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.

  • Not sure what you mean by stage?

    Stage is TxNxMx - tumour, nodes, metastases

    - - -

    Heinous

    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.

  • Thanks Heinous. My stage is T3b - Cancer penetrates the Seminal Vessel

                                                   N1 - Lymph nodes contain cancer

                                                  M1 - Cancer has spread to other parts of body, in my case the spine

                                                          and left lung

  • Hi Mothman 

    Sorry to hear about your condition. I cannot advise medically of course but can give you the benefit of my experience and reading. I had a prostatectomy in late 2018 after which at my first PSA test it was found to be 4 so something serious was wrong. They could not find anything initially but in late Nov 2019 I was diagnosed with metastatic cancer with some small nodules in one lung. I was started on ADT and then 9 cycles of Docetaxel. I tolerated the chemo very well with little side effects. I think the side effects of Docetaxel are relatively mild.,. My PSA is now undetectable. I continued to work throughout and my quality of life is good although I have no libido. That’s sounds worse than it is. In my case I cannot feel any sense of loss about it.,I’m alive for my wife and family.

    ADT plus Docetaxel is the standard of care for metastatic cancers especially high volume which includes any visceral metastases. Clinical trials such as STAMPEDE and CHAARTED have shown the survival benefits, median overall survival of 57 months. Other drugs such as enzulatamide and Abiraterone along with immunotherapy are available once castrate resistance has been reached ie ADT stops working and there are a lot of new drugs in clinical trials so it’s quite possible that some with this condition could end up living well beyond 5 years.

    Best of luck with your therapy

  • Hi Mothman. I was put on hormone therapy straight away for advanced prostate cancer gleeson score 9 although psa level only 8.8. It had spread to nearby lymph nodes too. After 6 mths on hormone therapy started radiotherapy for 37 days. Luckily I only suffered with a few hot flushes and peeing a lot, but put that down to more fluid intake and was only tired on the 3rd week couple of days. I would opt for the radiotherapy, you may get some of the side effects badly or you may be OK. Surprisingly most of the guys there said their treatment went really quickly after the 3rd week which I found too. I am still on hormone injections in the stomach for 3 years, 1 injection every 3 months and have 2 years to go. I get hot flushes once or twice a day/night but not really bad ones. However they do say side effects could appear weeks, months or even years later. I'll deal with that if that happens. I stay positive now my psa has gone down to 0.1 and have a consultation every 6 months. Sorry to hear you're having to go through this too and hope whatever you choose goes well for you. Hope this gives you more confidence. Take care and good luck

  • Im sorry to hear the news ,,, 

    i had hormone injections amd radiotherapy,  still have 1 more injections left next month , 

    side effects of both aren't to bad ,, 

    hot flushes i find are the killer , she now says you know how i feel ..

    toilet usage is very urgent at time, 

    good news is it works tho ,,, 

    i had  it spread to lymph and prostate bowel and last week was 1st clear test ... 

    keep fighting and stay strong you can get there.

    Iain 

    Live ,,,  Love ,,, Laugh ,,, And Enjoy Every Moment In your Life !

  • Tough decision to make,  I have no choice I'm on enzalutamide and zoladex injection for the last 3 months as my cancer had returned.....mostly OK but for the hot flushes quite frequent...libido is out the door last psa check was o.17...happy bunny...didn't go for chemo (wasn't given the choice..).cos of covid..am sure you will make the right choice my friend.

  • Hi PatBe. Thanks for your information. I was particularly interested in how well you tolerated Docetaxel. I found the idea of chemotherapy scary so I have now opted for hormone therapy ie enzalutamide. When that stops working I will probably be offerd chemo, in which case I can only hope that it goes as well as yours.

    Best of luck for the future

  • Hi Norfolkboy, Bikerboy66 and Delboy45.

    Thanks for your comments and info. I have decided to go with Hormone therapy and that is now being put in place.

    Will try and keep everyone in touch with how things are going once my treatment is well establishes

    Thanks again to everyone

    Pete

  • If the hot flushes start can recommend neck sports fans cool it down a bit..found on amazon Sunglasses

  • Good luck with the hormone therapy. I’ve been having it for the past two years. The only side effect I’ve had are occasional hot flushes. I’m also on Abiraterone.  Had chemo in the early days. PSA has gone down from over 3,000 to 5. Stay positive and live normally. All the best.