Adding Docetaxel to T3b?

[Adendino]

My husband is 63, stage T3b N0M0. His biopsy showed all 12 cores positive with 80%+ cancer, GL 4+5 with intraductal carcinoma and original PSA was 12. According to PSMA pet scan 12 months ago, he has additional risk factors such as ECE, SVI, PNI, but no other spread. He has completed 39 IMRT sessions and is 1yr into a 2 yr course of Lupron+Abiraterone. No gene mutations on his Invitae genetic testing. They didn't radiate his lymph nodes during the IMRT because he had testicular cancer 25 yrs ago and they assume they were radiated back then. PSA is currently .04.

So far, so good, BUT... I'm wondering if there is more we should be doing in lieu of all his high risk factors to prevent a recurrence or metastasis down the road. I was just reading the STAMPEDE trial and it appears some docs are adding Docetaxel to SOC for Stage 3 patients w/o cancer in the lymph nodes.

a) anyone out there using Docetaxel for Stage 3?

b) do you think this is something we should ask his MO to add to up his chances of avoiding a recurrence?

He is being treated at UChealth in Aurora Colorado (university of CO). He's a slim/fit athlete and has been working out like crazy to mitigate the side effects of the ADT. He's doing his best to eat well, and stay in shape to keep the SE and cancer at bay.

Thanks,

Adrienne and Jeff

[Tall_Allen]

STAMPEDE showed there was no survival benefit to giving docetaxel to non-metastatic men:

academic.oup.com/jncics/art...

[Adendino in reply to Tall_Allen]

thanks Allen. I was having a hard time deciphering the mixed messages in the trial report and whether there were benefit or not.

[timotur]

Hi, five years ago, I was also Stg3bT1M0+SV (GL 3+4) (PSA:33), facing a similar dilemma considering early chemo as suggested by my MO at the time. I read several studies looking at early risk-stratified chemotherapy for hormone-sensitive, non-metastatic groups. The conclusion I came to, was not to do it for two reasons: 1) I was GL-7 and there seemed to be a cutoff at GL-8 where it became beneficial, and 2) I responded well to ADT and HDR-BT/IMRT with PSA dropping to <0.02. The study below of a treatment-naive, high-risk population is one that swayed me, but would strongly consider it if I were GL-8+. Best to you. Tim

thelancet.com/journals/lano...

[tn12 in reply to timotur]

Hi Timotur, my husband's pathology is very similar to yours. I read the link you posted and curious where you got that it was beneficial for GL8 and not GL7? Thanks

[timotur in reply to tn12]

Hi tn12:

ascopubs.org/doi/full/10.12...

Since NRG Oncology RTOG 0521 was designed, there have been other studies examining the role of docetaxel CT earlier in the clinical course of prostate cancer. GETUG-12 (Groupe d’Étude des Tumeurs Urogénitales)19 randomly assigned 413 patients with high-risk clinically localized disease treated with local therapy to AS (36 months) plus four cycles of adjuvant CT with docetaxel and estramustine or AS alone. Although the addition of CT increased relapse-free survival, a recent update of GETUG-12 demonstrated no statistically significant improvement in a prespecified end point of metastasis-free survival.20 In addition, the Scandinavian trial SPCG-13 (Scandinavian Prostate Cancer Group) demonstrated no benefit in biochemical DFS in a cohort of 378 men with intermediate- or high-risk disease randomly assigned to AS (12 months) plus adjuvant CT with six cycles of docetaxel CT versus AS alone.21 Similarly, the SPCG-12 study showed no benefit in biochemical DFS for 459 high-risk patients randomly assigned to radical prostatectomy plus adjuvant CT with six cycles of docetaxel chemotherapy versus radical prostatectomy alone.22 The discordance in results between RTOG 0521, which showed benefits in OS, DM, and DFS, and GETUG-12, SPCG-13, and SPCG-12 may stem from differences in patient populations among the studies. The RTOG 0521 cohort included patients with more aggressive disease; 84% of patients in RTOG 0521 had a Gleason score 8 to 10 disease, whereas a majority of patients in GETUG-12, SPCG-13, and SPCG-12 had a Gleason score less than or equal to 7 disease. These differences underscore the need to select high-risk patients with the most aggressive disease when considering treatment with adjuvant docetaxel.

[tn12 in reply to timotur]

Thanks for this thorough reply! I will read through it hoping to be well informed in case of recurrence

[timotur in reply to tn12]

You’re welcome! I was in a tough spot there whether to do early chemo, one MO was recommending, but after reading these studies elected to decline being Gl-7 and having had favorable response to treatment. Cheers and brgds.

[ron_bucher]

My case is different, so take my experience with docetaxel with however many grains of salt you choose.

In 2017, for my second biochemical recurrence (with tumors too small to see on a scan), my use of docetaxel + prophylactic radiation of abdominal lymph nodes helped me avoid ADT for at least another 5-6 years.

I am also athletic, and at age 66 found the side effects of docetaxel to be more tolerable than the side effects from ADT (I stopped ADT at 9 months instead of the 18 months prescribed). Currently, for my third biochemical recurrence, I am considering cabazitaxel instead of ADT. Also thinking about enzalutamide after (or perhaps with) cabazitaxel instead of Lupron.

It helped me to have oncologists who are willing and able to think outside the box on "standard of care". Every case is unique, so I think "standard of care" is almost an oxymoron when it comes to prostate cancer.

Good luck!

[j-o-h-n]

What are his side effects of the ADT?

Note: I wish to offer my apologies if I offended anyone regarding my so-called humor about "race" or "misogyny". To me, humor is boundless and since we entered this word crying, I thought it would be a good idea to exit laughing.

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/21/2023 6:13 PM EST

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

Jeff’s side effects have been: Even though he works out at the gym and we are active and hike our 2 pups everyday, he said his muscles feel like mush. He broke a rib last week while casually using his body as leverage with some bolt cutters, and he’s lost much of the hair on his body. Mild man boobs. Hot flashes are annoying for him, but tolerable and he’s not suffering from much fatigue thankfully.

[j-o-h-n]

Well then he's a true ADT inmate.......Tell him I'm still there, have the tee shirt to prove it and if I was really stupid I'd have ink to prove it too (started 2002).......He can do it too....Give him (and you) my best........... Happy Christmas....

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 12/21/2023 9:35 PM EST

[tn12]

Did he have a prostatectomy?

[Adendino in reply to tn12]

No, he had radiation plus 2 yrs of ADT and Abiraterone.