MO wants to cut back dosage on last cycle of Docetaxel

Spoke with my MO yesterday when I was in for my nadir check . My PSA has reached 0.01. Yay! I'm also having neuropathy in my fingers and feet.What has me concerned is he wants to cut back my final dose because of my profession as a goldsmith and the fact that I work with my hands. I expressed that I really don't want to do that after going through this this far. Before the question of reducing the dose came up, I had asked him if the neuropathy would be permanent. He said no. I said good because I'm a goldsmith. That's when he suggested that we cut the dose.

I'm wondering if cutting the final dose back will make that big a difference? It seems that SE's have been cutting into my treatments this whole journey and it gets pretty frustrating. I don't want partial treatment.
That's how I felt when Brachy was taken off the board because of SE's. Yet.... this is my profession....

We left it open for now. My final cycle is in 2 weeks so I thought I'd ask for the wisdom of the brothers here.
I must say that this chemo has been tough on me. Crash days 2 days after and then has me knocked down for the remainder of the week. I have lost my sense of taste. I have broken out in rashes and I get bad bone and joint pain from the neulasta. Constipation immediately after treatment then diharea at about the 5Th day. I'll be glad to be on the other side for sure but don't regret the choice I made to do it.

Battle on brothers!

The Artistic One- Mark

A good question to ask. Some neuropathy can stick around for quite some time. I still have reduced sensation in most of my fingertips and toes, as well as under balls of my feet from chemo (for Colon cancer) in 2015.

It may be that the chemo for prostate cancer does not quite have the same effects or longevity of effects. Since you rely on fine motor skills etc for your job, I'd make sure about how long it might be an issue, and to what extent.

D

Have you been holding ice packs in your hands during the infusions?

Mark,
Did insurance pay for the chemo? Just curious since your PSA was .02 (undetectable) before chemo and it brought it down .01 to .01. My insurance would never pay for treatment if I was at a stable undetectable level...I have problems getting them to agree to treatments even though I have never had a PSA the same level twice and my lowest has been .17. They said they will not cover anything until my PSA rises to .20 above nadir (Phoenix study) so if there's something I'm missing I'd appreciate any info you have.

Mark,
I completed my 4th yesterday at 75% dose. As Tall Allen mentioned I have also been bringing gallon ziplocks filled with ice for my hands, put in a small roll along cooler (I am sure the folks on the elevator took a second look), and packed with 5lbs of dry ice . Used a commercial foot gelpack for feet. So far no neuropathy. I have some fatigue. After the first two treatments I had nasty "Taxotere Rash" on my back. After each treatment my throat and tongue loaded with a sensitive rash. Some fatigue. Loss of sense of taste for 10-11 days. Even ended up in isolation at local hospital when wbc fell to .9 (should be around 6 - 11). No Neulasta after treatment. Now I remind them. Bone pain is there, but better than 2 - 3 days in hospital.

I mentioned all this, and other issues, to MO who cut my dose to 65%. Explaining that I did not "metabolize" as well as some. Will wait and see.

I did read an article that indicated 86% of those who start the six treatments complete all 6. MO said it may be a little higher.

You may want to consider ice and gelpack for future treatment. There have been trials done on them. I particular for hair loss.

Wishing you the best.
Bill

Post Edited (mr bill) : 3/25/2017 7:57:10 AM (GMT-6)

Just an afterthought. The mo who treated me at local hospital for low wbc, and did his fellowship with my regular MO at clinic, told me that you receive 80% of benefit with first three infusions. I asked MO at clinic, his reply was "that's debatable."

Just wanted to add that for what it is worth.

Mark,
Same here with throat and tongue, runny nose, watery eyes, rash, etc. Not too mention muscle and joint pain from Neulasta. I would certainly check with MO re: 80% when making a decision. No it is not a walk in the park for some guys. Others sort of walk right through it.

Best wishes,
Bill

Mark,
Listen to MO. I insisted that we continue with full dose in spite of test showing no effect. I am now suffering from burning in my finger round the clock. Meds do not help much. I had a very rough time and a still facing continuing side effects six months later. Should have stopped after fourth dose like I started to when PSA showed no decline.

Cut the dose. You will not be able to do meticulous work. I can barely hold a pen or type.

Best to you
Don

There's a later version of the NCCN Guidelines, Feb 2017 now.

They still show docetaxel after EBRT+ADT, following the radiation therapy, but it's now a footnote, for what that's worth. "...in selected patients who are fit for chemotherapy."

It's not clear why they changed that. Just FYI.