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Docetaxel as adjuvant therapy

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Posted 7/13/2009 10:32 PM (GMT 0)
Am considering Docetaxel as an option to adjuvant radiation therapy.  It has been succesful in many other cancer treatments.  My rationale is as follows :

   1.  If my cancer cells have indeed leaked from prostate, where are   they ?   Most likely, because none were found in my margins, they are in my lymph system, or are traveling up my nerve bundles.

   2.  Most adjuvant radiation focuses on the prostate bed.  In my engineer style of thinking, I don't think they are there, if they are anywhere.

   3.  Radiation is know to "freeze"  ED and incontinence stages where they are.  I don't like that thought in my current state.

   4.  Hormone therapy also seems like a further insuly to my battered sex life as an adjuvant therapy, shootimg at something we don't know that exists.

   5.  Potential harm to tissue, the urethra, and the rectum is another unhappy thought.

   6.  I am saving the radiation cannon for when my PSA starts to rise.

Tony suggested I start this post.  Am interested in any and all argumnets, thoughts, etc.

 

Posted 7/13/2009 11:07 PM (GMT 0)
Some will see this pretty soon, so it will be a good post for anyone considering this option.  Obviously it's not for everyone but I understand your logic.  The brand name for Docetaxel is Taxotere.  It is intravenous chemotherapy for prostate cancer. 

Here is the list of side effects From the Taxotere website...

http://www.taxotere.com/consumer/taxotere_treatment/side_effects.aspx

I was offered this treatment after surgery as part of a sanofi-Aventis study on HT/Chemo versus no treatment placebo control arms.  I did not want a placebo, and I did not want neuropathy in my hands.  If I had it to do over again, I might have added Taxotere with HT/RT post surgery.  But this would have meant a gambit of side effects.  But I know Taxotere better these days and it isn't as bad as I thought it would be in low dose.  In high dose, it's a monster however.  Our friend here "FLHW (David E)" has been through a long stretch on Taxotere.  He has advanced disease with mets, but he is an amazing man and keeps bouncing right back.  His personal website is http://prostatecancerat42.blogspot.com

Another story to read that documents his ride with Taxotere is "War Eagle" Walter.  Here is his site... www.caringbridge.org/visit/walterwhited.  Walt is on his second go of chemotherapy as his PSA is now at 100 and climbing.  I am sad to report this, as Walt is my dear friend and he is terminally ill with prostate cancer.  I believe that David tolerated the treatment better than Walt did, but I believe that may be because Walt was given the highest dose possible.

I love both of these guys dearly, they have become my extended family and I keep them close.  Both have shown me incredible courage and faith. 

Goodlife, most who are on Taxotere do it because most other options failed.  But new studies are being done to see if earlier treatment with it is better than towards the end game.  Anyone on these trials are doing a great service for all of us.  If you elect to move forward with this option, I would be very hopeful that you stay and report back to us how well it's working.  But that stated, I had the radiation and hormone therapy after surgery, and I feel pretty darn good considering. 

Tony

 

Posted 7/13/2009 11:26 PM (GMT 0)
Thanks Tony.

That is precisely what this trial is about, Docetaxel as adjuvant to RP, with a PSA below .02.

I have considered the placebo thing as well. Not sure I would stay with the trial if I do know I am taking a placebo !

The FDA list of side effects does not mention neurosis.
Posted 7/13/2009 11:32 PM (GMT 0)
Here is a gentleman who had the treatment adjuvantly.  He is a popular comedy writer ~ Jerry Perisho.  He was treated at my center in the Los Angeles area.  He had Taxotere soon after surgery as he too was high risk and he didn't wait until relapse to move forward with a systemic treatment.

http://prostatecancerinfolink.ning.com/profile/JerryPerisho?xg_source=profiles_memberList

Also, a note to something you said...in almost 90% of cases, relapse starts in the area where the prostate was.  So radiation is a valid option both salvage and adjuvantly.  Hormose therapy is also a systemic treatment as is docetaxel...

Tony

Posted 7/13/2009 11:40 PM (GMT 0)
The study from two and a half years ago was stopped. There were issues with the number of people entering it, and they did not get enough participants. Since there have been new attempts to start the study back up with different criteria, including a control arm with radiation. But I know the study you are looking at and it will help answer the key question which is "is adjuvant chemotherapy better that salvage chemotherapy?"

If you like, I can get you in touch with Jerry, or you can write him at the InfoLink...

Tony

Posted 7/14/2009 12:01 AM (GMT 0)
Goodlife,
Google Dr Lam, Postate Oncology Specialists, in Los Angeles. He is a leading researcher on Taxotare and PC and it's affects. He has written several papers on the subject.
JohnT
Posted 7/14/2009 12:25 AM (GMT 0)
My uro no longer does 6 week PSAs, he says they too often cause needless worry. That said, considering possible options is reasonable. I would have to argue that engineering arguments are not necessarily appropriate to medicine -- I was issued a slide rule not a stethoscope. Why should cancer book a long cruise when it can vacation close to home?

My advice for right now would be to wait for the three month test while you consult with an oncologist. Imagination can be a great curse as you envision cancer speeding to every part of your body. Perhaps you are correct and will need drastic treatment, but it may also be just too early to tell. In any case out hopes and prayers are with you.
Posted 7/14/2009 12:26 AM (GMT 0)
Thanks John & Tony. You guys are really helping me !
Posted 7/14/2009 12:29 AM (GMT 0)

There is a guy I remember whom did chemo first and added brachy/radiation thereafter I believe his story is on yananow somewhere. It was a unique approach especially 6-7 yrs+ ago.

Could be wrong, but chemo and chemo plus additives  although can be of some usefulness are generally not super effective on PCa, compared to some other cancers where possible cure can be stated. Do we know of any patient cured (even by some loose definitions) by using chemo treatments??? If so, let's read it herein, I am not aware of any such patients. It can extend life which is basically accepted data,  how long is the same question on every drug protocol on PCa and it varies alot. There are other possible choices out there if one wishes to go fishing and find them.

Anyway good fortune if this is your path, maybe it will yield good results.

Posted 7/14/2009 12:43 AM (GMT 0)
I don't know of anyone cured by it, mostly it is used towards the late stages of treatment. But There has been some success with it adjuvantly, and we are finally at a Phase III trial that will yieid great results...in ten years. We have a couple members here who entered the trial as well. One whose cancer relapsed I believe. We also have several who have had it later who can at least speak to the side effects and how they are doing. These include the three examples I have given...

Tony
Posted 7/14/2009 12:46 AM (GMT 0)
Zufus

Great thoughts ! I do know of people "cured" by chemo, at least for some fairly long amount of time, at least the five years that us PC guys talk about. I am viewing the Docetaxel more like a herbicide we put on the grass. We may never see the weed, we just prevent it from growing.

Geezer,

I am inclined along your way of thinking, I just have so many disciplines telling me that Gleason 9 is a nasty one, and it most likely reoccur. The nomograms are predicting a 36 % chance. My surgeon, my urologist, my radiation oncologist, and my prostate oncologist are singing a quartet in unison !
Posted 7/14/2009 12:51 AM (GMT 0)
Hey Tony,

Just thinking about your comment about 90 % of relapses start in the prostate bed area. How do they know that ?
Posted 7/14/2009 4:47 AM (GMT 0)
Usually because they radiate it and the PSA returns to undetectable. Autopsies show whether there was traces as well in patients who died of other causes. Does this mean all of the cancer was there, no it doesn't but usually what causes PSA to rise is traces of the cancer in the prostate bed where it would first escape the prostate. Most guys who achieve an undetectable PSA after surgery, and are staged at T2 or T3, but suffer a relapse, can usually be treated well with radiation.

Looking at your numbers, low PSA but stage 3, and Gleason 9, you are a prime candidate for adjuvant radiation and hormone therapy. Old arguments stating that you shouldn't do anything until a relapse are losing out in many studies, butremember this is your life and these will be your side effects. So understand this stuff well. I have the studies that I used to make the decisions I did. You can look up the Stanford University study on WPRT for post RP stage 3 guys. This study is now mainstream in the radiation oncology world. It involves treating high risk cases like your and mine, in an adjuvant fassion with IMRT and hormone therapy. It offers an improvement of nearly 55% in reducing relapse. It is also showing that it extends time to relapse as well. The current standard for expecting relapse in my case now is over 8 years. Without adjuvant therapy it was 50% at year 5.  I didn't think at one time I would ever get to undetectable again, but I did. More time is needed to evaluate the mortality results, but that's the problem with prostate cancer ~ most studies takes ten years, even longer, to start revealing useful information about mortality.

Tony
Posted 7/14/2009 10:29 PM (GMT 0)
goodlife,
You are correct and I used the wrong term, neuropathy is the problem that goes with chemotherapy, not neurosis. I have changed my above post to neuropathy. Neuropathy is a condition that affects the nervous system, especially in the extremities. There are special gloves and boots available for use when under going infusion that help limit nerve damage to fingers and toes. They basically are "frozen" gloves that slow the blood flow into the hands and feet.

Info on neuropathy and chemo...

http://www.chemocare.com/managing/numbness__tingling.asp

Sorry for the mistype...

Tony

Posted 7/14/2009 10:55 PM (GMT 0)
Goodlife
My husband is on Taxotere for Gleason 9 and has failed hormone therapy - last month his PSA was over 1,000 but the bone numbers were better - we are hoping this month the PSA will be holding steady or dropping. Though this isn't one of the nastier chemo drugs it is chemo and between the cancer and the chemo he is fatigued. Just think 5 years ago this wasn't even an option - with a gleason 9 and if your not metasized to the bones it could probably only help with fighting the cancer if you can live with the fatigue and odd taste changes it gives you.
Posted 7/14/2009 11:28 PM (GMT 0)
Amy,
My prayers and best wishes are always headed your way for you and your husband. You are correct, this drug isn't as bad as some I've witnessed the effects of. Unfortunately, it isn't a walk in the park either. but if it can work better on the front end rather the tail end of treatment, then we should know about it. This study is trying to lift that mystery away. And "Metallic mouth" and loss of taste is also a very common side effect.

May peace always be with you,

Tony
Posted 7/14/2009 11:55 PM (GMT 0)
Thank you so much Amy. It brings tears to my eyes to hear of men so much worse off than I am, clinically anyway. In a backwars way, you may be pushing me towards what i don't want to do, RT and/or HT.

I get my 3 month PSA back tomorrow. That will probably either push me over the edge, or confuse me some more if it is zero.

God Bless you and your husband. This disease is no respecter of persons.
Posted 7/15/2009 4:13 PM (GMT 0)
Tony stated..."Old arguments stating that you shouldn't do anything until a relapse are losing out in many studies."

Are we moving to a point where you have surgery in month 1 and radiation in month 3, regardless if the psa after surgery is zero? Would major insurers cover another major treatment without indication of any relapse?

Goodlife, I responded to you in a different thread before I read this one. And I have to say the responses in this thread have been surprising to me.

Posted 7/15/2009 4:45 PM (GMT 0)
I don't feel I can venture any advice, but here is some info. WRT Taxotere, I had the neo-adjuvant treatment and while everybody is different, I had very few side effects. Fatigue and mouth sores were major ones (and loss of some hair, of course). I never stopped working and kept my busy travel schedule (every week). I was offered another neo-adjuvant option - Taxotere with hormones. In Stage II trials there were 2 people "cured" of cancer (after RRP they could not find any traces of the disease). Unfortunately for me, this was a randomized trial and I only had a 50% chance of getting the treatment. I chose Taxotere with Avastin. The good news is that chemo works better with higher Gleason scores. I had G8 on biopsy and G7 after prostatectomy. Best of luck!
Posted 7/15/2009 5:50 PM (GMT 0)
Hi joey,
I am a living example. And my insurance covered everything. But this isn't for everyone. I have advanced prostate cancer. My stage, Gleason, and Pre-Op PSA, and post op pathology, were all seriously above a standard case. I came out of surgery with a 50/50 chance of relapse in the first 5 years and 90% chance by year 10. I did get to an undetectable PSA after surgery, but multiple doctors said we weren't through. My story is on my blog below. Insurance has been in place the whole ride.

Once a doctor declares a patient as High Risk of relapse...then the doors are open to procede with adjuvant therapies...

High Risk Definition (any one of the following):

Pre-Op PSA at or over 20

Gleason 8 and above after surgery

Stage 3a and above

Extra Prostatic Extention (EPE)

Positive Margins



Tony

Posted 7/16/2009 2:42 AM (GMT 0)
I guess I need to find more time for HW, didn't realize I was referenced in this thread until tonight.

Here are my thoughts, a layman's perspective;
With a PSA of <.03 the number of prostate cancer cells circulating in your blood system are very minimal.
Chemo (Taxotere) isn't going to target those cell specifically, in other words it's just going to flood your body with
poison in an attempt to locate a very low amount of prostate cancer cells. Maybe it will work? A good place to go
search is hrpca.org. Howard has a lot of information about chemo trials.

You may also want to look at intermittent hormone therapy?

For what it's worth, I'd trade your Gleason 9 and PSA of less than .03 any day. While I understand your desire to completely rid your body of the disease
I am not sure I agree this is the way to do it. This is just my opinion.
Posted 7/16/2009 3:03 AM (GMT 0)
Thanks David E,

This is a hard struggle for me. I am literally afraid if radiation. Maybe it's because I grew up in the cold war era, I don't know. Rectal bleeding, urethea/sphincter damage, permanent ED, etc., all scare me worse than the cancer does.

It appears that Gleason 9 is as close to incurable as it gets. It is a terribly agressive cancer. If one or two cells escape out the nerve bundle, or into the lymph system, eventually it is going to come back. I was made aware of a study today that evn more reinforces the value of adjuvant therapy after RP

http://prostatecancerinfolink.net/2009/01/22/new-data-from-two-studies-on-adjuvant-radiation-and-thalidomide-post-surgery/

This study really starts to make a believer out of me. I have been looking at the Docetaxel as an alternative, but I am disovering it is no magic bullet.
Posted 7/16/2009 4:05 AM (GMT 0)
goodlife,
Gleason 9 is serious, no question, but you can do well with it. I know many guys who did do well for many many years and are still going strong. Your pre-op PSA was low and that is helpful for long term prognosis. David E. completed a long journey with Taxotere and he is giving you good advice. His disease is fully metastatic and Stage 4, Taxotere was a logical choice in his protocol. Intermittent hormone therapy (IHT) is what I am on, or soon will be on, now. I started it after surgery, and prior to IMRT radiation. Those fears you have with radiation are fears of the extreme rare case in prostate cancer. On August 3, I will have passed year two after IMRT. I do have some fatigue still, but light and likely more from the Lupron. But all in all, I am fine, and still getting my zeros in the lab. This September I stop taking the Casodex and start letting the Lupron wear off. I will monitor it very closely to see if we have acheived a durable remission at least for a few years. If not, I simply restart the IHT until I get back to zeros.

If you look up the stories of Mike Milken and Snuffy Meyers for example, you will see guys that have done great for many years, both Gleason 9's both stage 4. There is always hope...

Tony
Posted 7/16/2009 2:47 PM (GMT 0)
Not to minimize the seriousness of your situation, but as Tony points out there are a number of guys out there with G9 that have survived many. many years. In Milken's case he did have lymph node involvement.

The choice is your, that goes without saying and tax was, in my case, very tolerable. However, everyone reacts differently as has been said here over and over. Even though I tolerated it very well I do have some lasting side effects 6 months later; my red and white blood counts remain on the low side of normal, and the cartilage of both knees was damaged.

Just my $.02 again, but I would spend some time looking into intermittent hormone therapy with and without radiation as a follow up to RP.

Peace be with you all.....
Posted 7/17/2009 1:05 PM (GMT 0)
I had a gleason 9 and elected to have surgery. I had my 6 week post op appointment yesterday 7/16/09 and had a psa of less than .05 so I feel pretty good. Doc still recommends radiation but I am going to wait a few months before deciding. With my gleason 9, I tried to read about others that had similar scores. There are a lot that have been successfull in treating it so don't give up. Hope this adds a little encouragement. Good luck and keep us informed.
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