I have been on monthly Lupron for 7 years (starting in 2014) after the spread of prostate cancer to my bones following a prostatectomy in 2014. Lupron alone was very effective until December 2021. I then added Zytiga/Prednisone which had worked well. But current (June 2024) scans show substantial disease progression in my sternum and my sacral region, and my PSA has risen to 76, doubling every 2 months. My MO is recommending chemo (Lupron + Docetaxel/Taxotere) as the next step. He also suggested talking with a radiation oncologist since it appears that those 2 spots may be the cause of my PSA rising and the disease progression. But I am worried about collateral damage from the radiation.
I am Chek2 and currently getting a circulating tumor DNA liquid biopsy (awaiting results). While I have fatigue and shortness of breath, I haven’t experienced any pain yet. I am 80 years old and still relatively active.
I’d greatly appreciate any feedback from those who have done chemo and/or radiation, or any other treatments that I possibly should consider.
Thank you.
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sleepless-in-seattle
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I am NOT a medical advisor. I did tons of research and tried my best to find out what's going to help me with my QOL.
I agree with your MO to start with radiations. It is good starting point. You have only two spots, Which means it is going do SBRT session for five days.
SBRT may cause a little more fatigue, and blood work may be monitored during and after treatment.
Doubling time is two months, and currently, it is 74, which is aggressive. I had 3000 PSA, but I did not feel any physical symptoms like bone pain or back pain.
I 100% agree with Allen; chemo is a good option.
I would suggest clinical trials that focus on ADC or AMG 509. I read clinical trials that focus on ADC is, that something is very promising results with minimal side effects. At the same time, doubling time is concerning as well.
Please schedule an appointment with them and explore clinical trials during radiation treatment. It may help you explore more treatments options during radiation.
Questions to your MO
Can I participate in clinical trials that focus on systemic therapy, like ADC drugs or AMG 509, or any others?
When Lupron and second tier ARPI (Androgen Receptor Pathway Inhibitor) drugs like Zytiga (abiraterone) fail then you have to move to cytotoxic drugs that kill the cancer as opposed to simply putting the cancer cells to sleep. Chemotherapy with or without Xtandi (enzalutamide) is a good option. You might also want to look into Lutetium-177 (Pluvicto). Currently only available in North America after chemotherapy but there are several trials underway looking at Lutetium pre-chemotherapy and perhaps even more interesting comparing it to chemotherapy. Good luck!
Thank you for your feedback Ryder. I tried Xtandi several years ago but it caused my restless leg syndrome to become so severe I had to stop. Replaced it with Zytiga and that worked for about 2 years. Which chemo drug would you recommend. My MO wants me to start with taxotere/docetaxel.
Most people taking chemotherapy start with Taxotere (docetaxel) but there are other options like Jevtana (cabazitaxel). I have been told the latter causes less fatigue and a better quality of life. As for my recommendation, I don't have one. I have never been on chemotherapy. When Zytiga (abiraterone) plus Prednisone started to fail I opted for a clinical trial investigating the use of Lutetium-177 pre-chemotherapy. I have had three infusions with one to go. No side effects whatsoever! 😀 I certainly would investigate what clinical trials are available in your area.
I did chemo and Lupron and darolutimide when first diagnosed at 63. I had pretty mild side effects from the chemo. My worst side effect is neuropathy in my feet.
"... Lupron alone was very effective until December 2021. I then added Zytiga (abiraterone)/Prednisone which had worked well. But current (June 2024) scans show substantial disease progression ... My MO is recommending chemo (Lupron + Docetaxel/Taxotere) as the next step."
I think chemo Taxotere (docetaxe) is the usual next step after castrate-resistance. This radioligand therapy trial is interesting.
2024 Phase 3 PSMAfore Study. The PSMAfore clinical trial was designed to determine if 177Lu-PSMA-617 could also benefit a broader group of patients with mCRPC who have progressed on ARPI but have not received taxane chemotherapy. Patients who enrolled in the trial were assigned to either a change in ARPI, for example from abiraterone to enzalutamide or vice versa, or 177Lu-PSMA-617, a prostate-specific antigen (PSMA)-targeted radioligand therapy. This analysis found that treatment with 177Lu-PSMA-617 prolonged radiographic progression-free survival, improved PSA response rate, and increased objective response rate compared to a change in ARPI, regardless of whether patients had received prior abiraterone or enzalutamide." eurekalert.org/news-release...
My shortness of breath got better much after I was able o get off of Eliquis. I can't climb a flight of steps without some shortness but it recovers pretty quick. But I am 80 and expect that. I pray that your shortness situation improves soon.
I always said I would never do chemo either but now that I'm at this point, I may try it and see how I do. If side effects are too harsh I'll move on. Many insurers require a patient to do chemo first.
I'm sorry you lost your Dad but now he's in the presence of our Lord and His love. What could be any better?
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Next Step - Rising PSA
Next treatment options
One month after starting Lupron, Zytiga and Prednisone...
Lupron only after 4.5+ years
