores1 in reply to Tall_Allen]

thank you, sir!

[tango65]

How many bone metastases do you have? There is discussion about doing triple therapy in patients who have few, usually less than 5 bone mets, particularly if they are over 80.

Besides, the final results of the Stampede trials of ADT plus Zytiga had a mean overall survival of around 77 months, probably the same of higher than triple therapy.

thelancet.com/action/showPd...

[Poollover in reply to tango65]

I just read the Lancet article. It is very encouraging. I start adding Zytiga to Orgovyx next week. I guess I'll find out if this 86-year-old body can handle it. Thank all of you for your advice and encouragement.

[tango65 in reply to Poollover]

Best of luck. !!

[Poollover in reply to tango65]

Thanks

[EdBar]

Chemo is pretty awful, with your PSA at that level why would you push for it?

Ed

[Poollover in reply to EdBar]

I'm not, just wondering.

[Mormon1]

yes. Do the zytiga adhere to instructions. Avoid chemo if possible. Zytiga will give you occasional heatflashes. But it works. Been on it 6 years. How about targeted radiation?

[Poollover in reply to Mormon1]

My MO group wants to hold radiation back until very necessary. They appear to be moving slowly due to my age: in 5 months I'll be 87. I'm still able to hold onto my basic lifestyle: up early, ride my bike, take my Shepard to the dog park, where I throw her balls, finally setting up and repairing my Airbnb. And, the highlight of my day two hours of pool. Lots of stationary stuff in between, as I'm treasurer of a men's club. I mention all of this because I'm determined to hold onto it as much and as long as possible.

[TomMaloney in reply to Poollover]

Your activities are the greatest treatment for PCa. Chemo is not horrible. I have been through it and am about to do it again. I am 82. With your level of activity, you would hardly notice the chemo. You are the perfect candidate for chemo. Discuss with your oncologist.It is only 6 sessions 3 weeks apart.

[Poollover in reply to TomMaloney]

Thanks Tom.

If I can handle Zytiga, chemo and radiation are next. I have a background in science and know that it will not be too long before there are cures for many more cancers, prostrate among them. Again, thanks for your support, Terry

[Worked_the_World]

Poolover, I am right behind you at almost 85. I too have Gleason 9, level T2c, risk 5. My PSA last August was 9.2. I started Orgovyx five weeks ago. It has reduced my PSA to 1.2 and my testosterone to 3. The normal range is 216 to 919, so I am an official eunuch. I will follow you diligently. I am active and between my gym workouts for bone strength and piano playing plus writing novels for mental stimulation, I am pushing PC down to priority 4 or 5.

I can't speak to Zytiga/

[Poollover in reply to Worked_the_World]

We are indeed in the same or similar boats. Not a good metaphor. Orgovyx dropped my PSA to 0.68, and Zytiga dropped it further, but more importantly whatever bone pain I had disappeared. Like you I have stayed very active. Presently, my concern is less about cancer, but commodity. Specifically, the effect of these drugs on my heart. I have a new blood test tomorrow. Let's stay in touch. You can reach me at [e-mail], or text me at 508-237-4228. Terry Siegel, PhD.

[Worked_the_World in reply to Poollover]

Hello Terry,

I visited my cardiologist two days ago and gave him full information of my treatment and Prolia. He checked me over and said he was not concerned about my cardiac health interaction with Orgovyx. I have a blood test last week and things seemed accpetable after five weeks on ADT. We will see.

[Tinkudi in reply to Worked_the_World]

do you have bone mets ? You only took orgovyx and no chemo ?

[Poollover in reply to Tinkudi]

I'm stage 4 with bone Mets, which so far have not caused me any pain.

[Worked_the_World in reply to Tinkudi]

I have taken a guided MRI, bone scan, CT, and more. No bone mets showed up but this is where my skepticism comes in.

Any mets below about 5 mm in size escape detection. I will have a six-week PSA test at the end of July. If it is near zero, I will feel more confident. It was 0.3 just before my last visit to my medical oncologist. My signs look good but my powers of recuperation at 85 years old are diminished. We will see. So far, no chemo.