Pondering Imponderables

When the twin horns of a dilemma each poke an eye, it's hard to see straight.

Gleason 9, positive margins, surgery followed by radiation after PSA became detectable. Studies I've read suggest a 60+% chance of relapse.

I talked to my oncologist (Dr. Scholz) yesterday, and he's recommending adjuvant Taxotere. Adjuvant chemo is SOP for breast and other cancers, and even Johns Hopkins uses this modality for high risk folks like me, according to Dr. Walsh. Too bad the clinical trials are still in progress.

Dr. Scholz' hunch is that adjuvant Taxotere would give a 10% chance of cure at this point, and a 20% of improving survival absent a cure. Plug this into the 60+% chance of relapse, and maybe you bring the chance down to 50+%. In the meantime, you suffer the side-effects of chemo, not all of which are necessarily temporary. Some of which could be quite deleterious.

I'm leaning toward saying no to chemo for now, despite reduction in relapse potential. My bet is that the quality of life would be reduced enough that quantity of life would be less important. And if I get a relapse, it might go oligometastatic and be treatable with curative intent (50% chance?). It's just so hard to choose based on percentages and imponderables.

Most of us face dilemmas like this. If I could just get one of those prongs out of an eye, I might be able to make a good decision.

Nellie

Hi Nellie,
I agree with you in postponing chemo at present. There are many new therapies on the pipeline that have very high potential with less side effects. Preserving QOL and a more robust immune systems makes sense with your present status. Wish you the best for a long and sustained remission.

RalphV

I am in that high risk realm as well. I have responded well to the trifecta of HT, HDR brachytherapy, and IMRT. But....The odds are that recurrance is very real down the road, particularly regarding the PSA at dx and the apparent large tumor. My uro wants me on HT three years and my med-onc says maybe two years and then intermittant as needed. I have asked about adjuvant chemo and my med-onc says not at this time so long as I am responding well to the current treatment. My rad-onc stays out of the HT discussion.

The prospects of chemo are not welcome. My wife just went through her second bout of breast cancer. Each time she had chemo. This time it included taxotere and she did have significantly less side effects compared to 15 years aog, but they were significant nonetheless. A client of mine lost his PCa battle of nearly 10 years last fall. He had several periods of taxotere over the last four years. They affected him quite a bit. He was in his late 70's and used the same med-onc As I use. Though the side effects were significant, my med onc figures he added about four years of functioning lifespan. He had mets in his lymph system and lungs, but not his bones. Unfortunately he lost his wife about 18 months ago and after a few months without her he basically had had enough treatment and just withered away.

Hopefully, we will,as Ralph noted, have many more effective options that are as effective and less damaging than chemo as we go forward.

Riviere,

My husband just started Taxotere/Carboplatin last week.

We were shocked when the whole chemo thing was mentioned, because it was mentioned before then pulled off the table just as fast.

I can say that thus far, aside from fatigue, my husband is tolerating it very well. No nausea or anything.

Just through the course of some conversation and research, we are kind of leaning towards the possibility that if my husband fails Taxotere, he then becomes eligible for certain clinical trials. We are thinking along these lines because he is only scheduled for two rounds, and MD Anderson has a clinical trial that either just started or is due start that is the brain child of the med onc that is treating my husband. Maybe wishful thinking, but he didn't fail HT, and has not yet had any type of surgery or radiation... just HT for 4 months.

Failing taxotere would simply be not curing him or substantially debulking the tumor?

Aside from our thoughts with the clinical trial stuff, we truly are perplexed by the total 180 to do chemo.

Best of luck to you in whatever you decide. :)

Nellie,

Not in the way of advice, but sharing...

I have (had?) a high risk PCa and was offered a clinical trial for neo-adjuvant chemo. I agreed and did six rounds of Taxotere treatments. While everyone's reaction is different, this drug has a relatively mild set of side effects. In my case, I had minor mouth soars, fatigue, and partial hair loss. And a strange one where I lost a taste for wine (and only for wine). I was still enjoying food and beer.

I don't know if it helped me, but if I have a survival benefit from it in the future (even small) I would do it again, as it was not a big deal for me. My year long HT was more bothersome to me (though also quite tolerable and not a big deal).

Best of luck in your journey and whatever you decide will be the right decision for you.

Greg B.