Advanced Prostate Cancer - Treatment choice

I have recently been diagnosed with advanced prostate cancer. I have been given the choice of 2 treatmen regimes i.e. Hormone therapy or chemotherapy. The hormone therapy is Enzalutamide + Prostap (leuprorelin acetate) and the chemotherapy is Docetaxel.

Because of the relatively severe side effects of Chemotherapy I am tempted to go with hormone therapy, particularly because a lack of libido isn't a problem in my relationship with my partner.

I would be pleased to receive any comments, guidance or the experience of others.

My PSA = 37 and the cancer has spread to lymph nodes, spine and lung.

  • I can't advise on the big question, but a word on PSA:

    A raised PSA is always a good reason for a referral in the first place, but once you've had treatment, it's a different story:

    A single PSA result is virtually meaningless (unless it suddenly appears where there's no prostate), though it can be an indicator that further investigation is required. PSA varies tremendously from person to person, and can influenced by many things.

    PSA change can often suggest that change is happening (positive or negative). (minimum 2 tests, several weeks apart)

    The Rate of PSA change can be very useful in confirming trends. (minimum 3 tests, over months).

    To sum up: Unchanging PSA doesn't tell you much, a changing PSA matters, a fast-changing PSA matters more.

    - - -


    A healthy-looking decrepit, 69-year-old male, mentally alert but forgetful. I no longer have an urge to choke people who say "all you need to beat cancer is the right attitude" - better to smile and move on.

  • just spoke with urologist,my psa has gone from 2.1 to 8.3 in six months.

    He is hopefully getting a scan for me

    Quite a shock!

  • Good luck!

    I'd ask for a repeat PSA too, just in case it was a glitch of some sort.

    - - -


    A healthy-looking decrepit, 69-year-old male, mentally alert but forgetful. I no longer have an urge to choke people who say "all you need to beat cancer is the right attitude" - better to smile and move on.

  • Hi Mothman

    Sorry to read about your condition, it’s always a shock for you and everyone connected with you.

    Have you had a biopsy? If so what was your Gleason and stage ? 
    Sometimes the HT can cause some not so good side effects, I can personally vouch for that. Chemotherapy is the same, it effects people in different ways, but it is more severe than HT, the good thing is you can do HT and if that does not have an impact chemotherapy is still there. 
    HT will sap your sex drive it’s about stopping testosterone.

    keep safe


  • Hi Mothman, sorry to read about your diagnosis. I would assume you will be on standard hormone therapy (PROSTAP) plus either enzalutamide (more advanced type of hormone therapy) or docetaxel chemotherapy. 
    With advanced prostate cancer you would continue on hormone therapy after chemotherapy finishes. 
    evidence from the Stampede trial showed early use of docetaxel or enzalutamide improves outcomes quite dramatically.

    Hope that makes sense.


  • Thanks Heinois. My PSA in December was 27 and mid-January was 37. Hopefully my next one will be lower.

    Thanks again for your help

  • Thanks Ido4. The treatments I have been offered is hormone therapy Enzalutamide + Prostap (leuprorelin acetate) or  chemotherapy Docetaxel. My feeling is to go for the hormone therapy first as it has less severe side effects. The advice I was given by the consultant was that it did not matter which I did first as they both appeared to have a similar efficacy.

    Thanks again, Mothman

  • Hi Mothman,

    Sorry you are now in the club that nobody wants to be a member of. My diagnosis was similar to yours, initial PSA check was 74.8 and second 86 two weeks later. I was put onto hormone therapy, Prostap, straight away with chemo starting 12 weeks later for 6 sessions 3 weeks apart. Covi-19 and lockdown came along and changed my treatment plan instantly. I am now on 2 x 500mg of Abiraterone + one 5mg of Prednisolone daily until it stops working. My PSA has dropped dramatically to less than 0.1 (undetectable) for at least 6 months now. I have had a good few of the side effects regarding my medication including lack of libido but like you, it isn't a problem for my relationship with my wife (she is my rock). My quality of life is actually quite good and I have no regrets regarding the current treatment I am receiving at the moment. I wish you well with whatever treatment plan you decide take Mothman.

    Best wishes & take care. Tom

    " Nobody wins unless everybody wins "  Bruce Springsteen
  • Hi joevne. Thanks for your reply and helpful comments. My biopsy Gleason score was 8. Not sure what you mean by stage?

    Thanks again


  • Hi HarleyD (Tom). Thanks for your helpful comments. My idea of starting with Hormone therapy has got more certain with peoples' comments. It has really help getting feedback from people in a similar position.

    All the best Pete