Advice on treatment options prostate cancer

Hi Messi, and a warm welcome to the forum though sorry you have to be here, I noticed on your first post on the, new to the community forum,  you mentioned this is a recurrence, I am so sorry to hear this, as you are asking about hormone therapy HT and chemotherapy, does that mean you had radiotherapy RT when first diagnosed, can I ask if you know your PSA number, Gleason score and TNM staging,  and how long ago you had treatment and what you had and if you know how many lymph nodes are involved, sorry for all the questions but it will help us to give you  answers.  

Eddie 

Hello Messi 

My partner has Abiraterone, he will be taking it for as long as it keeps working for him. He had full pelvic RT including nodes, hips and lower ribs last year and now ticks over nicely with a combo of Zoladex and Abiraterone/ steroids. His life is now very normal after treatment his bloods are level and his PSA runs at a solid 0.05 . Side effects, that are most noticable are fatigue and putting on weight. He manages to keep weight under control with two sessions at the gym a week and keeping to a low carb /fat, high protein regime. Fatigue- if he knows he has a busy day he will double the dose of steroids to 10mg Or factor in a nap. At this point I can say it seems to be working very well for him. Obviously his libido is zero so something to consider as it will change your relationship with your with partner considerably. It’s something you will need to discuss and work through. In our case I would rather have him alive at any cost so it’s not an issue for me and of course with zero libido it’s not a problem for him. I would say overall Abiraterone is a very good drug to take. 
Hope this helps with your decision making 

L

Hello Messi . Sorry to hear that your cancer has spread. My husband has had both first and second generation antiandrogens alongside ADT, EBRT, chemotherapy and SBRT for several recurrences. What we have learnt is that there is no set pathway to deal with them as different types of prostate cancer react in different ways to each type of treatment - in my husbands case it is more responsive to radiotherapy than chemotherapy. What you will be offered will depend on what treatment you have already had and where the affected lymph nodes are in the body. One thing to remember is that hormone therapy controls the cancer whereas chemotherapy and radiotherapy give you the opportunity to kill off the cancer cells. One thing you could ask the oncologist about is Triplet Therapy which is a combination of injections, second generation antiandrogens such as Darolutamide and chemotherapy which has been demonstrated to improve outcomes.

As Eddie has said, it will help us to help you if you could put a little more information on your profile page. Please ask any questions no matter what.

Hello Messi,

Alwayshope has suggested enquiring about Triplet Therapy. I'm in a similar position a little in front of you, having been identified earlier this year with recurrence in multiple lymph nodes (not amenable to SABR) some 8 years after initial HT  and radiotherapy treatment.

I'm currently on Triplet Therapy (HT, 6 cycles of Docetaxel chemo and Darolutamide) - just had 4th session of chemo so 2 to go to completion of this element (each session being 3 weeks apart).

If you look at Blogs I am writing my account of treatment - it's under "Prostate Cancer Recurrence - Triplet Therapy" which you might find informative if you're thinking of asking your consultant about it. We are all likely to experience different side efects but at age 68 and reasonably fit and well I've been quite fortunate so far with nothing really significant by way of side effects to report.

I wish you all the best for successful further treatment. If you have any questions feel free to ask and I'll try my best to answer.

Derek.

Hello Messi 

Here's a link to excavator's blog.

 Prostate Cancer Recurrence - Triple Therapy 

Best wishes - Brian.

I know they’re the experts, but the oncologist has recommended Xdanti to start with for my husband and I’m wondering whether I should ask about triplet therapy, or is that the next option after HT? 

Many thanks for your advice. Xx

Hello JagChamp 

I am not an expert and I always trust the oncologist.

Xtandi is a brand name for Enzalutamide. It's second generation Hormone Therapy and it's one of the androgen receptor inhibitors - so it stops the testosterone. 

Once you start on Enzalutamide your oncologist won't be able to offer triplet therapy, and triplet therapy isn't offered to any one who has already been on HT for over 12 weeks.

Personal opinion, (I have been wrong before!) he's giving Xtandi in the hope that it keeps the PSA down, stops any further spread and keeps you away from Chemotherapy (it's still in reserve).

It will be interesting to hear what your oncologist proposes at the next meeting - I was wondering if it would include radiotherapy to the pelvic lymph nodes and the spot in the neck?

Best wishes - Brian.

Thanks for your reply Millibob - really appreciated.

I asked about RT on the lymph nodes and neck area but he said there wasn’t any point in blasting those areas as the cancer source was in the prostate - which to be honest, I thought was obvious and the point was to minimise further spread.

Your input is very useful as we have an appointment for the Xdanti prescription at the end of this month and I want to attend as informed as possible. 

Good Afternoon JagChamp 

Attached is our guide to Xtandi (enzalutamide) for your information.

https://www.macmillan.org.uk/cancer-information-and-support/treatments-and-drugs/enzalutamide

Best wishes - Brian.

Hello JagChamp .

Brian has given you a good summary of the Triplet Therapy and the possible reason why Enzalutamide is being offered at this stage. The Triplet therapy seems to work best for either newly diagnosed high volume advanced prostate cancer or newly recurrent high volume prostate cancer so I think it is worth asking the question as to whether it could be an option for your husband. Having Enzalutamide now does not preclude having chemotherapy at a later date if your husband finds that the HT on its own is no longer keeping the cancer under control, at which time the Enzalutamide would be stopped - in other words sequential treatment. Before offering chemotherapy the experts will assess the impact it might have on your husband and how well he might tolerate it, plus your attitude towards having it. I have attached one of the latest evaluations on Triplet Therapy which you might like to read.

https://www.sciencedirect.com/science/article/pii/S1558767324000028

You might also like to watch this video on when to act.

https://youtu.be/ygZNfQhrrYc?si=XZqysenpcjAUMxbN