What treatment next as PSA increasing on Daroludamide & Lupron

[mklc]

My PSA is increasing after a year on Daroludamide and Lupron.

Questions:

1) can the Daroludamide be increased?

2) what is the next treatment after this to reduce PSA?

Sincere thanks.

[Tall_Allen]

1.Your Nubeqa dose should be 1200 mg/day in two halves.

2. When PSA rises to about 2.0, PSADT≤9 months, and/or radiographic progression, it will be a good time for docetaxel, perhaps part of a cocktail.

[mklc in reply to Tall_Allen]

Is it possible to increase the Nubeqa dosage?

When is Radium used?

Most sincere thanks for your advise.

[Tall_Allen in reply to mklc]

1. No. Toxicity without extra efficacy.

2. If you have painful bone metastases, it can be used with docetaxel.

[mklc in reply to Tall_Allen]

Greatful for your advise. Thank you TA. Best wishes

[JohnInTheMiddle]

Hi M. I read your bio - you are a strong fighter. From what I read you have not had chemo. And from your answer to Tall Allen's question, I'm thinking that you are hoping to avoid chemo? Specifically Docetaxel?

[mklc in reply to JohnInTheMiddle]

Not so much avoiding Docetaxel, more hoping there would be an easier alternative. Have you had chemo and if so, how was he impact? Best wishes.

[JohnInTheMiddle in reply to mklc]

As "j-o-h-n-" says below, another 21 years! Your journey and courage has inspiring.

As for chemo, which in our case I believe is mostly Docetaxel, I did the typical six sessions, each 3 weeks apart. I tolerated it well. It was part of my triplet therapy initiated two and a half years ago after my diagnosis of metastatic stage 4B prostate cancer. I started with a PSA of over 1700, and metastasis to the spine. I met with palliative care multiple times.

However I have done a extremely well and recently went back to work part-time. (So far so good 😳) This is a big success for the new generation therapies.

My understanding of the chemo is that if it is offered to you that it could be very important. It wouldn't be offered if you weren't strong enough.

And Docetaxel attacks the cancer in a completely different way then anything else, such as hormone related therapies, or radiation or surgery.

My sense from my own reading including many posts on this forum, is that missing a chance for chemo is missing an important opportunity.

This isn't to say that some people don't have much worse reactions, or that chemo always is effective. In my case the nurses offered ice for my feet and hands to prevent neuropathy. Whether it worked or not I don't know but I have no neuropathy. And also I fasted the day before and the day after. I also learned recently that it is not standard of care everywhere to receive an anti-infection injection. I had that.

So keep up the good work, and if you are offered this therapy because it is appropriate for where you are in terms of your sequence of therapies, I encourage you to consider it.

Here's to another 21 years!

[mklc in reply to JohnInTheMiddle]

Thank you John for your thoughtful words and beneficial advise. I am delighted ou are doing well and long may it continue.

If ou dont mind me asking, what hospital are you being treated at?

Any and all advise regarding the doxetaxal is extremely welcome as this is an unknown for me.

Wishing you well and continued success.

[JohnInTheMiddle in reply to mklc]

Princess Margaret hospital in Toronto Canada, focused on cancer.

[j-o-h-n]

What's next? At least 21 more years....

Good Luck, Good Health and Good Humor.

j-o-h-n

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

and more years to you too John. best wishes

[RoseDoc]

Docetaxel is your next step. Generally 6 treatments each 3 weeks apart.

I tolerated it fairly well. Fatigue, muscle pain were the worst side effects. I used the Penguin Cool Cap so did not lose my hair. Use the cold mittens/socks to mitigate possible neuropathy.

My eyebrows thinned out quite a bit and have not recovered. So, all things considered, not so bad. My PSA went to zero by the 5th treatment.

[mklc in reply to RoseDoc]

Well done and congratulations that your PSA went to zero.

I thank you so much fo the advice about the cold cap, socks and itens. I will search for them.

Please keep well and may your good health continue.

Best regards, . I