Should I follow my MO's advice and do docetaxel? Since I'm now 78, and have read terrible accounts of chemo, I have held onto the belief that I would do everything to avoid chemo since the treatment appears to be worse than the alternative. But she's really not giving me an alternative, other than BAT (which she doesn't think I'm a good candidate for). See my profile: I've been able to stay fairly active and pain free since first diagnosed in 2008. Started Zytiga 6/12/21. Lost effectiveness so changed to Xtandi 9/15/23. PSA: 9/25/23 = 26.6; 10/26/23 = 27.3, 11/23: 34.2; 1/5/24 = 49.9. New bone and CT scans 1/24/24 shows disease is progressing though changes are not enormous. I just don't know how to decide! Anybody know of resources to help me decide, or what further questions to ask? Thanks as always~~
To Chemo or Not to Chemo--that is the ? - Advanced Prostate...
To Chemo or Not to Chemo--that is the ?
It's very sad to me when men hesitate to use docetaxel. They are often reacting to accounts from men who have used other kinds of chemo, have used it and had an extraordinary reaction, or have used it too late to do much good or have many side effects from the cancer.
Hi Tall Allen For elderly patients ,more than 80 yr old, is it advisable to reduce dosage of docetaxel ?
No, not because of age alone.
I did docetaxel and went on three ski trips during treatment. Don't get me wrong, I was glad to be done with it, but it's very tolerable. Personally I found the recovery from radiotherapy way tougher than chemo.
Consider to request Pluvicto treatment.
If you have Medicare part B directly with Medicare, they pay based in medical necessity. I had Pluvicto and Medicare paid, and I never had chemo because I have a peripheral neuropathy. MOs may get around this problem.
Chemo has its problems, this article have comments about chemo from a real expert:
grandroundsinurology.com/dr...
There is also the possibility of doing chemo with cabazitaxel a low dose every 2 weeks which seems to be better tolerated by older people and it works well according to the phase 3 Cabasty RCT.
jamanetwork.com/journals/ja...
Many thanks to each of you who responded so quickly! tango65, I was told that Pluvicto is not approved for use until you've had chemo. I will look into the other references you provided.
Your MO. may find some justification, some hematologic problems, fragility, neuropathy etc etc.
I did Docetaxel, 6 sessions. Along with Abiraterone, Prednisone & ADT, pushed PSA to zero and not much in the way of side-effects from Docetaxel, except some fatigue. I endorse Tall_Allen's comments. My wife did the anti-infection injections. Read up on ice and neuropathy (I experienced none). And on fasting (I did two full days with water and coffee and tea and stuff). Here are a few references - read comments up and down the threads:
healthunlocked.com/advanced...
healthunlocked.com/advanced...
Thanks JohnInTheMiddle. I will work my way thru these comments--but I'm surprised about the fasting. I've heard that recommended by others as well. But the UC San Francisco "Coping with Chemotherapy" guide specifically says "Eat a small, light meal before your chemo appointment. Most people do better if they have something in their stomach" Sigh--so many people have these treatments, it would be lovely if all the recommendations were the same
"Sigh--so many people have these treatments, it would be lovely if all the recommendations were the same"
Everyone's different...we all react differently. I personally found no difference between eating or fasting, the infusion team even offered me sandwiches during the infusion.
I think top-notch facilities like UCSF might base their advice on large numbers of patients, much larger than any sample size you'd get in the relatively small forum.
GI: Your comment about sample size and sources of information is confused. On our forum people might report scientific information based on large sample sizes. And in the hospital setting lots of little daily decisions are likely made on anecdotal and personal experience. Hopefully in the hospital setting major decisions are made based on the results of major clinical trials. The same trials we report on here in this forum.
I was focused on the "this worked for me" posts, not study referrals. I'm not confused but perhaps my wording was.
LQ: The advice to eat a small meal is sort of like dietary advice to "include whole grains everyday" in your diet. It's meaningless.
If however you follow up on the references to fasting around chemo you will find the nascent science for this. It has nothing to do with feelings.
But there is some evidence - not full-on clinical studies yet - but reasonable suspicion that fasting puts all your body cells except your cancer cells into a slightly quiescent state in other words not so active and apparently this means they won't be so vulnerable to uptake of the chemo poison.
On the other hand though apparently there is the possibility that cancer cells, given that they are usually so active, in circumstances of fasting don't react at all. And are thus more vulnerable than other fasting cells to chemo. Is my lay-person's summary of the situation.
So as you can see this is a completely different territory you're on now. And the nice thing is that there seem to be few risks with fasting for a couple of days. Read more about it and see what you think.
I'm only 61, and age might be a factor, but I found chemo to be pretty tolerable. 6 rounds of docetaxel. Lost of a lot body and facial hair, and some finger and toenails got a bit nasty looking, but nausea, exhaustion and all of that was short-lived and not that bad.
I got a lot of benefit from it for my very aggressive cancer, putting all bone mets and cancer in the prostate itself into complete remission. Cleared bone pain after just three rounds.
Remission only lasted 4-5 months though, but as I said, the cancer in me is an aggressive form and grows pretty fast. Sounds like yours doesn't/didn't.
Good luck.
Did you have any genetic or genomic testing done?
I was 55 when I did it. It wasn't fun but it was easier than I imagined it would. If you know what side effects to expect (severe fatigue during days 3, 4, and 5, temporary change in taste buds, loss of hair, etc) and are prepared for them, it's not that bad. It really knocked my cancer back. PSA 103.0 before chemo; below 1.0 after chemo.
How long did the effect last before PSA reversed? Or has it yet after how long? Thanks.
The severe fatigue ended after treatment ended and I've remainded with typical ADT fatigue.
Taste bud changes started after the fifth round of docetaxel and came back to normal after treatment ended.
My head hair grew back normally, perhaps a little thinner. About half of my body hair never came back.
I lost feeling in all of my toes during chemo (neuropathy). My fingers were protected with ice mittens. The feeling in my toes came back slowly after treatment ended. It took about 4 months for that to recover completely.
Thank. I meant is your PSA still 1, and how long since it dropped to that level?
Sorry for the confusion.
Sorry. I didn't read your question properly.
My PSA eventually reached a nadir of 0.17. It remained low for about 4 years. It's difficult to tell whether this was because of the chemo or the ADT that I continued to take.
Eventually my PSA began rising again but abiraterone has brought it back down to undetectable levels.
My brother was 82 when he had 5 rounds of docetaxel. He tolerated it well. He only committed to the first one (so he would be eligible for Pluvicto) but he kept going because he had no discernible side effects.
At age 66, my athletic body breezed through docetaxel pretty well. I'd rather do more chemo than go on ADT.
Strongly recommend some sort of fasting, as others have mentioned (either true fast for a couple of days before, or Modified Fast Diet for about 4 days). There is some evidence it mitigates negative side effects and makes the cancer cells more vulnerable to the chemo. Also, STRONGLY recommend icing hands and feet, and sucking on ice chips, at infusion time. My husband had no neuropathy, no dead fingernails, no issues with taste buds. The ice reduces exposure to chemo in those areas. Don't worry about hair - it's hard to ice-cap effectively without spending a lot of money (we researched!). Hair grows back in a few months. Stay extremely well hydrated before, during, and after. Walk around after your infusion. We were advised to stay ahead of nausea by using the prescribed oral nausea meds prophylactically for a few days. My husband had no nausea. You will feel ok for a day or two after infusion, and then crash around day 3. This lasts several days. Ask about post-infusion shot (i.e. Neulasta) to help prevent neutropenia (dangerously low white blood count) - some docs don't offer this until you've already had a bad experience (infection/hospitalization). Get it every time. Keep your skin well moisturized. Chemo is scary, and a challenge, but tolerable with some reasonable precautions.
This is a great write up on how to approach chemo, HW. I did not realize that the post infusion anti neutropenia shot was not standard.
I didn't either, it seems like such a no-brainer. But have seen a number of patients report that they didn't get it, and wound up in the hospital. Makes no sense to me!
What is the Modified Fast you refer to? Can look into it, but sounds like something there may be multiples versions of. Thanks!
Eric couldn't do regular fast b/c he's on low-dose abiraterone regimen which requires taking food with his dose. Hard to find good info on modified fasting - it IS confusing, and there are multiple versions. What you want is called "Fast Mimicking Diet", or FMD. There is an expensive kit you can buy (Prolon), but we thought that was ridiculous. It is basically a plant-based, low protein diet with very low calories - if I remember right, 900 or so Day One, and maybe 500-700 calories on succeeding days? My memory is a bit fuzzy. Try searching this website/forum, and googling FMD. Here's a good basic explanation: i2b.us/fasting-may-improve-...
Here are some other links to get you started - sorry not live links, but if you cut and paste them to search, the article will hopefully show up:
Fast-mimicking diet: benefits, side effects and how to get started
Fasting Mimicking Diet | ProLon FMD – Prolon FMD
Fasting-Mimicking Diet Is Safe and Reshapes Metabolism and Antitumor Immunity in Patients with Cancer - PubMed
Five-day fast: A guide to the fasting mimicking diet for weight loss
The Fasting-Mimicking Diet: What You Need to Know | Fullscript
What Is a Fast-Mimicking Diet, and How Does It Work? | U.S. News
What is an FMD (Fasting Mimicking Diet)? | Carb Manager
What is the Fasting Mimicking Diet (FMD)? – Dr. Berg - YouTube
Exceptional tumour responses to fasting-mimicking diet combined with standard anticancer therapies: A sub-analysis of the NCT03340935 trial - PubMed
Fasting mimicking diet as an adjunct to neoadjuvant chemotherapy for breast cancer in the multicentre randomized phase 2 DIRECT trial - PubMed
Safety and Feasibility of Fasting-Mimicking Diet and Effects on Nutritional Status and Circulating Metabolic and Inflammatory Factors in Cancer Patients Undergoing Active Treatment - PubMed
Short-Term Fasting Synergizes with Solid Cancer Therapy by Boosting Antitumor Immunity - PubMed
Fast Mimicking Diet- Q & A - YouTube
Fasting Mimicking Diet- Possible Benefits for Breast Cancer Patients | Ackerman Cancer Center | Radiation and Proton Therapy in Jacksonville, Amelia Island
Fasting-Mimicking Diet Before and After Chemotherapy | NutritionFacts.org
Thanks very much. I haven't had chemo yet, but that should give me plenty to work with. I guess the idea is to keep from caving in from hunger.
DHCP - (can I get an IP address from you? Oh, I think I asked about this before. Sorry!) - my wife and I had been fasting periodically before I was diagnosed 2 years ago so we had some familiarity with it. It's not so hard once you figure it out.
We're also kind of on a low-carb diet and this is part of the solution for not becoming ravenous and insane during a fast. To the point of impossibility of course.
I find if one eats a high-fat meal, say eggs and cheese and lots of lovely vegetables and everything nicely spiced, before a fast then the fast isn't so hard.
But if you're accustomed to eating a lot of carbs then my understanding (and previous experience) is that carbs are burned up more quickly and that your body then notices that you're out of fuel pretty quickly. This is my lay person's understanding.
Of course that we are not saying "no liquids". The right amount of water, coffee, tea whatever is fine and important. Think it was HW above that reminded us that you want to be well hydrated before an infusion so that the poison circulates nicely. LOL.
Per HW's post there's also the issue of any drugs that you are prescribed that must be taken with food, during the period of the fast. Supplements you could probably skip a day or two I suppose. And then there's the difference between fat soluble and water soluble drugs. And there's also the question as to why you need to take a drug with food - is it because of stomach upset or is it because of absorbability? When I fast now and need to take a pill that is fat soluble I take a tablespoon or two of butter. Apparently this does not put your body out of a fasting state.
This was all hard to figure out but I've learned that fasting is a useful adjunct to my "live a long time" regime - and worthwhile learning to do.
[Dang - I need to get cracking! Another long post on MaleCare in HealthUnlocked! I've got chores to do! And working on getting back to work! 😂]
Thanks. Your posts are always helpful. I do the whole food plant based diet, which is high complex carbs, but I tend to agree harder to enter a fast than with high fat diet.
Fortunately, I can do nuts, seeds, sardines (didn't know they were plants?), and cacao butter wafers, or even better, 100% cacao wafers (which includes both butter and powder).
I'm fasting now for a colonoscopy tomorrow, but I eased into it with high fat dairy, and aforementioned sardines, for three days.
I did a 10 day water only fast once, and numerous 40-60 hour water only fasts (about 40 total), but much harder to break from a carb diet, as you say, complex or not.
This is really interesting HW - because I'm on full dose Abiraterone fasting was not a problem (I can't remember what I did about the prednisone). Are you on low dose for economic reasons? Is there a protocol for low dose Abiraterone for medical reasons? I agree that fasting is confusing when you have to take drugs and supplements. I still fast one day a week. It's the day of the week that I feel the best! LOL
Nope, not economic. Figured less drugs = maybe less chance of adverse SE (we were concerned about liver and maybe nausea on empty stomach). We had heard about it and asked our two MO's about it (one at Dana Farber), both said they had numerous patients on the protocol, they were doing great, and enthusiastically endorsed. The 1000mg on empty stomach thing came from clinical trials of drug where that was the protocol. Food with a lower dose results in same blood levels of drug (there may be a slightly greater degree of variance over a 24 hr period). Food enhances absorption of the drug. Eric's been doing it for a year, doing great, no issues, PSA staying down. We are careful that his "abi breakfast" is as close to 300 calories/9 gr fat as we can get - that's what was used in studies about this.
Thanks so much for replying HW. This is really interesting! In my case I'm on full dose Abiraterone/Zytiga and fortunately have not experienced stomach upset.I have noticed some people writing about taking lower dose Abi economic reasons - a bottle goes further with food!
Now I have a question though. If food enhances Abi absorption so that you have the same serum level of the drug, how does this reduce side effects? In particular liver? (Liver is something I'm concerned about although I have no issues now.)
What intrigued me though was the possibility that MO's enthusiastic about a lower dose because it might increase the time to resistance? Am I reading too much into this?
Bravo the engaged and thoughtful "therapy hacking"!
Sorry to intrude again. I think the thinking today is that saving or holding back a treatment to keep it in reserve is useless, at least on the first three levels (ADT, anti-androgen and chemo). However, still many docs, including mine think more cautiously about piling on treatments on the front end.
DHCP - no intrusion at all!
You are highlighting one of the key questions in metastatic prostate cancer. As you say the new understanding from the recent big clinical trials is "pile up the therapies" up front and you will live longer (i.e. ADT, ARPI or ARi, chemo). PSA to zero!
This is a change from the previous regime - or the previous regime which is still not uncommon - where you try one therapy after another sequentially. Try one, fail, try another, fail etc.
But while there is very good evidence for this - the new concern is "selection pressure", which is eventually a few prostate cancer cells figure out a way thrive in such an unforgiving environment. This is what is usually referred to as the development of resistance.
I think this is what you are alluding to. I'm happy and healthy on triplet therapy, as described in my first paragraph above. But I'm worried about resistance due to selection pressure.
Am I right in thinking this is what your doctors are balancing in their minds? Do you have more that you can report from them? Any good ideas? BAT of course directly addresses these questions but I haven't seen any reports that it has been particularly successful yet!
When I was diagnosed in mid 2018, the (at the time) "doubling" therapy of, say, Lupron + AA was new and not all MOs leapt on it. Once I had been on Lupron for a while, and the years passed, my MO pointed out that "had we started at the beginning", might have been useful, but no trials to show efficacy of starting much later.
Not my MO's fault totally. I sought 5 or 6 opinions and eventually settled on him.
Now his position is and has been that if I want to add AA or similar, or even chemo, he'll go along, but I haven't pulled the trigger. I know the day is coming, though. I suppose I keep watching new developments.
Neither of them mentioned anything about increasing time to resistance, and I haven't seen anything. Your question about blood levels and SE is a good one. We just kind of felt that if you can get the same effectiveness with 1/4 the dose, why wouldn't you? (clinical study said this protocol is "not inferior" - will have to rummage for link, lol)
Have you seen this? Kind of the genesis for the low dose Abi idea:
uchicagomedicine.org/forefr...
Is there anything more current
Not sure. I know the usage of low dose abiraterone seems to have grown in the years since. With it now being a relatively cheap generic, though, perhaps not as much economic incentive to use as years ago. Not sure whether it yields lesser side effects; I've read both opinions.
Thanks for your detailed response ~~ many good ideas. I'm unclear about the "hand mitts" and "feet things" for the ice. Where do I find them, and what do I ask for? And should I assume that the infusion center will have the ice?
The infusion center will probably have ice, but probably just something like an ice-and-water machine. A few might help you with icing hands and feet (most don't - you need to ask). We ordered icing mitts (amazon.com/gp/product/B086V... and booties (amazon.com/gp/product/B0892... on Amazon, extra gel inserts for them, and pre-froze them all (there are a number of brands and prices). Also cooler packs to keep them cold - these things are great! (amazon.com/gp/product/B07TN.... Layered everything in a small rolling cooler (amazon.com/gp/product/B00AU... (lotsa jokes asking whether we had beer in there!). My job was to switch out the extra frozen inserts, and to keep giving Eric ice chips from a cup. It was a pain to do - but he had no neuropathy or mouth issues whatsoever. Kept all his finger and toe nails. I know other people have frozen 16 or 20 oz water bottles and held them, used baggies of ice for hands and feet, or plastic shoe boxes of ice. Don't put ice directly on skin - wear socks or something on both hands and feet (like a sock, a baggie, and then put it in ice). There's a lot of info online about icing for chemo. We researched head caps for hair - learned it's hard to fit them properly and you can get patches - can rent expensive systems at about $400 per infusion.😳 We figured hair would grow back, and it did.
Thanx for the detailed abd timely reply!
I'm currently be treated with Docetaxil. So far so good. I'd rather not be having it run through me and thought I'd be opening up a can of whoop ass on myself but it's been tolerable.
My husband did 6 rounds of chemo and didn’t miss a day of work….he got the infusion and worked from home the rest of the day. We also traveled during that time. He reported a bit more tiredness by the end of the day and a funny taste in his mouth, but that’s about it.
He too was very hesitant due to the fear of side effects, but found it to be more than tolerable. He used an ice cap to prevent hair loss, and ice booties to prevent neuropathy, both of which worked perfectly.
When he did decide to do the chemo, his medical team told him they thought he would tolerate it fine, but he could stop if he had any issues. I think it helped him to know he had an “out” if needed.
Best of luck!
Chemotherapy with docetaxel (Taxotere) was not nearly as bad as I had feared before I started. I had many of the most common side effects.
Best of luck whatever you do.
Choice between chemo and BAT!?!? The docs are all over the map. I'm still working on my MO to even learn about BAT. A little like running a marathon while pushing your car the whole way.
For me chemo was awful and I had it when I was 55 years old, I had early chemo per CHAARTED and it was by far the most difficult treatment I’ve had and I’ve had many (you can read my profile). Everyone is different, but I’ve heard others who had the same experience. However if I didn’t have it early on I probably wouldn’t be here today, but I’m not sure I’d ever go through it again. I would look to other treatments first.
As you view replies I’d pay more attention to those that have had it than those who haven’t, it’s easy to recommend a treatment that you’ve never experienced the side effects of yourself. You can always start it and if it becomes unbearable you can stop. I’m just sharing my real life experience.
Ed
My diagnosis: prostate cancer, ductal variant, stage lV. Gleason score 8. Age 68.I am post RP Surgery with a chemical resurgence of cancer to abdominal lymph nodes.
Two Lupron shots and three docetaxel treatments and I'm back to undetectable. <0.1.
I've had 5 treatments thus far, and will have my final chemo appointment come February 14th.
Thus far, I may be the exception to the rule, but each treatment has become less and less bothersome.
Though there is a litany of side effects one can experience, does not mean you will suffer them.
In my case, I bounce right back... The few I have experienced I refer to as chemo dips... which are now virtually non existent. Yes... Diarrhea is probably the main one. Tiredness that does not resolve with rest was another one. All short-lived. They usually hit about 3 to 4 days post treatment and last a day or two at most. My ability to interact and carry on with a regular routine has not been impeded by my chemo treatments.
So far so good. No neuropathy and I am a type 2 diabetic.
You will not relinquish your control over treatment in the event you do experience side effects that are intolerable for you.
Don't look for the worst in it all hope for the best possible outcome that you are stronger than the treatment being administered. That's the key!
Ron
If you choose to defer docetaxol chemo for now, you could easily try a few cycles of BAT and see how it works for you. Just one shot of 400mg testosterone cypionate every 28 days and monitor PSA to see if you are a favorable responder or not. It can restore responsiveness to ARSI drugs in some. You find out by doing it. Another option would be the Pluvicto. Your MO or RO can request an exception to the prior chemo requirement. Again, some respond favorably and others do not. Just as with the chemo. Good luck.
Your MO could have put it in a simpler form, that if you wish to fight the disease, start the Doctaxel, but if not........
My husband was diagnosed in 2008, had docetaxel in 2010, he was 66 now 80, everyone is different he did not fair well with docetaxel, neuropathic and hospitalised a couple of times and also Multi pulmonary embolisms and only short remission. He did well on Abiraterone for 6 years good QOL but became toxic to Liver so stopped. RT Proctitis. Had Lutetium in 2021 and except for fatigue was OK but short remission. Now having R223 3rd treatment due in February.
WOW--you folks are wonderful with yourtimely responses! I appreciate, and will study, each and every one of them. Thanks so much!
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