Recurrent: Treatment ? Doublet or Triplet?

De novo and recurrent lymph node only metastases have, as I understand, relatively good long-term outcomes. Recurrent, which you are of course, is also a better place to be than de novo, which is where I am. On the choice between triplet and doublet, it’s a conversation I’m likely to have next week, I have read that the volume of spread is important. I’m low volume but will try to push for triplet still, but I don’t know how far that will be my choice. There’s an interesting pcri video on just your point. I can’t post the link as it’s outside UK but if you search pcri treatment for advanced metastatic disease and look for the discussion about 3.30 minutes in.

This is obviously information I have gathered recently from reading around and I have no medical training.

Hello Dave,

It looks like you've already decided on doublet but doubt remains about triplet by adding docetaxel. My observations based on what you've said are:

* I wouldn't dwell on the cost of darolutamide too much, your consultant has prescribed it for you as a suitable treatment. I don't know what it costs the NHS but according to the most recent info. published by NICE the list price "...is £4,040.00 for a 28‑day supply of 112 x 300 mg tablets (excluding VAT, BNF online accessed September 2025)". However the manufacturer has a commercial agreement making it available to the NHS with a discount, the size of which is commercial in confidence. However you might have further information?

* I started triplet last year starting with HT then adding docetaxel and darolutamide. I'm 69. It wasn't easy but doable. Because I also had chemo several years ago for a different cancer this made docetaxel more difficult (so said my consultant) and I finished 5 of the planned 6 treatments. I wrote a blog at the time which might be of interest if you want to consider it (or rule it out) and this can be found at:

Prostate Cancer Recurrence - Triple Therapy

* During my cancer journeys I have always taken the maximum treatment available which made my own decision easier. 

I don't know if that's any help, but if you've any questions just ask and I'll do my best to answer.

All the best, Derek.

Thanks. Not yet found specific video, but I shall read around the links that the search throws up.

Some of the docetaxel side effects would play badly with some of my existing co-morbidities. 

Chemo would I think have to be a last resort and probably not even then.

If I time it right I will be able  to make the 1 way trip to Switzerland, which has of course to be solo!

Good luck, Dave.

Thank you excavator. I have skimmed your excellent blog. It has strengthened my resolve against chemo. 

I am 77 with extreme COPD, erratic heart rate and BP  -  though active enough, I shall achieve my annual cycling target of 5,000 miles, weather permitting!

The thought of being even more breathless etc does not attract.

If I were younger my thinking might be different.

Even if the 2nd Chamber doesn't kill (!) it the Assisted Dying Act will not be operative in time so the solo trip to Switzerland remains the plan. 

Thanks again and good luck.

Dave.

Don’t book your ticket quite yet! In the video, and elsewhere, it was suggesting that 5 and 10 year survival for lymph node-only metastases was pretty good. Good luck to you, too, Dave.

Thanks! Well, COPD will do for me in less than 5. Closest match I can find for me gives 62% survival at 2 years, but that may assume chemo. 

Time will tell.......

Regards, Dave 

Thanks Dave. I wish you all the best. Phillipp

Thanks  some of these discussions might help my upcoming decisions

Hello Big Col, are you thinking about these treatment options? Any questions just ask and I'll do my best to answer.

That's what my oncologist confirmed...he said you will be seeing me for years.