Chemotherapy ~ Early Treatment Questions

After I had my surgery, my pathology indicated a serious situation. I'll repeat it here pT3b, N0, Mx, G4+3=7, EPE, bilateral SVI. I was referred to an oncologist who offered the options and a study. The study by sanofi-Aventis involved two arms, including four groups. The arms were action now or wait until a PSA rise. The groups were HT or HT and Chemo. Neither allowed RT. I did not like the no RT so I opted out of the study. I raise this question because my oncologist offered chemotherapy to me. Since I have become more astute about PCa and treatment, I see no one having chemo until the late, late stages.

My question is a two part:

1> Have you been offered chemotherapy by your oncologist pre-relapse?

2> Would you consider chemotherapy even though you have not as yet relapsed?

These are yes or no questions, but I'd like the remarks, too. I was told of a doctor who had LRP and added RT and Chemo even though he had contained disease and was not as advanced as my case was. This question has lingered in my mind since I started seeing my oncologist, I thought I'd ask it here because I know there are cases like mine here and doctors prowling around. (healingwellers, I originall asked this question at http://prostatecancerinfolink.ning.com a site started by a surgeon)

Tony

Several PCa specialists in the US (Dr Strum, Mayers) and Singapore (Tucker) do indeed suggest chemo therapy along with hormone therapy depending on the situation of the individual patient as it can consolidate the effect of hormone treatment. On the on-line forum (P2P), Strum suggested it to my husband (who was diagnosed with stage IV PCa). However, my husband wasn't ready to start chemo - too invasive - and his own oncologist suggested Lupron to which we added Casodex. We're still happy with this decision: the HT turns out to be very effective and does not have much impact on daily life. Good luck, Dutchy

Hi Tony, I am similar to you in Gleason & Stage, since my radiation I have had a drop in PSA to .4 and hope to see a further drop, my urologist did mention possible hormone therapy, my onocologist said in discussion, that chemotherapy has not been considered at my stage, however in my opinion if it got to that situation, I would just go ahead with it, hopefully it won't be necessary.

Regards Mal.

Thank you all for responding.

This, I think, is the next big study. sanofi-Aventis has been trying to get this one done over the last year and a half but too few participants.

David, my oncologist and above, the makers of Taxotere, have been trying to get studies done on this matter. But as you know the results are far away. I almost did this because I was mired into the dam the torpedoes approach when I started out. The question is simple, is Chemotherapy from the get go a better approach than later on in treatment? No one knows because it will take many participants willing to try to find out. And those participants will have to go into controls arms that include placebo, and so few want that option. There are too few watchful waiting participants in the young group that can reap usable results. I was willing but a clerical error disqualified me from the group. Then the study was cancelled after too few participated. We won't know that answer for some time. That's not good. But I applaud your efforts to try everything else. You are the best. God Bless you David. My support is unending.

Tony

Thanks torgeir.
Great response. I am interested also, in more of your "mixed feelings". Please feel free to say what you need to.

All HW friends,
C'mon, more input and don't be afraid to say your mind. don't tell me you didn't have to. Tell me why you would or wouldn't consider it. This is a serious discussion to to get your thoughts even though you think you might not have needed this treatment option. (I'm being....provocative!) But this is real world discussion. Chemo is a very serious step and my oncologist offered it at my option. And it just may become a part of supplemental treatment for all.

Tony

I know my father wouldn't have done chemo right away. I don't know if he would do it now. His reasons: everything happened so quickly between dx and surgery and then to find out he needed additional treatment was such a huge blow. He missed so much work and the physical and emotional toll was exhausting. It has taken almost a year for him to get back to feeling like somewhat of his normal self. My dad didn't want to feel like a guinea pig and it is all so taxing on the body.
I understand that we need people to do these trials, otherwise, we will never have answers, but I was under the impression that chemo has not cured Pca. Therefore, I have a hard time understanding what they are going to be measuring in the study. The time to recurrence? Well what happens when recurrence happens? Radiation at that point would most likely not be an option right?! HT maybe if a person is not already on HT? Good food for thought.

Fair Question, Landcrab,

By my own action of not as yet, I shied away.  it was a fear that it would take too much away in my life.  I am in a very high risk group and may still be revisited with it, which is why I ask this question.  I am still considering this treatment even though I have not relapsed in Hope that it never does.  Risky business to say the least.   BTW when I said "there are doctors prowling around, it is because this is not the first forum I posed this question.  I asked it verbatum at a site started by Dr. Arnon Krongrad, a renowned daVinci surgeon and author.  He responded many of my posts, but not this one. 

Dr. Krongrads site below:

http://prostatecancerinfolink.ning.com/

Tony

Great question Tony. We will discuss this in person this week. WaaaaHoooo.

I do feel qualified to offer an opinion on this one. I have had 5 cycles of chemo now. As it shows in my bio, I've had surgery, radiation, HT, and now chemo. If, and I mean if, I had known what I know now, I would have jumped on the chemo from the start. I feel my chances of the PCa morphing over to HR would have been less. Johnnie and I have watched many conferences on the web where many oncologists are now thinking that PCa should be treated the same as breast cancer. That is, surgery followed by chemo. I don't know the survival rates of this treatment schedule, but it must be better than what I am on now.

I have always thought that it is better to attack than to play defense. I have been playing defense for three years. Where would I be now if we had had the option to attack? I know that we can not look back and second quess ourselves. One day this will be an option and I feel it will be a good one until we come up with a cure.

As the great Auburn (War Eagle) coach Pat Dye once said, "Hidesight in 50/50".

Love, peace, and War Eagle to all,

Walt