Questions

[Cleantop]

I saw my PSA suddenly rise to 3.67 in January 2023. My PMD was not overly concerned as it was under 4. His plan was to repeat it in 6 months. I will also not I was on Tamsulosin and Finasteride for some time at that point for urinary frequency. That started several years before (at that time I was a somewhat functioning alcoholic) and I now question if the initial frequency issues were related to massive consumption of alcohol. In July I had the repeat PSA and the level had increased to 20.76. I was referred to a Urologist who did a DRE that indicated a right sided area of concern, he ordered a repeat PSA and scheduled a Biopsy. The repeats PSA showed an increase from July 26th to August 22nd level of 25.66. The Biopsy was done August 30. Results showed a Gleason 4+4 -Gleason 8. I will add that on July 28 I had a routine Low dose Lung scan that showed a 4cm long mass on the left 7th rib. A follow up bone scan showed 4 rib mass' and 2 pelvic mass'. I immediately started on Bicalutamide. I had a DNA test done and that was negative. On September 27 I had my first 6-month injection of Eligard. And finally on October 12 was able to start on Erleada. The delay in Erleada was due to cost and my ability to pay for it. Fortunately the manufacturer had a program to provide it for a year. A follow up visit to Urologist on November 27 resulted in discontinuing Finasteride and a PSA done on Dec 1st showed a decrease to 0.42. I was referred to an Oncologist for possible Triplet Therapy with Docetaxel. Another PSA on December 27th revealed another decrease to 0.24.

Here is my question! The Oncologist did not feel Triplet therapy was necessary now. He said the good result of the ADT and high quality of life I was enjoying did not warrant chemo. He also said that when ADT failed, he could start it at that time. He also said he would never do Triplet therapy with Erleada because it had not been studied. He further said if he had seen me at initial diagnosis, he would have started docetaxel at that time! I did not get a warm fuzzy feeling from his conclusions, first he misread the bone scan report (which I happened to have the foresight to have brought a copy with me and presented to him for further analysis); second, I was under the impression that Triplet therapy was supposed to further improve survivability; and third his comment that he would never do it with Erleada made me wonder why he would not jump at a chance to experiment after having told me that I would never be cured and would die anyway! So, is his approach the rule of thumb or should I seek another opinion?

I really appreciate all the comments and knowledge others have on this site! I hope a few of you long time warriors have some good things to offer me. By the way I am in Western New York and have the Roswell Park Cancer Center nearby. My Urologist trained there, but is associated with a health system in nearby Rochester, NY. The oncologist trained at NY Technical Institue of Osteopathic medicine and does not list his residencies or any fellowships. Another concern of mine! Not because he is a DO, but rather because of a lack of information on education. He has been in practice for 13 years. Thanks all and Happy New Year!

[Tall_Allen]

There is a time limit on starting docetaxel with triplet therapy. In the ARASENS trial, all patients got it within 6 weeks of receiving darolutamide. The reason for the time limit is that the cancer cells go dormant after Erleada (in your case), and docetaxel is only effective if cancer cells are rapidly dividing.

[Cleantop in reply to Tall_Allen]

Thank you. With PSA having dropped drastically in a short period of time then that does seem to be reasonable. Your wisdom is remarkable! Best wishes

[GoBucks]

It is your life. Take the bull by the horns and have your case analyzed by a Roswell oncologist. Almost all insurances allow a 2nd opinion and if not, the cost would be worth the peace of mind for me. Good luck.

[maley2711]

from my read, triplet therapy provide appeox an extra year of life expectancy...approx 5 years, vs Lupron + abiraterone without Docetaxel. Of course, your results will vary.....plue past ime limit to start chemo as part of triplet?

[vintage42 in reply to maley2711]

So Doublet provides 4 years and Triplet provides 5 years, if you are fit enough to withstand the chemo effects of docetaxel.

[maley2711 in reply to vintage42]

yes, we must always understand that life expectancy means 50% longer life and 50% shorter life.....that is where a highly experienced MO should provide valuable insight re an individual's situation. So, we need to read about the overall health of those who had the triplet in the study...I believe the Stampede study? we always have more questions than we have answers re medical conditions and treatments.....especially cancer!!! I imagine being a Doc can often be very frustrating !!!!!!!!!!!!!!!!!!!!

[Yzinger]

I dont think it is that clear cut folks. Mono vs Doublet vs Triplet cant measured in adds 1yr, or adds 2yrs etc....please be cautious with that line of thinking

[maley2711 in reply to Yzinger]

read the studies on this comparison

[Leader4077]

If your PSA remains below 1, I don’t see the need for Docetaxel or Carboplatin at this time. Pluvicto early on is being tried by some nowadays…….the requirement for a “failed” chemo response(rising PSA) has been loosened by some agencies and you don’t have to go overseas to get coverage.. The VA protocols for treatment scheduling will probably affect ALL insurance companies coverage for Pluvicto in the future in the US. In some places like Germany, Pluvicto is already easier to get than here.

Mike

[Mgtd]

Mike what the VA protocols? I can either do the private health care route or go to the VA so I am curious is there an advantage to one over the other protocols. Thanks.

[BigCDrugSurfin]

Sounds like you are getting good advice. I did triplet w/docetaxel but my diagnosis was late stage4, on death's door so to speak with psa over 80, urinating blood etc. The hit-it-hard approach was warranted in my case. Now 1+ year survivor with psa .4. Everyone's experience is unique. All the best to you.

[Cleantop in reply to BigCDrugSurfin]

Wow, happy to hear that it has helped you. Keep on keeping on brother!

[j-o-h-n]

How old are you?

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 01/05/2024 9:01 PM EST

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

70

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

Thank you for your response. Stay well!!!

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 01/06/2024 11:58 AM EST

[68Guitar]

My understanding is that Triplet Therapy would include brachytherapy, 23 sessions of IMRT plus ADT. Earleda (Apalutamide ) is for castration resistant patients or where the cancer has metastasized. Even though I have neither of those conditions, I am in a study where they are trying to determine if using 2 forms of ADT improves outcomes for high risk people. (Earleada, Eligard)Sounds to me you better get to a major cancer center.I agree with you that your docs advice seems shaky. All the best,

[Jewelrylady]

I think it’s important to feel confident in your doctor’s knowledge and experience with prostate cancer. It doesn’t sound like you feel that, so maybe explore finding another doctor. Also, if you have access to your electronic medical record, I strongly recommend reading progress notes after each visit. I have found so many mistakes in the notes!