My husband was diagnosed in Feb. 2018 with oligo metastatic - 2 spots on spine and local lymph node involvement. Had radiation to the lymph nodes and was on Lupron and Casodex for 5 years. Went off treatment a year and three months ago.
Cancer returned to one lung only - no Mets to bone or lymph nodes.
Treatment now is Eligard and Nubeqa. Husband wants to add Docetaxel to get the triple therapy effect.
Tall Allen, do you have an opinion about this?
Yes Its good treatment options.
No, he shouldn't take docetaxel now b ecause cancer is not actively growing. Triplet therapy has to be done all at the same time, not sequentially. When his PSA returns and there is new metastatic activity, that will be the time to use docetaxel.
The one met in his lung isn't enough to do docetaxel? Why wouldn't it? Is there a minimum number of Mets, or are you saying because he's already started Nubeqa?
The met was discovered when he was on vacation.
Why Eligard? Your husband did one injection of Firmagon. I'm just curious if you told that the Eligard / Lupron "is more convenient" with a 90-day injection?
They're both ADT but it's not the same technology. There are lots of posts on this topic in this forum.
The Firmagon was given to get the immediate effect of bringing down the PSA quickly. Our understanding was that Eligard/Lupron allows PSA to continue to rise then starts bringing it down. Doctor was avoiding this PSA flare.
Now that it's down he starts Eligard next week.
Here's an interesting question that it might be good to know the answer to.
And my context for this question is that I'm over two years on Firmagon. I rejected the choice to change after the beginning to Lupron.
There are good arguments for staying on Firmagon, even though it may be "less convenient".
Thank you. Something to consider.
Sequence of treatment line(s) is always a huge conundrum in regard to the heterogeneity of patient care! It all depends... Using the hammer too soon, or too late each have their own respective issues. If the question is whether or not Triplet therapy has better efficacy than mono or dual, well yes, it does. But as noted above, using it misguidedly may not provide the benefit you think it will.
Question is have the mets been biopsied and genomic testing performed? Or blood testing been done (CTC) for the same search for biomarkers that might provide additional avenues of therapy?
Anyways, what has your care team prescribed? Have you questioned them on treatment choices and "next" steps? Are you at a Major Cancer Center? One rated in Excellence? If not, it might be worthwhile getting to one even if as a 2nd opinion!
Good Luck and Best Regards
Lung met was biopsied and reported to be prostate cancer which had migrated to the lung.
Care team has currently prescribed Eligard and Nubeqa. We are going to Dr. Joel Picus at Siteman in St. Louis, who was recommended by previous oncologist Dr. Maha Hussein from Chicago.
Please ask the doc(s) if your husband's lung meds would be treatable using Keytruda. (Worked for me).
Good Luck, Good Health and Good Humor.
j-o-h-n
I would suggest getting the lung lesion biopsied along with genetic testing. How long has he been on Eligard and Nubeqa? How old is your husband? Is he in otherwise good medical condition?
I believe most would start him on Docetaxel, 6 cycles. If PSA becomes undetectable and scans show no lesions after being on ADT for 2 years after that, could consider a drug holiday with close monitoring.
Docetaxel would seem to be indicated in your husband's case. Wish you the best!
After RP who goes over Pathology? 
Advance prostate cancer metastasis to lung and lymph nodes
External Beam Radiation Therapy for High Risk/Locally Advanced PCa: The Shifting Landscape
ADT Vacation/What PSA to Resume and Prostate Cancer Bipolar Therapy With Testosterone
Investigating Proton therapy for salvage treatment following RARP 
