Hi all -
Curious if anyone here was prescribed doublet therapy for metastatic prostate cancer? My dad, 73 (Initial PSA 151, Gleason 9, 4 small mets to pelvis, spine, tailbone) had an appointment today, and his MO indicated that he would like to proceed with doublet therapy. I wasn't aware he would be a candidate for this treatment given his mets. Curious to hear others input on this.
I’m on doublet therapy. Orgovyx (since December) and Abiraterone (after radiation, starting in May). My PSA, which was nowhere near your dad’s (4.8), under doublet therapy has become undetectable. Ask me anything.
Thanks for sharing! Did you have metastasis or lymph node involvement? Or was your cancer localized to the prostate?
It had spread to my pelvic lymph nodes.
How did you feel on the abiraterone? Any advice?
It’s got similar side effects to the Orgovyx (hot flashes, muscle loss, brain fog), and your blood needs to be checked frequently for liver problems. It’s an additional annoyance, but I keep telling myself it gives me an additional 33% chance of success.
But I’d also listen to Tall_Allen and his advice. Bone mets are something worse than what I had, in terms of spread. Obviously, listen to his doctors.
Thanks for sharing your experience Jpburns ! The way the MO explained it to my parents was that he doesn't think "triplet is necessary" as he is classifying my dad as "low burden metastatic" , however based on Tall Allen, others in this group, and my own research, I think triplet would be better long term. It's a tough situation and I am trying to navigate next steps.
With bone metastases, he should be discussing triplet therapy:
prostatecancer.news/2021/05...
Tall_Allen I was finally able to listen to the recording of the appointment, the way the MO explained it to my dad was something along the lines of him being "a low-burden metastatic case" because he only had 4 small bone mets (no node involvement, no organ involvement), and he doesn't "think triplet is necessary." Based on what I've learned from you and this group, I am worried about this approach. What would you suggest? Should we get a 2nd opinion?
Definitely get a second opinion. Preferably from Maha Hussain who did this analysis:
I was diagnosed in March 2000, PSA 177 Gleason score 5 + 4 = 9.Commenced Eligard every six months, 20 rounds of radiation then Enzalutamide 4 x 40gm every day. Several side effects fatigue hot flushes, weight gain, muscle loss. But still in there batting every day.
PSA still undetectable my medical oncologist refers to my results as "biochemical in remission", for how long is anyone guess, so live for the moment, then the day and see what tomorrow brings.
Diagnosed at 73, T3a/b mets to pelvis, spine and rib. Psa 11.2 gleason 9. Started prostap (lute) and abiraterone. Abi stopped after two and a half years due possible heart problems. Continued just prostap at 79 psa up to 0.7.psma scan still confirmed original diagnosis. Restarted Abi at half dose, psa currently 0.360. Doublet seems to work for me at 80 years. Sadly no one told me to exercise so suffering from lack of energy/weakness. Keep going and enjoy life.
You can start exercising today, with patience and a lot of FAITH and you will be surprised what your body can do. Will make you stronger and improve your mood. Cheer up and go for it!!
I will second the exercise - walking and resistance training. Go slow at first and remember the next summer Olympic events are in four years in LA so hope to see you there.
My thing is tennis, maybe we can sign up for Super Veteran Category and bring back home a couple of medals. Look forward to see you ther!
I was diagnosed in March of 2024. Gleason score of 9, PSA of 76. Stage 4 PC. I started doublet therapy on April 3 with Firmogon injections every 28 days and Erleada tablets (240 mg) daily. After 4 months PSA down to .2 and reduction in main tumor, lymph node improvement and less uptake in bones. Side effects are hot flashes and brain fog. Taking black cohosh for hot flashes and trying to stay as active as possible. Hopefully, I can be castrate sensitive to the treatment for several years. So far so good!
Good morning. Sorry to hear the news about your Dad.
I was diagnosed with G9 in 2021 at the age of 69 with no known metastases on Imaging. Had RP. Within 6 months my PSA had risen and subsequent PSMA PET revealed met to thoracic spine. I eventually found a very experienced MO who is heavily involved in trials and research at Johns Hopkins. He immediately started me on triplet therapy (Lupron, Darolutamide and Docetaxel) based on ARASENS trial. I also had SBRT (radiation) to T8 to kill the met. After triplet therapy I had pelvic radiation treatment.
By the definition of some MO/RO, your Dad has oligo metastatic disease. There are current trials (and many practicing MO/RO around the world) that are also treating the limited metastatic sites with radiation to kill all disease apparent on Imaging/PET while the systemic therapy targets the micro metastases not yet visible on Imaging.
Yes, I had the choice of 1) ADT/Abir and radiation or 2) Docetaxel/ADT/Abir followed by radiation. I went with the more aggressive 2nd option as my PCa was Gleason 4/4 with some other adverse indicators. Dx at age 59, so the SEs were tolerable.
"... 73 (Initial PSA 151, Gleason 9, 4 small mets to pelvis, spine, tailbone)... MO indicated... doublet therapy. I wasn't aware he would be a candidate for this treatment given his mets."
Doublet and triplet are indicated with mets. I have mets to nodes only, and started doublet last winter with Orgovyx and Abiraterone+Prednisone. Was afraid to add chemo Taxotere for triplet because of being age 81. As it turned out, I have hardly any unpleasant effects from doublet and think I would have handled triplet well.
Triplet therapy is what he should be on with his diagnosis. My husband was diagnosed in 2017 with similar (Gleason 9 and mets to several bones) and, at that time, doublet was brand new. My husband did ADT plus chemo to start. After chemo ended he added zytiga plus prednisone- he's been on ADT and zytiga plus prednisone ever since. I wish triplet had been already used. But at that time it hadn't finished trials yet.
For me I am now only doing doublet, Orgovyx and Nubeqa, my psa went from 254 to 0.4 in 5 month next test in 6 weeks. Doc wanted Chemo I decided to hold out. But I am also taking Low Dose Naltrexone, Nitazoxanide, Ivermectin and plans to add Mebendazole. I try to maintain strict diet, no dairy no meat plenty of veggies , fish, tofu, some chicken now and then. Modest weight lifting and stay active. Take only a few supps vit D3/k2, Alpha Lipoic Acid, Acetyle L Carnitne TurkeyTail mushroom powder. My research has shown all above mentioned are good for PCa and mets. Mod Citrus Pectin / 9to10 grams a day is said to be good as well, I stopped taking cause it's a binder and decrease effects of certain meds - IVM and NTZ. So far no SE from any of the above. Except for- Very minor( now and then) hot flash at night from ADT drugs . Best
Can you share your protocol for ivermectin etc. Where did you learn about them from ?
Yes, rather than trying to explain ,I followed the advise of this guy who is on Rumble called SunFruit Dan, now before you laugh, his info is backed up. Look for his IVM and Meben protocols for cancer videos. Plenty of science to back up these drugs. As they say don't shoot the messenger. Also search Dr Kathleen Ruddy - Ivermectin interviews.
Second Tall Allen's recommendation to look into triplet therapy - this is now standard-of-care for patients newly diagnosed with bone mets. Tall Allen is our resident expert.
Since May 2020 I have taken Erleada every day and Lupron injection every 3 months. My PSA has been undetectable and testosterone around 10. Metastasis in ribs.
My prostate cancer was widespread metastasis to bones and lymph nodes, PSA 1311, when I was diagnosed in May 2020. At the time the standard of care was doublet therapy and I have been on quarterly Lupron (Prostap Leuprolide) injections and daily Enzalutamide (Xtandi) tablets. I have been lucky and responded well. As Tall Allen and others have stated, triplet therapy is the Gold standard of care today. Good luck to you all.
doublet therapy here. G9 PSA 31, NOW DOWN TO .011 , SIDE EFFECTS NOT HORRIBLE. BUT NOT WHAT I WANT TO DEAL WITH FOR BALANCE OF LIFE
Treatment options for metastatic prostate cancer? 
any similar stories extensive metastatic prostate cancer 
Should I Add Docetaxel to Lupron and Zytiga?
