Husband hormone resistant after 4 months treatment. Chemo next?

Hi Deanna,

Sorry to hear of the short time on Lupron/Casodex. I'm a G9 and had a short time as well on the first line HT. Not a medical professional, but Chemo does not seem to be a bad option. One thing you could try first is to stop the Casodex, some patients benefit greatly from the withdrawal of this med.

What part of the country are you from? There are some great clinical trials to consider in the US. I'm on a docetaxel (chemo) and XL184 trial at NIH in Bethesda MD. They also have a trial with Xtandi w/ Prostvac, which may be effective for you husband.

There a other options out there and you should get some great input from other here shortly.
All my best to you, contact me via e-mail if you wish,

Deanna,
My husband was diagnosed in Febrary and his medonc is recommending the Taxotere/Lupron combo for him.
He is currently doing Casodex + Lupron depot shots every three months and his PSA is at 2. We were hoping it would go lower. The CHAARTED study showed promising survival benefits for metastatic disease which my hubby has. Frank is seriously considering starting the chemo in October after farming season winds down. The sooner, it seems, the better, as the best results were before castrate-resistance.
Another thought is to pursue Zytiga as second-line hormone tx. See if it drives his PSA back down. Maybe, another bone scan to find which area/s could be hot spots and zap them with radiation...
I second Steel Guy's thoughts on adding medonc to your treating team.
Keep us posted and will be thinking about you and your husband.

Lisa

You may want to watch Dr. Snuffy Myers latest online videos. He states that the term "hormone resistant" might be a misnomer and that the PCa cells just learn to get around the drugs, by 1. Creating more androgen cell receptors and 2. Creating T from LDL cholesterol.

He suggested that Lupron/docetaxel (Taxotere) may be a thing of the past and that the 2 new drugs, Xtandi, which blocks the extra androgen receptors, and Zytiga, which inhibits the cholesterol to T conversion, and much more powerful with less side effects.

I know there have been some conflicting studies about using the 2 drugs together, but that may be something to consider. Other guys here would know more about that firsthand.

There are 5 or so recently approved by FDA treatments that all show promise. Each is known by a couple different surnames, but I will label them Xtandi, Zytiga, Xofigo, Provenge, Jetvana etc.

You have already gotten some excellent advice form the first few replies.

While conventional wisdom used to be to avoid chemo as long as possible, the recent result that shows something like a 16 or 18 month survival advantage (while most treatments are about 4 month) brings chemo back in competition with the others to the forefront.

While everybody agrees these 5 new treatments are good, no one can agree what order they should be taken in, nor whether it is best to use them sequentially as Monotherapies, or whether to sue them in combination as "cocktails".

Strong arguments both ways.

So it boils down to what you are most comfortable with, after you research them all.

LupronJim