Docetaxel Failing

[Fisherman2]

Greetings from Inverness in the beautiful Highlands of Scotland! I would like to share my journey with you and hopefully get some advice on future treatments.

In December 2022 following diagnoses of advanced prostate cancer with multiple bone metastasis I started zytiga + prednisone and 6 monthly triptorelin injections every 6 months, (unfortunately triplet therapy is not part of SOC in Scotland). This treatment initially yielded good results with PSA dropping from 39 to 1.1 in August 2023. Hormonal treatment was discontinued in November following PSA rise to 12.7

Started chemo (docetaxel) December 2023. PSA dropped to 7.4 after first 3 infusions but has now risen to 14.4 after infusion number 6 (10 are planned). The rise in PSA together with some niggly groin pain leads me to suspect that docetaxel is failing. I am very active, physically very well and coping well with docetaxel..

I suppose my questions are:

1. Does it look like docetaxel is failing?

2. What are the options if it is. Pluvicto is not available in Scotland .

Kind regards and best wishes to you all.

[RyderLake2]

Hello,

My wife's family comes from even further north than where you live in Inverness. They emigrated from Wick, in Caithness. I know when we visited many years ago the roads north of Inverness were one way. Between sheep, oncoming traffic, and right hand drive vehicles you needed to be very vigilant. Anyway, if chemotherapy (Docetaxel) is failing you are nearby to many countries that routinely use Pluvicto (lutetium) or a similar radiopharmaceutical quite routinely. Germany, England, Austria are three that come to mind. Don't worry if you don't speak English, the doctors and most of the nurses do. Load Google Translate onto your cell phone. As they say in Scotland: "Dinnae fash yersel" and "Lang may yer lum reek"! 😊

[j-o-h-n in reply to RyderLake2]

For us Unscotts: "Dinnae fash yersel" and "Lang may yer lum reek"! = Don't worry yourself" and a wish for long-lasting prosperity and success".

"Sonas, Slàinte, agus Sònraichte."

Good Luck, Good Health and Good Humor.

j-o-h-n

[Tall_Allen]

You are still getting triptorelin injections, right?

Jevtana (cabazitaxel) may work even after docetaxel fails. If you can get enzalutamide, it may get extra benefit by combining with chemo, as in the following trial:

prostatecancer.news/2022/10...

[Fisherman2 in reply to Tall_Allen]

Thank you for your quick response TA. Yes still getting triptorelin. Next one due in June. Will discuss your recommendation with MO at next appointment. Thanks again. Your wisdom and vast knowledge is much appreciated.

[winkoliu]

If you are only bone metastasis , Radium 223 might be a good try.

[Fisherman2 in reply to winkoliu]

Thank you for your response. I believe there are a couple of lymph nodes affected in groin area. Would this exclude Radium 223 treatment?

[Tinuriel in reply to Fisherman2]

Our RO in the US (not sure about Scotland) said Ra223 can still be beneficial even with soft tissue involvement (which remain unaffected by this treatment) - it can reduce the tumor load on the bones and serve to reduce pain.

[dhccpa]

Finally made it to Inverness in 2018. Great trip!