( I made this post earlier but am doing it again in the hope that more men in their 80’s could share their experiences if they took chemotherapy. )
I am 82 and was diagnosed last month with PCa metastatic to a few bones. Gleason 9. PSA 21 at diagnosis.
Have been put on orgovyx and been told soon will be put on an ARPI - either zytiga or xtandi.
Chemo was not mentioned.
Reading some posts here I wonder if chemo would be an important option for me?
I do 45 minutes of walking and some light exercises daily. I would not call myself strong but well kept enough to function independently. I take medicines for hypertension.
Would welcome views and experiences of those around my age who have done chemotherapy along with adt plus ARPI. Was it very tough on the body ? Was the chemo started after the arpi was added or before it?
What is the determining factor to decide if chemotherapy has to be added ?
Thank you
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Simpson80
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Doctors have a treatment bias. My father is 81 and his details are on my profile. I wish we did chemo at the start or earlier when he was at his strongest. Performance status is really important. My dad sleeps 13-17 hours a day and blood work isn't great. Chemo and Pluvicto would exhaust him and really take away his QOL for what is important right now. Read "Being Mortal" especially chapters 5-8 and figure out what is important to you and what you should look at. I have a friend who has a dad the same age as mine. Was sleeping most the day with widespread mCRPC and mets to liver. Could only take two rounds of Pluvicto before blood work indicated he could take more and the MO suggested he "try chemo." " New oncologist recommended against it but her dad insisted on it and had to sign a form. He has essentially been sleeping now for most two weeks and can hardly get out of bed from just one treatment. I owe this board a huge amount of gratitude for figuring out the best way to help my dad. Read about performance status and identity what is important to you. Good luck!
Again, performance status and biological age should dictate dose, not chronological age. There are usually 6 infusions - why not see how you do after the first one, and back off on dose if you have trouble with it?
If I decide to do chemo , is there a timeline by when I should start it to get best results ? Should the chemo be done before or after adding the ARPI ?
I see the link you shared shows that ADT + abi had a medial survival or 50 months ( latitude ) and 56 months ( Stampede) , whereas adding chemo increased it to 61 months ( peace-1) , so it gave about 5-11 months increased survival by doing chemo.
Are there any additional benefits doing chemo apart from this little increased survival ?
Did the trials that you stated above , all have men with advanced disease ? They say 4-5 years but don’t most men with advanced disease become castrate resistant before that long a period ?
My husband’s Oncologist is offering cabazitaxel chemotherapy but says his WHO 2 @ best. Should he be advocating chemotherapy, he is 80
PSA 59 widespread bone mets lot of pain following 4 treatments of R223 with progression in the coccyx, got weekly Butec patches also Oramorph but Oramorph gave him hallucinations so home care hospice nurse contacted GP to change prescription. Daily battle with rectal Proctitis spends most mornings on the toilet, but HB 93 holding since blood transfusion. At last Seeing Gastroenterologist Thursday
Performance status is indeed a concern. However, chemo does a lot to relieve bone pain and delay progression, so he has to weigh those benefits against the risks. Maybe he can try a lower dose and ramp up if he tolerates it well.
I have mixed thoughts about chemo. It nearly killed my spouse twice. Neutropenic fever and then heart issues. He went from a healthy fit 62 years old to weak and couldn’t do anything. It did shrink his tumors hence the mixed thoughts.
I think it affects people differently. There was another guy in our infusion clinic that breezed through it and had a T time after chemo he didn’t want to be late for. So with that said you could probably inquire about it and always stop. They pulled my husband off after his third round because it was so toxic to him. We were told by the Medical Oncologist that insurance is one of the drivers of the use of taxotere. It’s cheaper and you have to fail it before you get offered other types that cost more. He said if the oral meds fail he can go to platinum based.
Also a urologist will treat you differently than a medical oncologist. Also ask for somatic tissue tests to see what genes your tumor cells have. It will help your oncologist make an informed treatment decisions. For example my husband has a gene that is favorable for androgen therapy. It’s expensive. I think our insurance was billed like $6k.
I wish you good luck with whatever treatment you use.
I really think genetics plays into how you react to chemo. You can always try it and see how it goes, stopping if it’s not working. Just make sure all your liver and kidney numbers are good. Also make sure they give you Nuelasta. They didn’t for my husband and it nearly killed him. Have you had families members do okay with chemo? My husband was super fit and we are working on him being active again. He has neuropathy from chemo so it’s been hard.
No one that I know of in my family has got cancer. I seem to be the first. Is the Nuelasta for blood count ? Did your husband have this severe reaction after his first chemo or subsequent ones ? Best wishes for him to recover soon
It’s for white blood count. The chemo will kill all your healthy cells with the cancer ones. My husband went Neutropenic (zero white blood cells) on his first chemo and had a run away infection and ended up hospitalized and nearly dying from it. The Nuelasta auto injects after chemo and helps you to build white blood cells. His doctor said he didn’t need it and was wrong. He is doing much better now but has been thru the ringer. I hope your doctors and you have success with whatever treatment you chose.
He got tachycardia. HR of over a 100 for weeks. BP was extremely low 80’s over 50, Edema, they were testing him for congestive heart failure. They don’t think chemo permanently his heart but they pulled him off of it.
I am approaching 80 and I am in superb physical shape. I have had radiation to prostate and pelvic area with 6 months of ADT at the same time.
Here are my thoughts. If I have biological reoccurrence as determined by PSA my going in position is to watch the PSA and make hopefully do chemotherapy and short term ADT.
I figure the best time for chemo is in the beginning when I am in great shape and can handle the physical stress.
Have you had any genomic testing done. It may tell you how effective chemo would be. In my case when Xtandi stopped working after 2 months and 8 months of Zytiga did very little good, my MO urged me to start Taxane chemo. After a lot of reading and other opinions and reading my genomic testing reports, I concluded a course of Taxane would probably give me a few months more overall survival after several months of likely poor quality of life. No thanks. I'm going to try a clinical trial.
Simpson80, There are two types of genomic testing I am aware of. I am not an expert on this subject. One is "germline testing." That identifies mutations or other issues that have been inherited from your family. Other tests address mutations specific to your tumors. Some genomic testing will require tumor tissue to examine. Other tests require only a blood sample. One of the good ones is Ambry germline testing. FoundationOne is another well known test. It looks at many different genes in the tissue sample or blood sample to help identify whether a patient's tumor has a specific gene mutation. Tempus is another test specific to your tumors. The value of these tests is that they can often tell you what treatments are likely to have a good response in your unique situation and which will not. That can save you a lot of time, expense, and misery trying therapies that are unlikely to help you. I'm sure you can get a better understanding of this subject than I can provide from Google, although I think your doctor should be talking with you about them. I think it is not uncommon that a local medical oncologist won't tell you about these tests. Too often they will give you the first drug on the shelf and see if it works or not. If it doesn't, or when it stop working, they give you the next one in line. In other words, trial and error medicine. Oncologists sometimes say "No I won't order that, because it won't change your treatment." It might not change the treatment they would offer, but a doctor at one of the centers of excellence may well be able to prescribe a treatment targeted to your cancer with the info from genomic testing. My local oncologist didn't see any use in ordering genomic testing, but eventually an excellent oncologist at Mayo Clinic did. As a result I'm entering a clinical trial that has a reasonable chance of helping when the series of drugs I've taken have done more harm than good. Good luck.
Where are you being treated (also doctor(s)? Please Update your bio with voluntary info. It helps you and helps us too.
Make sure you get the best of the best doctors (ask for doctor names here if need be).
Good Luck, Good Health and Good Humor.
j-o-h-n
I was 81 and in very good shape when I was diagnosed with metastatic PC …my PSA was 194 ….I was immediately put on Lupron and did 9 rounds of Jevtana….I had no probs with the chemo..No hair loss or nausea…this treatment dropped my PSA to hardly nothing , and lasted for 4 years…I just turned 86….
Do you know why they chose Jevatna and not Taxotere Most people seem to be taking taxotere . Was it due to age ?
I wanted a chemo that had no hair loss…so Jevtana was my choice…Also I had no nausea…I don’t know about Taxotere…I think Jevtana was more expensive than other chemos but since I have neuropathy in my feet Medicare paid….
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