Was diagnosed with stage-4 prostrate cancer with metastasis to lymph nodes and bones in April 2024. PSA was 400 when diagnosed and it shot up to 700 in a month.
Started with Lupron and Nubeqa. PSA has come down to 8 in 2 months. Next PSA test (after 3rd month) is tomorrow.
My Oncologist wants to give me Triplet-therapy and start me on Chemo Docetexel 6 cycles soon.
Please advise if this is best for me.
Thanks in advance!
I'm on triplet therapy, in Toronto. If you're offered triplet therapy that means that you're strong enough to do it.
And the massive clinical trials show that "triplet" is better than anything before, and not just by a margin (sadly we haven't really turned mPCa into a chronic disease yet, let alone found a cure). For me the side effects of triplet therapy were very tolerable.
Triplet therapy adds a real punch on top of doublet therapy (you could think of triplet therapy as "doublet therapy + chemo", where doublet therapy is "ADT + a second hormone therapy"). Instead of starting one therapy sequentially on the inevitable failure of the previous therapy, the big idea with triplet therapy is "hit 'em with everything we've got, all at once". (FYI, there's no "quadruplet therapy".)
I'm not sure if triplet therapy is standard of care yet across Canada.
There are a million things to say, but the short answer is you should 100%, all things being equal, accept triplet therapy. (And then of course there are details...)
Save me typing because I am in same boat as John and would mimic his words.
See TA's reply below.
It may be too late for triplet. If your PSA continued to come down below 1 on your test tomorrow, it is probably too late. The idea of triplet is to do Nubeqa and docetaxel at the same time, not sequentially. Nubeqa drives cancer cells into a senescent state where it is no longer vulnerable to chemo.
That is a very valuable piece of information. Thank you.
When on Lupron only, and PSA is below 1, are the cells in a senescent state? Or only when using an ARPI?
Very important comment about a hormone therapy administration sequence that puts PCa cells into a quiecent state - where then they are less susceptible to chemo!!!
So as someone who did two cycles six months later on Nubeqa who is BRAC2, would you count that as not interfering with future Parp inhibitors, since they say to wait on chemo and radiation for it to be more effective?
Sorry, I don't understand. Two cycles of what? If your PSA is not rising, what are you medicating for?
I know, I'm not big on details, my apologies. Two cycles of docetaxel
Take the triplet therapy if you're offered it as going in hard when you're "young, strong, and can take it" appears to lead to a better outcome. I'm on it now (just completeled cycle six of decetaxel. PSMA PET next week) and luckily have tolerated it well. If the chemo side effects are too much you can come off it and revert to doublet. Take what you can and see if it works. All the very best.
Thanks and all the best for the scan results.
I was 66 when diagnosed and when I started triplet therapy 😃.
Depends on your (and others if possible) opinion of your M.O.
Good Luck, Good Health and Good Humor.
j-o-h-n
Another Triplet Therapy patient here...It has worked for me so far (lower PSA, improved scans) and I was confident receiving "everything they have"...
Yea do it… I have started it and my psa is now .85 down from 591 Mar 3. 2024. I am 65
Thanks for your encouraging comments dear friends. I will start triplet as advised by the doctor also.
Update: My PSA was at 5.2 today ie. after 3 months Firmagon/Lupron and 15 days of Nubeqa. Starting on chemo (Docetexel) on August 22.
Reading between the lines - did you start on Firmigon/Degarelix and then your doctor switched you to Lupron?
That’s right, I started with Firmagon (2 months) but Liver enzyme levels (ALT, AST etc) started going up so they switched to Lupron. Enzymes came normal after a month.
I started 2 years ago with 6 rounds of docetaxel, while taking Lupron every 3 months and 600mg darolutimide twice daily. My Gleason at dx was 52, PSA was 52, 10 of 12 cores had cancer, imaging showed metastasis in my pelvic and periaortic lymph nodes. After chemotherapy I took a 3 month break and then did 28 EBRT treatments to the prostate and pelvic lymph nodes.
At my last imaging the radiologist said they saw “no sign of active disease” and my current PSA is < 0.03 (undetectable). So, I’m doing pretty well. I’m healthy and pretty strong and active. My wife and I are making plans for the future. I keep moving forward. I cut way back on alcohol and try to have a relatively healthy diet now. I have some lingering neuropathy in my feet from chemotherapy but nothing that’s going to hold me back.
I know, rationally, that some day I will become castrate-resistant and I’ll need to change my therapy. But I see a very good oncologist every 3 months and I feel like we have a pretty good handle on this thing.
That’s my journey so far.
Triplet here, diagnosed metastatic at 50 gleason 10...if you are in shape, do it before it's too late to start it, stats are good, keep working out while on chemo, it's the best way to manage side effects and mood!
Hormone Therapy failing?
Should I start ADT ?
What scan should I get?
Should I do chemotherapy? 
