Good Information

[chefjlu]

Sorry if this was posted before, but good read if you didn't see it. As I always say, you need to be your own best advocate. Information is power and those on here are lucky to have so much afforded to them.

cancer.gov/news-events/canc...

[dhccpa]

I fall into that category, using only Lupron from the beginning in 2018, 6.5 years now. My MO and I have discussed adding an ARPI continuously for years. He was not my original doctor, and he argues that since I was not put on the two-drug regimen originally, the studies don't apply neatly to me. He's also concerned about additional side effects; I think he'd be skeptical that adding an ARPI wouldn't likely produce new uses, since I have no pain or bone density issues. He's also skeptical of Big Pharma in his own way. But he says I can override him at any time and he'll go along; it's just not his recommendation.

[kainasar in reply to dhccpa]

A number of studies show significant difference between ARSI's and ADT vs ADT alone. Several cancer survivors here and elsewhere have repeatedly recommended to get another opinion. ASAP

[dhccpa in reply to kainasar]

I actually have and opinions have been split. For instance, the prostate cancer specialist at Moffitt Cancer Center at the time told me that I was doing fine on just Lupron in 2019, a year after diagnosis. Others recommended the same or differently, so there was never a clear cut consensus. But I revisit it periodically.

[JohnInTheMiddle]

Another scandal. Just like the prejudice and recommendation against PSA testing. The article did not state whether we were talking about personal physicians or urologists or oncologists. Personal physicians have too much on their plate to be trusted for anything complex. But for the others?

[chefjlu in reply to JohnInTheMiddle]

Understood, but it is my loudest advice to men I meet newly diagnosed - be your own best advocate. Seek as much information as possible, talk to many different levels and make a call. I have a Primary, Cardiologist, General Surgeon, Urologist, Dermatologist, Pulmonologist, Radiologist, and Hematologist. They all get questions, they all offer opinion and I take that all in before making the full decision. I also have connection to a Cancer Center (my Radiologist actually teaches in connection with them). ---- We're all a bit different, our diagnosis is personal to us, our reaction to treatment is individual to an extent. There is no exacting answer, but it is important to follow the SOC that shows positive outcome.

[mababa]

It's often difficult to fully understand treatment recommendations from our MOs, especially what level of treatment is appropriate. I queried Chatgpt as to current recommended practice regarding single, doublet, or triplet therapies for early stage treatments. I am fairly early stage although my PCa has metastasized to nearby lymph nodes. Technically, as a Gleason 7, 4+3 intermediate risk, and N1M0, according to the Stampede trials, a doublet hormonal therapy of ADT and ARPI is SOC. (I'm on relugolix and abiraterone/prednisone.)

But if you are N1M1, you really should consider asking about triplet therapy, like adding a chemo regimen like Docetaxel. I've pasted in the long answer from my query below.

In prostate cancer patients with a Gleason score of 4+3 (intermediate risk), N1M0 (lymph node-positive, no distant metastases) who are already on doublet hormone therapy with ADT (androgen deprivation therapy) and an ARPI (androgen receptor pathway inhibitor, such as abiraterone, enzalutamide, or apalutamide), the addition of Docetaxel chemotherapy as part of triplet therapy is a debated approach but may be considered in certain cases.

Is Docetaxel Recommended?

• For high-volume or aggressive disease: The addition of Docetaxel to ADT and ARPI is more commonly recommended in high-volume metastatic disease (M1), as per CHAARTED and STAMPEDE trials.

• For N1M0 disease: The role of Docetaxel in node-positive, non-metastatic (N1M0) prostate cancer is less clear. Some oncologists may consider it if the disease burden is high, but for many patients, ADT + ARPI alone is standard.

• Current guidelines (NCCN, EAU, ASCO): Generally do not mandate Docetaxel in N1M0 patients unless there is aggressive disease behavior (e.g., very high PSA, rapid doubling time, or significant lymph node involvement).

If Used, How Long Is Docetaxel Given?

• When Docetaxel is added to ADT in triplet therapy, the typical regimen is:

• 6 cycles (one infusion every 3 weeks)

• 75 mg/m² IV per cycle

• Without prednisone, unlike in castration-resistant settings

Conclusion:

For an N1M0 patient already on ADT + ARPI, adding Docetaxel is not routinely recommended but may be considered in select aggressive cases. If used, it is typically given for 6 cycles. It’s best to discuss with a medical oncologist to assess individual risk factors before deciding on triplet therapy.

[chefjlu in reply to mababa]

Yes, there is difficulty. It is where several doctors giving view as well as discussion can help. It has given me perspectives I didn't consider. In all of this it is always important to understand the "personal" aspect of each of our diagnosis, as well as our own personal reaction to treatment. I'm a bit different in that I have extensive medical training & education before deciding not to complete that journey in my life. As a result this gives me an ability to talk on a more technical level and that can be both frustrating and helpful for my doctors. I'm at times ahead of them in the discussion & questions, but they know I'm going to push. I will be talking with other doctors and including that in my discussion and questions. ---- I will add, that all of my doctors do say agree on one aspect - my approach to this "pothole" along my journey is momentary. I have approached it with total positivity. It has not stopped me from pursuing what I please in life. It does not define me, it is one part of me.