For 2+ years have been taking Zoladex, Zytiga and Prednisolone. The CT bone scans and Nuclear medicine full body scans every 6 months show no radiographic progression and I feel ok, apart from fatigue when not active. Recently have some discomfort in left hip when climbing stairs. PSA has steadily risen to 41 but stable for last 3 months. Testosterone is stable and low (0.4). ALP normal.
I recently had a PET choline scan done abroad, to get another view. It showed that all my mets are in the bones.
PET Choline summary
- absence of residual lesion at the level of the prostatic compartment or seminal vesicles
- absence of pelvic or distant lymph node lesion
- multifocal secondary bone damage involving the posterior arches of the tenth ribs on right and left (SUV max 11.8), the left ischiopubic branch (SUV max 15), the posterior pillar of the left acetabulum (SUV max 12.6), and the right edge of the hyoid bone.
First time I see the hyoid bone show up.
Docetaxel is being suggested back home. Not my first choice as I think there might be interim steps which could be effective, eg:
1/ zap (SABR) the left hip joint to get rid of the discomfort, also zap the hyoid.
2/ change from Prednisolone to Dexamethasone to get more out of Zytiga.
3/ if (2) fails, move to Xtandi. Zoladex seems to be working, not sure whether to change.(?)
4/ if Xtandi begins to fail, start Docetaxel. Per the PRESIDE trial, this could also have the effect of prolonging Xtandi effectiveness.
I would much appreciate your thoughts on the above interim steps. Am ready to do chemo but not right away if there are valid alternatives.
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Ian99
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Thanks for coming back. Your reply would imply that chemotherapy is inevitable in my case, and I accept that. Can you explain why that is. Some seem never to need it.
No reason to avoid, except for an endless list of potential, toxic side effects. I must say hormonal treatment has done the job so far so I hope not to give up on it once starting chemo.
T A, Have YOU had a lot of chemo? you seem very eager for others to put it into their bodies. Once the ADT stops, I think ALL of us are a bit afraid of what's next. I posted My concerns about a month ago, and was made to feel as though I was crazy for questioning "Next Line" treatments. Then I read today of RADIOACTIVE PEE , WEARING DIAPERS AND PEEING IN JARS.........but I'm the crazy one with irrational fears. Many of these second and third line (after ADT) treatments buy 3.5 months, 6 months or 9 months.......and I question "Is That Worth It"? To Me, Absolutely not.
Ian99 and TommyCarz, my mother had much worse chemo than docetaxel. And I have many friends in my support groups who have had docetaxel - a couple of whom I went with to all their infusions. Unfortunately, I had a couple of friends who let their fears get the better of them, and in the end, wished they hadn't succumbed to imagined fear.
You both imagine you have choices you sadly don't get. The way prostate cancer progresses is that it causes pain, and brittle bones. The bones fracture and collapse, and you become immobilized. Opiates sometimes can't relieve the pain. The roommate of one man had to move out of his home because the man was screaming in pain every night. Docetaxel reduces such pain.
We know that the pain prevention it provides is better if used sooner rather than later. We know that survival is better if used earlier rather than later. We also know that the likelihood of side effects increases with disease progression.
If you read the list of potential side effects from Lupron, you may be frightened away from using it too. Yet most men (not all) find the side effects manageable and tolerable. Unlike salvage ADT, which is lifelong, chemo usually consists of 6 infusions, 3 weeks apart -- so, after 15 weeks, you are done. If it works well and is well tolerated (as it is for most men), you can still get more infusions later, or switch to cabazitaxel. It also qualifies you for Pluvicto.
I agree. And the nine months is not likely. With the side effects, not worth it. I am waiting for some Actininum trials to report their findings though. Pluvicto does not get the results to make it worthwhile.
IMO, I think you've got a great handle on your decision points, Ian. I have definitely benefitted from the switch from P to D while on Zytiga and would encourage that switch now.
I am also a proponent of SABR (as is my RO, of course!). Understandably, in the past my MO has shrugged, said "it can't hurt," and reminded me that it statistically does nothing about my systemic metastases and zapping one or two mets doesn't mean this halts ultimate progression. But I'm not looking for that - I'm only looking to postpone the next systemic treatment. This paper supports this view:
After SABR, however, the decision gets tougher. I personally wouldn't move on to Xtandi without chemo or a targeted treatment (Pluvicto). Like you indicate, all the newer information suggests that it is good to get a systemic treatment in between novel hormonals. It was the reason I agreed to Pluvicto when I finally failed Zytiga in late 2022 even though my overall health picture was similar to yours, i.e., rising PSA (but not completely alarming in doubling) with some new middling SUVmax indications and good overall health.
It was enough to make me question whether I wanted systemic treatment, but I wanted to make sure to give Xtandi the best shot. Surprisingly, it has turned out that the the combination of winter 2022/spring 2023 Pluvicto and SABR to a scapula met (August 2023) seems to have temporarily arrested my PCa progression and I've only been on ADT!
It's been great...okay, good because cancer sucks and all ADT stinks....but the relevant part is that I am ready for Xtandi when I need it. Good luck, brother! - Joe M.
Thanks for this, Joe. I would still like to switch from P to D but am unlikely to get that choice. The more I dig into chemo, the better I feel about starting it (cf recent TA post on this thread). We are in similar situations.. i like to regard this as a move to a systemic treatment (in my case chemo vs targeted in yours) between hormonals. Hope it works for you. Good luck !
For us SIOALOC "Spell It Out At Least Once Crowd":
Stereotactic Ablative Radiotherapy (SABR) is a radiation treatment that delivers a high dose of radiation to a small, focused area of the prostate while sparing normal tissues. SABR may be effective for men with hormone-sensitive prostate cancers that have spread to other parts of the body. SABR is non-invasive, comfortable, and involves fewer treatment sessions. Most treatments are short outpatient visits of 30 minutes to an hour.
I'm on chemo and it's keeping me alive. The only physical SE that is bothering me is that I feel exhausted all the time.
I still get out and do stuff. I did a couple of weeks of downhill skiing in March. I've got a golf game scheduled for this Tuesday. I see my wife everyday and plan excursions with friends.
The MO told me that I only had 90 days to live if I didn't start chemo immediately. Dying right now doesn't fit my schedule, I've got too many other things to do. I'm also looking for the next treatment cause as long as I'm alive and things are bearable that's good with me.
You don't know what your SE's will be until you try treatment. Make your decisions on what actually happens, not what you think might happen. You can always pull the plug anytime you want.
Docetaxel worked great for me. Your body is stronger now than it will be in the future. The side effects were not as bad I expected. I would follow your doctor's advice. They know more than you or I will ever know.
Docetaxel was great for me, my first round with his chemo started in 08/2021, after Xtandi and Zytiga failed. I had 10 infusions. My second round of docetaxel started after I was taken out of Pluvicto program (PSA 758) in January 2023. My PSA went from upper 700 down into the 200s, but my platelet count became very low so I had to drop out of the chemo treatment. I then tried Nubeqa and Lynparza, neither were effective, as PSA went up to upper 400s.
Now going to try a combination of chemo, Cabazitaxel and carboplatin.
I’d see if you could get Pluvicto. Insurance may require that you have taxotere first but I’d sure as hell try. See my posts on Healing well as Steve55777.
Spent about an hour in the chair getting "juiced" as I called it... My side effects were minimal. Diarrhea and my hair fell out.
I had what I called chemo dips.... That would kick in about 4 days after treatment and lasted for a few days thereafter... A tiredness that did not resolve with rest.
Otherwise I was oddly highly energized.
I didn't slow down a bit... In my case my PSA was knocked back to undetectable after my
First Lupron shot and two Taxotere treatments and has remained there throughout the remaining Taxotere treatments.
My hair has grown back rapidly, albeit I look like a chia pet as it does...
He determined that I had Prostate Cancer Ductal Variant Stage IV. Gleason score 8.
Treatment options offered:
1. Lupron alone.
2. Lupron and Zytiga.
3. Lupron and Taxotere followed by
continued Lupron and Zytiga.
I was advised that triplet therapy (option three) afforded me the best chance for longevity.
I opted for option three... I entered treatment with a PSA of 0.3... thus far I have completed all six Taxotere treatments and have had 3 Lupron shots all returning an undetectable PSA number of < 0.1
I am now on the post leg of Taxotere treatments beginning five weeks post juicing. I'm taking Abiraterone acitatate and prednisone for a month now... Next oncology appointment April 24th 🤞
As for neuropathy I did not experience any... And used nothing to prevent same.
FYI...
I am a type II diabetic well over 20 odd years. No neuropathy or retinopathy.
I had a heart attack and quadruple bypass in 2010.
I just turned 69 in March.. and started my cancer journey after a biopsy revealed such in July of 2022.
Remember...
You can try chemo treatments and stop if adverse effects become too much to handle... or neuropathy sets in...
They monitor you very closely and do blood work prior to each dose and read the results right there and then before putting you in the chair and juice you... If something is off they will postpone treatment right there and then...
I think of chemo as ROUNDUP for the body... It goes around killing those little bastards regardless of where they are hiding... the trick is to be stronger than the treatment...
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Docetaxel/Taxotere. 2nd time in 3 years. It's a no go this time. No benefit after 3 infusions.
Pluvicto / Lu-177 - Do it now or later?
Help on next step - Chemo or Xtandi?
Help with Results
