Chemotherapy ~ Early Treatment Questions

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Tony Crispino
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Date Joined Dec 2006
Total Posts : 8128
   Posted 6/12/2008 1:24 PM (GMT -6)   
After I had my surgery, my pathology indicated a serious situation. I'll repeat it here pT3b, N0, Mx, G4+3=7, EPE, bilateral SVI. I was referred to an oncologist who offered the options and a study. The study by sanofi-Aventis involved two arms, including four groups. The arms were action now or wait until a PSA rise. The groups were HT or HT and Chemo. Neither allowed RT. I did not like the no RT so I opted out of the study. I raise this question because my oncologist offered chemotherapy to me. Since I have become more astute about PCa and treatment, I see no one having chemo until the late, late stages.

My question is a two part:

1> Have you been offered chemotherapy by your oncologist pre-relapse?

2> Would you consider chemotherapy even though you have not as yet relapsed?

These are yes or no questions, but I'd like the remarks, too. I was told of a doctor who had LRP and added RT and Chemo even though he had contained disease and was not as advanced as my case was. This question has lingered in my mind since I started seeing my oncologist, I thought I'd ask it here because I know there are cases like mine here and doctors prowling around. (healingwellers, I originall asked this question at http://prostatecancerinfolink.ning.com a site started by a surgeon)
 
Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Post Edited (TC-LasVegas) : 6/12/2008 11:38:32 PM (GMT-6)


smilingoldcoot
Regular Member


Date Joined Jan 2008
Total Posts : 338
   Posted 6/12/2008 2:16 PM (GMT -6)   

Tony,

I can't give yes or no answers but when I first consulted with UFPTI they discussed a new trail protocol for high risk patients of Chemo along with PBT.  I am not sure where that protocol has be started here or not.  I would, based on what little I know, accepted that treatment had it been offered. 

Richard yeah tongue yeah


Retired USAF Richard & Debbie on The Shores of Toledo Bend Lake Louisiana
Biospy 1/10/08 Gleason 10, Stage T1C  8 of 12 samples positive all Less Than 5% 
Jan & Feb & Mar all tests clear
MD Anderson = No surgery and No Proton only Hormone and IMRT
Contacted with Loma Linda and UFPTI in FL
May 2, 20008 LUPRON & Casodex
IMRT to started  5/27/2008 Will get 42 treatments 19 IMRT and then 23 Proton
Turn Stumbling Blocks into Steping Stones and Keep Smiling
Our Journey is on WWW.GLEASON10.COM
 


dutchy
Regular Member


Date Joined Jun 2007
Total Posts : 75
   Posted 6/12/2008 4:45 PM (GMT -6)   
Several PCa specialists in the US (Dr Strum, Mayers) and Singapore (Tucker) do indeed suggest chemo therapy along with hormone therapy depending on the situation of the individual patient as it can consolidate the effect of hormone treatment. On the on-line forum (P2P), Strum suggested it to my husband (who was diagnosed with stage IV PCa). However, my husband wasn't ready to start chemo - too invasive - and his own oncologist suggested Lupron to which we added Casodex. We're still happy with this decision: the HT turns out to be very effective and does not have much impact on daily life. Good luck, Dutchy
Dutchy's husband
Diagnosis: 7/6: PSA 1,946, multiple bone metastases in thoracic, lumbar spine, pelvis, bilateral ribs and proximal left tibia, 2 weeks Casodex (50 mg)

Treatment: 3 monthly Lupron injection (22.5 mg) + Zometa (4 mg IV). Added daily Casodex (50 mg) in September 2007.

25/06: PSA 407
20/08: PSA 3,7
29/09: PSA 0.7
14/10: PSA 0.17
18/12: PSA < 0.003
15/03: PSA <0.003
15/05: PSA <0.003

May 2008: diagnosed with advanced colon cancer

Post Edited (dutchy) : 6/13/2008 5:15:11 AM (GMT-6)


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 6/12/2008 5:01 PM (GMT -6)   
I to would probably wait for my psa to rise before going on chemo. I have been on Lupron now for a year and just a week ago added Casodex and avodart back into the mix. FOr me that has been a tough combo, so going full throttle on chemo??? I am not sure, I think if giving the option I would wait until I absolutely have to, which looks like might be sooner than later. I will be watching this thread to see others responses.

peace and love to all
dale
My PSA at diagnosis was 16.3
age 46 (current)
My gleason score from prostate was 4+5=9 and from the lymph nodes was 4+4=8
I had 44 IMRT's
Casodex
Currently on Lupron
I go to The Cancer Treatment Center of America
Married with two kids
latest PSA 5-27-08 0.11
cancer in 4 of 6 cores
92%
80%
37%
28%
 


maldugs
Veteran Member


Date Joined Jun 2007
Total Posts : 789
   Posted 6/12/2008 7:39 PM (GMT -6)   

Hi Tony, I am similar to you in Gleason & Stage, since my radiation I have had a drop in PSA to .4 and hope to see a further drop, my urologist did mention possible hormone therapy, my onocologist said in discussion, that chemotherapy has not been considered at my stage, however in my opinion if it got to that situation, I would just go ahead with it, hopefully it won't be necessary.

Regards Mal.


age 67 PSA 5.8 DRE slightly firm Rt
Biopsy 2nd July 07 5 out of 12 positive
Gleason 3+4=7  right side tumour adenocarcinoma stage T2a
RP on 30th July,
Post op Pathology, tumour stage T3a 4+3=7, microcsopic evidence of capsular penetration, seminal vessels, bladder neck, free of tumour, lymph nodes clear, no evidence of metastatic malignancy, tumour does not extend to the apical margins.
 
Post op PSA 0.5 26th Sept.
PSA 23rd Oct.0.5 seeing Radiation Onocologist 31st Oct.
Started radiation treatment on 5th Dec, to continue until 24 Jan. 08.
Finished treatment, next PSA on 30th April.
PSA 30th April 0.4


FLHW(David E)
Regular Member


Date Joined Nov 2007
Total Posts : 201
   Posted 6/12/2008 8:50 PM (GMT -6)   
As you know I chose to wait until all (or at least most) other options had stopped working.
Though I am tolerating chemo well after just three days, I can only pray my response continues.

I would ask your Ocn what the studies have shown? That is, what is the benefit of chemo over
other options? If I remember correctly it's not very much.

If I were to do it over again, I'd do the same and try every other option first.

Hope this helps - peace be with you all!!
Dx'd 2/18/05
PSA 219, bone mets, lymph node involvement
Gleason Score: 7
Current (6-9-08)
PSA: 52.02
Taxotere + Prednisone + Atrasentan
[started June 9th]
Clinical Trial:
http://www.clinicaltrials.gov/ct2/show/NCT00134056?term=prostate+AND+atrasentan&rank=2
Lupron
Personal Blog:
prostatecancerat42.blogspot.com


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/12/2008 11:08 PM (GMT -6)   
Thank you all for responding.

This, I think, is the next big study. sanofi-Aventis has been trying to get this one done over the last year and a half but too few participants.

David, my oncologist and above, the makers of Taxotere, have been trying to get studies done on this matter. But as you know the results are far away. I almost did this because I was mired into the dam the torpedoes approach when I started out. The question is simple, is Chemotherapy from the get go a better approach than later on in treatment? No one knows because it will take many participants willing to try to find out. And those participants will have to go into controls arms that include placebo, and so few want that option. There are too few watchful waiting participants in the young group that can reap usable results. I was willing but a clerical error disqualified me from the group. Then the study was cancelled after too few participated. We won't know that answer for some time. That's not good. But I applaud your efforts to try everything else. You are the best. God Bless you David. My support is unending.

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Post Edited (TC-LasVegas) : 6/12/2008 10:15:44 PM (GMT-6)


torgeir
Regular Member


Date Joined Apr 2008
Total Posts : 35
   Posted 6/13/2008 12:29 AM (GMT -6)   
Tony
 As you know I have opted for chemo treatment on a trial before any other treatment as I was considered in a high risk group. My psa reading before starting the chemo was .3/.4 .I will have my psa levels checked next week 20th when I have my fourth session. I have mixed feelings regarding the early stage chemo, and I also feel there was an element of hard sell from the doctors to participate in the trial, but only time will tell.
Dx 10/12/2007 after rise in psa level to 4.7
Biopsy 7 out of 12 cores positive.
Gleason 7 3+4.
Da Vinci 4/02/2008
post op pathology positive margin gleason 7 4+3.
Staged t3a
nerves saved one side
continent from day one can't say the same about ed
still not able to achieve an erection, but close using cialis.
three month post op psa .3 (ouch)
Enrolled in clinical trial for chemotherapy 18/04/2008 using
Taxotere 75mg/m2 every three weeks for six sessions.
Waiting to see results of first psa test after chemo.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/13/2008 12:47 AM (GMT -6)   
Thanks torgeir.
Great response. I am interested also, in more of your "mixed feelings". Please feel free to say what you need to.

All HW friends,
C'mon, more input and don't be afraid to say your mind. don't tell me you didn't have to. Tell me why you would or wouldn't consider it. This is a serious discussion to to get your thoughts even though you think you might not have needed this treatment option. (I'm being....provocative!) But this is real world discussion. Chemo is a very serious step and my oncologist offered it at my option. And it just may become a part of supplemental treatment for all.

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator

Post Edited (TC-LasVegas) : 6/12/2008 11:53:31 PM (GMT-6)


torgeir
Regular Member


Date Joined Apr 2008
Total Posts : 35
   Posted 6/13/2008 2:15 AM (GMT -6)   
Tony
       Obviously since I started the chemo I have searched on the internet and there is some school of thought that maybe prostate cancer cells are too slow growing to be affected by chemo.
 Also there is the question that somebody else here raised recently regarding the effectiveness of chemo, are there cases where chemo treatment completely removed all cancer cells and the patient was cancer free ? From what I can see chemo will reduce the cancer but not totally eliminate it.
  I hope I'm wrong and somebody out there has received chemo and been completly cured.
  I know that the manufacturers are keen to get their drugs into these trials  for obvious commercial reasons.
 
Dx 10/12/2007 after rise in psa level to 4.7
Biopsy 7 out of 12 cores positive.
Gleason 7 3+4.
Da Vinci 4/02/2008
post op pathology positive margin gleason 7 4+3.
Staged t3a
nerves saved one side
continent from day one can't say the same about ed
still not able to achieve an erection, but close using cialis.
three month post op psa .3 (ouch)
Enrolled in clinical trial for chemotherapy 18/04/2008 using
Taxotere 75mg/m2 every three weeks for six sessions.
Waiting to see results of first psa test after chemo.


Doting Daughter
Veteran Member


Date Joined Aug 2007
Total Posts : 1064
   Posted 6/13/2008 11:12 AM (GMT -6)   
I know my father wouldn't have done chemo right away. I don't know if he would do it now. His reasons: everything happened so quickly between dx and surgery and then to find out he needed additional treatment was such a huge blow. He missed so much work and the physical and emotional toll was exhausting. It has taken almost a year for him to get back to feeling like somewhat of his normal self. My dad didn't want to feel like a guinea pig and it is all so taxing on the body.
I understand that we need people to do these trials, otherwise, we will never have answers, but I was under the impression that chemo has not cured Pca. Therefore, I have a hard time understanding what they are going to be measuring in the study. The time to recurrence? Well what happens when recurrence happens? Radiation at that point would most likely not be an option right?! HT maybe if a person is not already on HT? Good food for thought.
Father's Age 62 (now 63)
Original Gleason 3+4=7, Post-Op Gleason- 4+3=7,
DaVinci Surgery Aug 31, 2007
Focally Positive Right Margin, One positive node. T3a N1 M0.
Bone Scan/CT Negative (Sept. 10, 2007)
Oct. 17 PSA 0.07
Nov. 13 PSA 0.05
Casodex adm. Nov 07, Lupron beg. Dec 03, 2007 2 yrs
Radiation March 03-April 22, 2008- 8 weeks 5x a week
Praying for a cured dad. First PSA 3 months!


Co-Moderator Prostate Cancer Forum


landcrab
Regular Member


Date Joined Feb 2008
Total Posts : 25
   Posted 6/15/2008 9:18 AM (GMT -6)   
Not sure how I would feel if I was offered chemotherapy at an early stage after rp, the question is will it be more effective than traditional treatment ie HT/RT. Searches on the internet show some trials have been carried out on high risk pc patients as long ago as 2004 but there are no results and I have yet to see any person who has entered any of these trials report on their personal experiences.
If you are high risk after rp and are offered chemotherapy it is a big decision to make, perhaps this option may become the norm when the results of the ongoing trials are known.
Torgeir is the only person who I have heard that has entered this trial and I hope he keeps us all informed
what reaction the chemotherapy has on his psa levels after the trial is finished.
Tony you did not state your own feelings regarding chemotherapy at an early stage.
diagnosed pc Nov 2007 after small lump
found during routine examination
gleason 7 (3+4 ) psa 4.6.
Da Vinci Jan 2008.
post op pathology report gleason 7 (4+3)
positive margin right side nerves spared.
no incontinence problems.
ed is a problem.
psa 3 weeks post op .5
psa three months post op .3
wait and watch possible rt.


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 6/15/2008 9:30 AM (GMT -6)   

Fair Question, Landcrab,

By my own action of not as yet, I shied away.  it was a fear that it would take too much away in my life.  I am in a very high risk group and may still be revisited with it, which is why I ask this question.  I am still considering this treatment even though I have not relapsed in Hope that it never does.  Risky business to say the least.   BTW when I said "there are doctors prowling around, it is because this is not the first forum I posed this question.  I asked it verbatum at a site started by Dr. Arnon Krongrad, a renowned daVinci surgeon and author.  He responded many of my posts, but not this one. 

Dr. Krongrads site below:

http://prostatecancerinfolink.ning.com/

 

Tony


Age 45 (44 when Dx)
Pre-op PSA was 19.8
Surgery on Feb 16, 2007 @ The City of Hope
Post-Op Pathology: Gleason 4+3=7, positive margins, Stage pT3b (Stage III)
HT began in May, '07 with Lupron and Casodex 50mg
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 9 '08): <0.1
I will continue HT until May '09. 
Years in Remission (3/23/07): 1
Visit my Journey at:
And at:
 
STAY POSITIVE!
 
Prostate Cancer Forum Moderator


dutchy
Regular Member


Date Joined Jun 2007
Total Posts : 75
   Posted 6/15/2008 7:31 PM (GMT -6)   
Hi Tony, we too thought that in general chemo takes more away from life than HT which is why my husband shied away from it. With the advanced colon cancer, chemo became unavoidable and although it's considered a 'mild' chemo, it affects him more than the HT ever did. He never felt like a 'sick person' or a 'patient' before. I read somewhere that chemo for PCa is normally relatively mild (am not an expert on this), but you should check with the folks at the yahoo group for advanced prostate cancer, and the group for HRPCA. Most of them are on chemo. Dutchy
Dutchy's husband
Diagnosis: 7/6: PSA 1,946, multiple bone metastases in thoracic, lumbar spine, pelvis, bilateral ribs and proximal left tibia, 2 weeks Casodex (50 mg)

Treatment: 3 monthly Lupron injection (22.5 mg) + Zometa (4 mg IV). Added daily Casodex (50 mg) in September 2007.

25/06: PSA 407
20/08: PSA 3,7
29/09: PSA 0.7
14/10: PSA 0.17
18/12: PSA < 0.003
15/03: PSA <0.003
15/05: PSA <0.003

May 2008: diagnosed with advanced colon cancer


War-eagle
Regular Member


Date Joined Sep 2007
Total Posts : 219
   Posted 6/15/2008 7:46 PM (GMT -6)   

Great question Tony. We will discuss this in person this week. WaaaaHoooo.

I do feel qualified to offer an opinion on this one. I have had 5 cycles of chemo now. As it shows in my bio, I've had surgery, radiation, HT, and now chemo. If, and I mean if, I had known what I know now, I would have jumped on the chemo from the start. I feel my chances of the PCa morphing over to HR would have been less. Johnnie and I have watched many conferences on the web where many oncologists are now thinking that PCa should be treated the same as breast cancer. That is, surgery followed by chemo. I don't know the survival rates of this treatment schedule, but it must be better than what I am on now.

I have always thought that it is better to attack than to play defense. I have been playing defense for three years. Where would I be now if we had had the option to attack? I know that we can not look back and second quess ourselves. One day this will be an option and I feel it will be a good one until we come up with a cure.

As the great Auburn (War Eagle) coach Pat Dye once said, "Hidesight in 50/50".

Love, peace, and War Eagle to all,

 

Walt


Age: 55 ( still alive at 55)
PSA 43 7/2005
Biopsy 12/14 Gleason 7 & 9
Divinci 9/2005 - spread to bladder
HT - 10/2005 (Eligard every 6 months)
RT - 10/2005 (38 treatments)
PSA 0.12 to 1.9 2/2007
Bone Scan and CT 4/2007 Bone mets
Casodex 4/2007
Zometa infusions 4/2007
PSA 4.8 8/2007
PSA 6.34 12/2007
Radiation (15 treatments) started on bone mets 12/2007
PSA 6.72 1/2008
PSA 8.23 2/2008 - Starting prednisone for 30 days
PSA 14 2-29-2008 - start chemo on 3/12
PSA 12.82 3/1/2008 round one chemo
PSA 12.24 4/2/2008 round two chemo 
PSA 10.86 4/24/2008 round three chemo
PSA 10.4 5/15/2008 round four chemo - increase dosage next month
PSA 12.98 6/5/2008 round five chemo
 
"I will persist without exception - I will find a way where there is no way"

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