Husband completed 6 cycles of Docetaxel on 10/03. His previous PET/CT F18 FDG scan was done on 10/28 and was good. Doctor told us that triplet therapy and especially chemo worked great. Unfortunately , within less than 4 months the situation changed. The most recent PET/CT F18 FDG scan was done on 01/21 and showed "1. increase in intense FDG uptake in the left prostate love suspicious for locally recurrent malignancy. 2. Mild FDG uptake of a soft tissue mass along the left pelvic sidewall and extending into the left anteromedial acetabulum. 3. New FDG-avid sclerotic lesions in the left interior pubic ramus suspicious for metastatic disease with suspected superimposed pathologic fracture. 4. New FDG-avid pathologic fracture in the left superior pubic ramus." Now we need to decide what to do. Our oncologist suggested to try two more cycles of Docetaxel 6 weeks apart and then repeat the scan. Her argument that Docetaxel has been very effective before and she wants to save cabazitaxel as a future option. At the same time, she suggested to ask for the second option. We asked for the second option and this second doctor was concerned for short lived response to the treatment and suggested to start cabazitaxel and Zytiga (instead of Docetaxel and Nubeqa). We understand that we should start doing something ASAP. But which way to go? My husband wasn't to try to repeat Docetaxel, I am not sure. Any thoughts? Thank you!
Re-challenge Docetaxel or switch to C... - Advanced Prostate...
Re-challenge Docetaxel or switch to Cabazitaxel? Advise?
Dear Anna, did consider to get localized chemotherapy with Keytruda as we do in Germany?
The specialist offer “Priming”: Short-term immunotherapy with the immuno-oncological intraprostatic administration of Impilimumab/Yervoy™ + Docetaxel for the treatment of prostate cancer
Thank you for the suggestion. I will ask the doctor about the combination of immunotherapy and docetaxel. Earlier she told us that based on genetics testing immunotherapy is not expected to work.
Thank you for sharing. 
I agree with doctor to try docetaxel. It will also rollout that whether cancer resistant to docetaxel or not yet.
One users also mentions, I do not know his country. His oncologist going to repeat the docetaxel again after 2 years because of new mets
In my personal opinion, try Docetaxel with Radium-223 ?
Here is clinical trial : clinicaltrials.gov/study/NC...
Appreciate your input! I will about Ra-223.
Some patients get 10 cycles of Docetaxel. Therefore it is probably no mistake to get more cycles. I would not call this a re-challenge. I think the first opinion is better than the second one. If you need a second opinion you should contact a well-known hospital and not another oncologist.
My husband is glad to hear that you like the 1st opinion better. Meanwhile, we scheduled a consult in Memorial Sloan Kettering.
I don't think it matters much, as long as they do a repeat FDG PET/CT after a couple of infusions to check if the docetaxel is working and to change to cabazitaxel if it isn't. You may want to discuss adding carboplatin. Also, maybe discuss getting an interventional radiologist to biopsy at least one of the larger metastases and do histology, IHC, and genomics on it before chemo shrinks it.
Thank you, Tall Allen! I remember that in response to my earlier post you mentioned cabazitaxel plus carboplatin. I took notes and brought it to our doctor. She agreed that it can be an option at some point. His biopsy was from metastases in lungs. The doctor and also the patient have never been in favor of another biopsy... Will ask again
Don't biopsy the lungs you could end up with collapsed lung and end up in a hospital for 12 days.
Thanks for the warning but lungs biopsy was done earlier.
What was the result? Did they performed a genetic testing also on the sample?
The results were poorly differentiated carcinoma primary prostate origin. Genetic testing they did later using the blood sample.
I am not a doctor just wish to understand things. Why couldn't they perform a genetic testing from a lung tissue biopsy?
My prostate biopsy tissue was sent to Peter Mac Callum cancer Centre in Melbourne but they refused to do a genetic testing stating quality control issues with the tissue sample.
According my information the liquid biopsy could only yield some meaningful results if the PSA is above 5 or even better above 10.
I wish I would know the answer...
Have you looked into Pluvicto or orxofigo ?
orxofigo is injected radiation that goes to growing bones. In an adult that is pretty much the spots with bone metastasis. So if your cancer is in soft tissue it’s a bad choice but all bone metastasis then it’s a good medicine.
Thank you for your suggestion.
Greetings AnnaViktoria, (two of my favorite names, except one N and the K should be a C). Note: However two N's and a K = Greek spelling.
This is just a passing note to you. My lung metastasis due to a melanoma on my neck was treated with Keytruda (at MSK btw) and it worked. Not related to my Pca.
Total of 16 treatments (one every21 days):
Number 1 treatment with KEYTRUDA on Tuesday 02/07/2017.
Number 16 treatment with KEYTRUDA on Wednesday 01/10/2018.
Good Luck, Good Health and Good Humor.
j-o-h-n
Hi J-o-h-n, do you mind if I ask about your experience with MSK? Who is your doctor there? I followed Tall Allen's advice and asked our doctor about a biopsy. She now is in favor of prostate biopsy.
My Pca M.O. at MSK is Dr. Michael Morris....The doctor who treated my Lung metastasis is no longer with MSK (she's now in Connecticut). Both of them are terrific.
Need more info? Just ring my bell.
youtube.com/watch?v=AvEcIeW...
Good Luck, Good Health and Good Humor.
j-o-h-n
Thank you, J-o-h-n. My husband will go to MSK in the end of this week. Warm wishes
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