Progress?

[Luvmyman]

Had first shot of ADT a couple of weeks ago, went from 7 psa to 1.2 before first round of chemo this week. Made it through round 1 - tired on days 3 and 4 with a head ache - no nausea. Is the score of 1.2 promising - is this a good outcome? I have been told that the goal is to be at .02 by 7 months. The faster you drop, the better. Gleason 7 - had a radical prostatectomy last September - PSA was at 5 after surgery - 3 months. Beginning Nubeqa tomorrow. Cancer in five nodes - feel fine. No bone mets.

[Tall_Allen]

Chemo? Have you been diagnosed with distant metastases?

[Luvmyman in reply to Tall_Allen]

I don’t think so - four small nodes in pelvic area and one higher up - none in bones or organs

[Tall_Allen in reply to Luvmyman]

I have never seen a clinical trial showing that docetaxel is beneficial when there are no bone or visceral metastases. Your oncologist may have seen such data -- I think it's worth a discussion.

prostatecancer.news/2019/02...

[Luvmyman in reply to Tall_Allen]

I was incorrect - five lymph nodes outside of the pelvic region - up by chest and neck. God - I am terrified. Does this mean the survival rate is now 34%? Not yet in bones or organs.

[NemoHic in reply to Luvmyman]

I see from your profile that you are starting Nubeqa soon (if not already). That has been a game changer. Five year survival is over 50% on triplet therapy and those of us whose PSA drops quickly and deeply do the best overall. Plan on being around for a while!

[BigJ32 in reply to NemoHic]

This is good to hear. I’m a GS7 (4+3) I went from PSA 7.5 to undetectable in 30 days after starting ADT. MO says this is positive, but didn’t elaborate. Just that this is favorable. Thought he was just boosting moral.

[NemoHic in reply to BigJ32]

Here is the journal article on it: sciencedirect.com/science/a... . Also, an interview with the lead author of the study who describes it in more layman terms: onclive.com/view/link-betwe... .

[Rocketman1960 in reply to Luvmyman]

Take a deep breath brother. They are hitting it with a sludge hammer. I'm kinda surprised it moved so quickly to distant lymph nods with a gleason 7 score. Be thankful they lymphatic system is gathering the bad guys and it isn't in major organs. Stay positive.

[Luvmyman in reply to Tall_Allen]

PSA had risen from 5 at the three month mark after RP to a 9 by February. Gleason 7 - tertiary 5 very small, had a PSMA scan - showed minimal lymph nodes - 5

[Nusch in reply to Luvmyman]

Wait for the TA’s response. From my side, I’m not a doctor—just a warrior like you: You don’t need to be afraid of GS 7; the PSMA PET scan shows no metastasis except in the lymph nodes. There are highly effective treatments available for your case!

[Luvmyman in reply to Nusch]

It is in the lymph nodes - five or six of them

[Nusch in reply to Luvmyman]

If it’s just in the lymph nodes you have a lot of options.

[podsart in reply to Nusch]

GS 7 , but importantly is it 3 plus 4 or 4 plus 3?

[Luvmyman in reply to podsart]

4 plus 3, tertiary 5

[podsart in reply to Luvmyman]

yes people forget that there is a material difference between aggressive level between whether the 4 is first or second. I am also a 4+3

[Vangogh1961]

Mine dropped in half every check until finally undetectable after 9 months. I had completed chemo and was to start radiation. Has been ned for 3 years. You've got this.

[Tigerfox4321 in reply to Vangogh1961]

My dad is finishing chemo, last session Monday, going to start radiation after. How was radiation for you? Was it worse than chemo? They have to drive 1 hour up every time which sucks also.

[Vangogh1961]

Less fatigue, more irritation to the prostate, was up more in the night until they finished. Worst part for me was keeping bladder full. I had a space oar put in. Some say you don't need it, but I've had zero issues since, so I was glad I had it.

[Hawk56]

Sounds like triplet therapy. TA is not necessarily wrong, I have seen literature on the benefits of chemotherapy in high versus low volume PCa, what is low volume, well, generally, 3-5 sites of metastases.

But, that is statistics, not individualized treatment decisions.

Is it "wrong" to include chemotherapy in triplet therapy for advanced PCa, not necessarily.

I did, but I am high risk, GS 8, GG 4, PSAT and PSAV very rapid, short time to BCR. My triplet therapy brought close to five years off treatment.

I have seen data that indicates rapid drop in PSA is an indicator of favorable response to treatment and may portend longer progression free survival. I think that may be a factor in my time in remission as mine dropped from almost 5 to undetectable in three months.

So, my answer to your question, yes, that is a good response!

Clinical History

[RoseDoc]

Looks like you are doing just fine. I'd recommend using the iced mittens/gloves to limit any neuropathy during the chemo infusions. A cool cap, if you wish to keep most of your hair. Seems like your doc is being aggressive, which is great. You are on the right path and on the right meds. The side effects from docetaxel are cumulative, hand in there. Exercise, get plenty of rest.