MCRPC

[Break60]

I have a history of oligometastatic PCa since dx in 2013. See my profile. After relative quiescence for the last three years on XTANDI and five years on estradiol patches for ADT, PSA jumped from .9 to 4.2 from July to October. CTPETPSMA scan found three bone Mets. The only pain I’ve ever experienced due to what may be from PCa is in now in my lower back.

I have peripheral neuropathy mainly in feet and calves so I’m very leery of chemo. My RO has me scheduled for MRI to area of pain in back. He wasn’t overly anxious for me to treat the bone Mets seen by CTPET. MO has not taken me off ADT/ Xtandi. Any suggestions?

Bob

[Tall_Allen]

You may want to go back to traditional ADT now, since it is unknown what effect estrogen may have on castration-resistant prostate cancer. In lab tests it stimulates it.

Xtandi may get new life if combined with docetaxel.

prostatecancer.news/2022/10...

Ice your hands and feet during infusions to prevent more neuropathy.

[Break60 in reply to Tall_Allen]

How does icing work? Is it 100% effective? Hey I’m nearly 81. I’ve lived with PCa for 11 years. I have total urinary incontinence, wear depends briefs and pads, was in hospital 6 times this year with UTIs , came close to death with sepsis and have stage 3 kidney disease. And my wife of 55 years died on September 16 from effects of a stroke in 2022.. Other than that everything has been great.

[Explorer08 in reply to Break60]

Regarding UTIs: our urology clinic recommended taking D-Mannose for UTI prevention. Seems to work well.

[Break60 in reply to Explorer08]

Forgot to mention that I’ve been using a Foley catheter now for a couple years. That alone contributes to UTIs.

[Tall_Allen in reply to Break60]

I'm sorry to hear about your wife. Discuss your reservations with your oncologist -there are ways to go slow with chemo.

[Break60 in reply to Tall_Allen]

TA

Thanks for your condolences re: my wife’s passing. To be honest, I’m happy that I outlived her . She could never have managed our estate.

I know from past dialogue that there’s no proof that RT to oligomets is effective . But seems to have worked for me so far. At the same time, RT has left me with a scarred uthera and incontinence . I assume that was from SRT to prostate bed after failed RP. You agree? I don’t see how RT to bone Mets far from my urinary tract would have caused damage to my urethra.

Bob

[Tall_Allen in reply to Break60]

I agree that SRT may have damaged your urethra.

[j-o-h-n in reply to Break60]

My sincere condolences regarding the passing of your dear Wife....May she Rest in Peace....

j-o-h-n

[Break60 in reply to j-o-h-n]

Thank you sir!

[CoastalTex in reply to Tall_Allen]

Allen...I'm in a similar situation with Xtandi failing. I read the study you linked. Would the docetaxel normally be infused on a weekly basis, or is there another method of delivery? I live about three hours from the nearest infusion center. I do travel to get a Firmagon injection every 28 days. Thanks!

[Tall_Allen in reply to CoastalTex]

It's normally 6 infusions, 3 weeks apart.

[CoastalTex in reply to Tall_Allen]

Thanks!

[Shorter in reply to Tall_Allen]

Hi Allen, Your reply makes mee want to ask another question. You mentioned that estrogen has stimulated CRPC in lab tests. I have been on a low dose of estrogen for about 2 years, and my cancer has just recently become mCRPC. This may be like splitting hairs, but was the estrogen you mentioned at high doses, or do you recommend going off estrogen entirely?

[Tall_Allen in reply to Shorter]

That was about using estrogen as ADT.

[Break60 in reply to Tall_Allen]

TA I’m curious: if not as a substitute for traditional ADT , what else would Estradiol patches be used for? I did however use just one .1 mg patch to quell hot flashes when I was on Lupron and getting IMRT to pelvic LNs.

[ragnar2020]

Break60,

Have you discussed radiating the bone mets with your RO? If your RO is not inclined to favor radiation, ask him why not.

[Break60 in reply to ragnar2020]

He did use SBRT on rt. femur in 2017 and on a rib and scapula in 2018. I had no pain with these Mets . I’m not sure why he’s reticent about using SBRT this time. Could be the location. But he did order an MRI on my back where I have pain this time. We shall see what comes of it.

[ragnar2020]

Break60,

After you have the MRI results, I will be interested to hear what your RO gives your as his explanation why he hasn’t discussed radiation with you for the spinal mets. To my way of thinking, I’d avoid chemo and try to postpone becoming castrate resistant as long as possible.

[Break60 in reply to ragnar2020]

I am castrate resistant already, no? Increasing psa while on estradiol patches and Xgeva?

[ragnar2020]

Break60,

Yes you are CRPC. Misspoke. Sorry.

[Apisdorsata]

I agree with Tall AAllen that you might consider going back on traditional ADT now. Xtandi is a testosterone receptor blocker. It does not reduce testosterone levels. Traditional ADT such as leuprolide with or without a different testosterone receptor blocker might be effective for you. Have you talked to your MO about this?

[Break60 in reply to Apisdorsata]

No I have not. My T has been <3.0 ever since starting to use the patches five years ago.

[Apisdorsata in reply to Break60]

OK. I'd still talk to your MO. There are so many options now for treatment.

[Break60 in reply to Apisdorsata]

The first thing out of her mouth was chemo to which I responded I’m gonna talk to my RO about zapping the Mets. It worked before. The thought of chemo makes me shudder particularly with my neuropathy!

[V10fanatic in reply to Break60]

FWIW, one infusion of Docetaxel put me in a wheelchair within a few days and then into the hospital for neutropenic fever for 4 days. The neuropathic shit-storm in my legs and feet took a couple months to wear off and now my baseline neuropathy has been permanently changed for the worse.

[Apisdorsata]

Yes, I feel the same way about chemo. I was an MO 40 years ago and hated doing it so I changed specialties. Of course things are very different now. But I too have peripheral neuropathy in my feet, probably from multiple frost bite episodes. But I enjoy playing the guitar and I wonder if I'd have to give that up. Anyway, I'm 76 and have had a good life. Once my cancer is ADT resistant I may just say adios. I don't have to make that decision yet.

But I've had salvage RT multiple times also so I think your idea has merit.

[Break60 in reply to Apisdorsata]

So when you say things are very different now what do you mean?

[Apisdorsata in reply to Break60]

How are things different? Many new meds, especially for prostate cancer. When I was treating patients the only treatment for prostate cancer was open radical with or without RT with subsequent castration (we call it orchiectomy--doesn't sound so bad). No Lupron or anything else was available.

[Break60 in reply to Apisdorsata]

I get that but I was wondering if chemotherapy has changed. When comparing say docetaxel to other treatments how much is overall survival increased?

[Apisdorsata in reply to Break60]

What I meant was that chemo in general is much better with many new treatments for cancers for which we had nothing to offer 40+ years ago. We had good treatment for childhood leukemias and for many lymphomas, chronic myelocytic leukemia, and multiple myeloma, testicular and ovarian carcinomas and somewhat effective treatment for small cell undifferentiated lung carcinoma and we had Tamoxifen and somewhat effective chemo for breast cancer. I can't remember any other malignant disease for which we had effective chemotherapy.

I don't know much about docetaxel as it came along much after my time. We were excited about docetaxel's precursor, pacitaxel but it wasn't available yet. If you are asking has overall survival for prostate cancer improved I'm sure it has but I don't know the numbers. I'm sure it has for other cancers too.

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

So you're the SOB who scheduled my chemo back in the 1980's. May a giant bee sting you in the ass and make you laugh till it hurts....Now Now, don't you ever say Adios to us....

Good Luck, Good Health and Good Humor.

j-o-h-n

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

Well, I quit that in 1982. If you had chemo from me you got a great response!!

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

Yep, and it helped with my silliness and my sense of humor. Thanks!

Good Luck, Good Health and Good Humor.

j-o-h-n

[NecessarilySo]

You might try heat on the lower back pain. See my profile for more details.

[Break60 in reply to NecessarilySo]

Yours is an amazing story! Thank you.

[garyjp9]

My deepest sympathies on the passing of your wife. May she rest in peace.

[Break60 in reply to garyjp9]

Thank you ! Losing a partner of 55 years is crushing to the heart and soul!