To Chemo or Not To Chemo !??!

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JoeyG
Regular Member


Date Joined Jul 2009
Total Posts : 162
   Posted 8/11/2009 6:22 AM (GMT -6)   
Just thinking---
 
The decision for men in what I call, the "terminal" stage of PCa, to try Taxotere, seems to be a decision that many men make blindly (hey, its the "last chance"). Of course, Taxotere, usually prolongs life by a few months or more but at what cost to the patient? I understand that Taxotere's side affects are tolerable but that is at the standard dosage. What about the higher dosages that are in clinical studies right now....the higher doses presumbably will take a higher toll in adverse reactions.
 
So there is the question that a lot of us are or will some day face....is it worth a few months more, if those few months are going to be spent vomiting, not eating because everything tastes like metal, more bone loss, etc?? Maybe in the next year or so, Provenge will likely take the place of Taxotere and with that, quality of life will be preserved till close to the end. And for that, the decision should be easier. Also, the continual improvements of hormone ablation drugs will hopefully prolong patients in the hormone-dependant zone, which ultimately is the better alternative.
 
 
 
Age -57; Diagnosed 10/05 PSA 13.4 GS 9 Organ confined (T2B)
Cryoablation 4/06 Allegheny Hosp-Dr Ralph Miller (Cohen/Miller)
Post Cryo Nadir 8/06 0.2
Rising steadily to 0.7 4/09 :-(
Steady at 0.7 (7/09) (Pomegranate???)
Looking to take next steps soon
Hoping to qualify for salvage cryo or radiation


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/11/2009 6:49 AM (GMT -6)   
Joey...I could be wrong here...but I didn't think that Taxotere was for end stage only. Seems I have read where lots of men have had Taxotere and certainly have been around longer than just a few more months after treatment. What am I missing here?
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/11/2009 8:14 AM (GMT -6)   
I'll respond both of you guys here...

Joey,
I have a few friends that did multiple phases of Taxotere and responded well to it. The general statement that it adds a few months is true for the population but some guys it works for much longer. Some guys it does not work at all. One such friend of mine (His login name here at HealinWell is War-eagle) did not do well with heavey dose chemo in his first round with it. But his PSA lowered and he enjoyed a brief drop in PSA. Unfortunately, his second round is really beating him up. He no longer posts here but he is a dear man that my wife and I took the time to fly across country to meet in person. I stay in touch with him, and can report to the group that know him, that his attitude, humor, and always kind demeanor has not changed a bit, We are not sure this round will work, but we hold out hope for him...

Les,
You are correct. Taxotere is not just an end game maneuver. I was offerred it by my oncologist. My disease had heavy evidence that cells escaped the prostate. Thus I am on HT adjuvantly. I also with a simple yes could have been through 6 sessions with Taxotere in hopes that it could be far more effective up front than later. It was an option I was afraid of. I play guitars and it is an important part of my quality of life. I read where neuropathy in the extremities was possible and I declined it. Should my PSA rise before I stop HT, i will do it, however.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


LV-TX
Veteran Member


Date Joined Jul 2008
Total Posts : 966
   Posted 8/11/2009 9:23 AM (GMT -6)   
Thanks Tony for the outstanding information you provide as always. Keep us informed about War-Eagle...I haven't seen any posts in awhile and had wondered about him and how he was doing. I so enjoyed your story and his too...on the meeting you two had a year or so ago. It always makes me feel so good inside to see folks get together that are miles apart and enjoy so much friendship and compassion towards each other. It is stories like those that keep me smiling and feel blessed to be amoungst the company of wonderful men and women here on Healingwell.

Again thanks for all you do Tony.
You are beating back cancer, so hold your head up with dignity
 
Les
 
Age 58 at Diagnosis
Oct 2006 - PSA 2.6 - DRE Normal
May 2008 - PSA 4.6 - DRE Normal / TRUS normal
July 2008 - Biopsy 4 of 12 Positive 5 - 30% Involved Bilateral w/PNI - Gleason (3+3)6 Stage T1C
Robotic Surgery Sept 18, 2008
Pathology October 1, 2008 - Gleason 7 (3+4) Staged pT2c NO MX - Gland 50 cc
Seminal Vesicles and Lymph Nodes clear
Positive Margins Right Posterior Lobe
PSA 5 week Oct 2008 <.05
                   3 month Jan 2009 .06
                   6 month Apr 2009 .06
                   9 month Jul  2009 .08


Amy41
Regular Member


Date Joined Jan 2009
Total Posts : 30
   Posted 8/11/2009 10:18 AM (GMT -6)   
Joey as a wife to a 51 year old with advanced prostate cancer - I want those extra months - I want more - though these last few months have been pretty low key we have spent time together. Side effects vary by person - my husband has been fatigued but has had no nausea and is eating ok but taste buds have changed he doesn't say things taste like metal he just doesn't want complicated meals is happier with plainer food. Also the chemo can beat down the cancer and stop some pain.

John T
Veteran Member


Date Joined Nov 2008
Total Posts : 4227
   Posted 8/11/2009 10:28 AM (GMT -6)   
I can't comment on the success of Taxotere, but I can comment on the side affects as my wife was on a very high does of Taxotere and Epicurine for Breast Cancer. There are a lot of new drugs that eliminate most of the severe side affects like nausea, red blood cell loss ect. A good oncologist pays as much attention to reducing the side affects as he does in the drug's effectiveness. The side affects are very tolorable but no means a picnic. Sturm feels there is a lot to be learned from breast ca treatments, because biologically PC is a close cousin.
JohnT

64 years old.

PSA rising for 10 years to 40, free psa 10-15. Had 5 urologists, 12 biopsies and MRIS all neg. Doctors DX BPH and continue to get biopsies yearly. Positive Biopsy in 10-08, 2 cores of 25, G6 less than 5%. Scheduled Surgery as recommended.

2nd Opinion from Dr Sholtz, an Oncologist said DX wrong, path shows indolant cancer, but psa history indicates large cancer or metastasis. Futher tests and Color Doppler confirmed large transition zone tumor that 13 biopsies and MRIS missed. G 4+3 approx 2.5cm diameter.

Combidex MRI in Holland eliminated lymphnode mets. Casodex and Proscar reduced psa to 0.6 and prostate from 60mm to 32mm. Changed diet, no meat and dairy.

Seed implants on 5-19-09, 3 hours door to door, no pain, minor side affects are frequency and burining urination. Daily activities resumed day after implants.

Scheduled for 5 weeks IMRT in July

JohnT


Tony Crispino
Veteran Member


Date Joined Dec 2006
Total Posts : 8128
   Posted 8/11/2009 10:40 AM (GMT -6)   
Good point, John,
My brother told me that we had so much in common including your's and his wifes battle with breast cancer. Kathy did not do chemo as she was clear after a lumpectomy and radiation. We both researched Taxotere, her for breast cancer and me for prostate cancer. Our stories were one week apart pretty much from diagnosis to surgeries. But I was very happy to get my brothers report that you and wife are doing well.

Tony
 Age 47 (44 when Dx)
Pre-op PSA was 19.8 : Surgery at The City of Hope on February 16, 2007
Geason 4+3=7, Stage pT3b, N0, Mx
Positive Margins (PM), Extra Prostatic Extension (EPE) : Bilateral Seminal vesicle invasion (SVI)
HT began in May, '07 with Lupron and Casodex 50mg (2 Year ADT)
IMRT radiation for 38 Treatments ending August 3, '07
Current PSA (May 11, 2009): <0.1
 
My Journal is at Tony's Blog  
 
STAY POSITIVE!


Geebra
Regular Member


Date Joined May 2009
Total Posts : 476
   Posted 8/11/2009 2:48 PM (GMT -6)   
I had Taxotere as a neoadjuvant treatment. Aside from fatigue, there were no side effects worth mentioning (yes, wine did not taste right, but beer did). My Gleason score was lowered at surgery possibly due to the treatment and my initial pathology showed organ confined disease (where according to monograms, I had 17% chance of that). So I think it helped.

Father died from poorly differentiated PCa @ 78 - normal PSA and DRE

5 biopsies over 4 years negative while PSA going from 3.8 to 28

Dx Nov 2007, age 46, PSA 29, Gleason 4+4=8

Decided to participate in clinical trial at Duke - 6 rounds of chemo (Taxotere+Avastin)

PSA prior to treatment on 1/8/2008 is 33.90, bounced on 1/31/2008 to 38.20, and down at the end of the treatment (4/24/2008) to 20.60

RRP at Duke (Dr. Moul) on 6/16/2008, Gleason downgraded 4+3=7, T3a N0MX, focal extraprostatic extension, two small positive margins

PSA undetectable for 8 months, then 2/6/2009-0.10, 4/26/2009-0.17, 5/22/2009-0.20, 6/11/2009-0.27

Salvage IMRT + 6 Months ADT: Casodex started 6/12/2009, Lupron 6/22/2009, PSA 6/25/2009-0.1, T=516, 7/23/2009-<0.05, T<10, IMRT to start mid-Aug


Purgatory
Elite Member


Date Joined Oct 2008
Total Posts : 25380
   Posted 8/11/2009 3:15 PM (GMT -6)   
I wondered where our friend War Eagle went, I remember posting with him when I first joined here. Thanks for the update.

David in SC
Age 57, 56 at DX, PSA 7/7 5.8, 7/8 12.3,9/8 14.5
3rd Biopsy Sept 08: Positive 7 of 7 cores, 40-90%, Gleason 7, 4+3
Open RP surgery 11/14/8, Right nerves spared, 4 days hospital, staples out 11/24/8, 5th cath out on 1/19/9
 Pathlogy Report:Gleason 3+4=7, pT2c, 42 grm, tumor 20%, Contained in capsule, one post. margin, clear lymph nodes 
2009 PSA   2/9 .05, 5/9 .10, 6/9 .11, 8/11 ?
Lastest 7/13 met with Rad. Oncl, considering options, 7/20 Catheter #6 after complete blockage, scarring closed up bladder neck, corrective laser surgery scheduled for 8/18
 
 


livinadream
Veteran Member


Date Joined Apr 2008
Total Posts : 1382
   Posted 8/11/2009 6:43 PM (GMT -6)   
This is a great thread. Many of us in later stages will face these decisions sooner or later. I have looked into Taxotere and as of now that will not be my trial of choice. I do however think that it has had successes in PCa for many men. I think we all should live life as long as we can. We never know the miracles of modern medicine or spiritual. I plan on living till the end.
I am glad you guys mentioned War Eagle it has been a few months since I have called him, I think it is time for me to check in with him.

peace and love
dale
My PSA at diagnosis was 16.3
age 47 (current)

http://www.caringbridge.org/visit/dalechildress

My gleason score from prostate was 4+5=9 and from the lymph nodes (3 positive) 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

PSA July 24th, 2008 is 0.04
PSA Dec 16th, 2008 is .016
PSA Mar 30th, 2009 is .02
PSA July 28th 2009 is .01

Testosterone keeps rising, the current number is 156, up from 57 in May

T level dropped to 37 Mar 30th, 2009
cancer in 4 of 6 cores
92%
80%
37%
28%


goodlife
Veteran Member


Date Joined May 2009
Total Posts : 2691
   Posted 8/11/2009 8:48 PM (GMT -6)   
There is a current government trial investigating Taxotere and prednisone as adjuvant therapies for higher risk PCa patients, hoping to extend reoccurence times.

But your other point is valid, and cetrtainly many of us will have to face some day. When is it enough ? Family issues, health issues, financial issues, frame of mind issues, personal stamina and philosophy of life issues, will all take part in this decision, which no humor intended, will be one the hardest decisions we will face in our lifetime.

What I really am becoming more fearful of, is that our "end of life counselor" may also have a say in these decsions at some point in the futire. That is scary stuff !
Age 58, PSA 4.47 Biopsy - 2/12 cores , Gleason 4 + 5 = 9
Da Vinci, Cleveland Clinic  4/14/09   Nerves spared
0/23 lymph nodes involved  pT3a NO MX
Catheter and 2 stints in ureters for 2 weeks due to anatomical issues with location of ureters with respect to bladder neck.  Try 3 tubes where no tubes are supposed to be for 2 weeks !
Neg Margins, bladder neck negative
Living the Good Life, cancer free  6 week PSA  <.03
3 month PSA <.01 (different lab)

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