Taxotere likely next

Hi All, I just returned to HW after an absence. What a great group! I see there are others with high PSAs.

We are anxious as always about my husband's deteriorating condition. He had a bone scan last week and will have a CT scan on Monday....appointment with the oncologist on Thursday.

I expect that Taxotere will be the next step. John's PSA last month was in 400s. He has not had any bone pain but has nephrostomy tubes in his kidneys. That happened last May and he has done well with them until a couple of weeks ago when he got a kidney infection along with a return of the pneumonia he had in January.

We are wondering how challenging the taxotere will be on him. He is a skinny guy without a big appetite. So far, he has felt quite well until very recently when sick with pneumonia and kidney problems. He has had no pain except for some muscular pain. Spazzy muscles.

He has tried ketoconazole briefly. He is still on Degarelix and prednisone. We are in Canada and so don't have insurance for many of the big drugs. The government will pay for Zytiga after one has tried chemo....at least one.

I guess we will know more on Thursday. Just wanting a heads-up re the chemo in advance. We really don't know what to expect.

Does the chemo usually shrink the tumour? John's so far has been contained in the pelvis but that can cause problems too. He is also on Lovenox, a blood thinner.

Thanks for any advice you may have for us.

Oci

Dx: 1999
Brachytherapy in Seattle: 2000 Gleason was 3 + 3
treatment with Prostasol, an herbal for years
2011 - PSA started to rise - @7
2012 - tried various drugs ie Lupron, Casodex, Flutamide, Avodart - PSA continues to rise
May 2012 - nephrostomy tubes put in PSA: 19
Nov 2012 - began prednsione
Dec 2012 - 1st Degarelix
Feb 26/13 - PSA 350 - started Ketoconazole
Mar 14/13 - PSA 425 - stopped keto because of rise
waiting for results of bone and CT scans

Hi Oci. Can't give you any insights I am afraid but wanted to add some moral support. Sorry to hear about the latest with your husband. Did you get the bone scan March 14th? When on earth will you get the results. That is not very timely!!!

We are Canadians too. Where are you?

Perhaps the most serious, and sometimes fatal, SE from docetaxel is neutropenia. Neutropenia is the loss of the most common type of white blood cell, needed for fighting disease. It needs to be monitored closely.

Pre-treatment with a medicine called filgrastim (Neupogen) or pegfilgrastim (Neulasta), [synthetic forms of granulocyte colony-stimulating factor (G-CSF)] prevents the most dangerous kind of neutropenia. So if there is evidence of neutropenia after the first cycle, or if his white blood cell count is low because of other illnesses or medicines, you might want to discuss this kind of pre-treatment before the next cycle.

Here are some references:
Prophylaxis of chemotherapy-induced febrile neutropenia with granulocyte colony-stimulating factors: where are we now?
Peg-filgrastim and cabazitaxel in prostate cancer patients.

My husband was on Taxotere for three infusions (opinion now is he was not on it long enough). The PSA was going up (no scans were done so we don't know the impact on the tumors; we now know scans are a required indicator). His side effects were peeling skin on hands and feet, fatigue, and loss of most of his hair. Also after the infusion, his white blood count dropped severely and he had to go to the ER so anything you can do to monitor that or avoid that is good. Taste was also affected; things didn't taste the same. He was driven not to lose any weight so he ate regardless.
He may go back on Taxotere if it is appropriate.
Good luck and I hope all goes well. Knowing so much as you enter this next phase can only help!

Hi Oci, I meant to say it was after the first infusion that he went to the ER. After that, the doc reduced the taxotere. Be sure to ask how much he is getting.
I think a port would be handy if there were going to be lots of infusions. If my husband ever has to go back on chemo, I think I would like to see him get a port. They have such a problem now getting a needle into his arm for anything now.
He could wear a face mask around the kids if there was any suspicion of infection.
One thing we realized after our ER visit is if you have to go to the ER, make sure you tell them he is receiving chemo! They'll face track him into care, at least away from the germy waiting room!