Halfway through chemo, status report

Checking in after my first three (of six) chemo (Docetaxel + Carboplatin) treatments, also on Lupron and Darolumatide (Nubeqa).
Thanks to all the great advice on this site, I've had minimal side effects except for the "chemo crash" which has been increasing in severity. I’ve been traveling from Massachusetts to Minneapolis for treatment, but last week went to Mayo/Rochester for a new PSMA Pet scan (Gallium 68) and to meet with my doctor. I’ve included the narrative/results below.
In short, my new scans show some tumor reduction, and the Standardized Uptake Values (SUV) also seem to be decreasing from levels on my earlier scan (9/26/22). Nothing dramatic in terms of improvement but, notably, no increases in size and no new cancer is evident. My PSA, for whatever that’s worth, has been undetectable since November, when I started back on Lupron. (PSA has always been low and never a reliable indicator of my PCa.)
Doc says this is the progress he would expect after three treatments. Also, he says the Max SUV scores show the cancer still lighting up; he believes that dead cancer cells still emit this energy for some weeks after they die, so he expects to see that.
I have three more treatments, ending February 28, and then I go back to Mayo March 29-30 for additional PSMA Pet scan, MRI, blood tests and my quarterly Lupron shot. By that time, my doctor believes we should see significant reduction of the disease…and we will chart next steps, likely radio-ligand therapy (Lutetium-177 and/or Actinium-225).
While we will try to get treatment approved in US, doc says I might have to consider travel to a foreign country, such as Turkey. As I understand it, the FDA wants to see evidence that chemo and/or 2nd gen ADT (Nubeqa) have both failed, and the cancer is starting to return, before approving Lutetium-177. My doctor believes it’s important to move quickly with the therapy and keep killing cancer cells, and not to wait for them to go into remission then regroup…my gut (what else do I have to go on??) tells me to follow his advice. Would be interested in hearing thoughts on this...
Best wishes to fellow prostate cancer warriors as we head into 2023. Here's hoping for good treatments and successful outcomes, and thank you for providing such important support through this challenging journey!

RESULTS FROM MAYO SCAN:

Patient DOB: 09-Jul-1956 _____________________________________________________________________________
IMPRESSION:
Interval mild reduction in size of some of the previously seen widespread metabolically
active nodal disease, although significant PSMA avidity still remains both in the previously seen nodes as well as multifocal osseous metastasis.
miPSMA Expression Score: 3
EXAM: PET CT SKULL TO THIGH PSMA
RADIOPHARMACEUTICAL/MEDS:
Route: intravenous
gallium Ga 68 gozetotide injection (Ga-68 Illuccix/Locametz),5.49 millicurie
TECHNIQUE: Ga-68 PSMA PET/CT scan was performed from the orbits through the proximal thighs with low dose, non-contrast, free-breathing CT images for attenuation correction and anatomic
localization (AC/AL), with imaging beginning at approximately 60 minutes after radiotracer
injection.
COMPARISON: 09/26/2022
INDICATION: Prostate carcinoma restaging. Subsequent treatment strategy. PSA: <0.10
FINDINGS: Compared to prior examination, and allowing for differences in technique, there is mild interval treatment response with primarily reduction in size of the PSMA avid previously seen retroperitoneal lymphadenopathy. For example, one of the previously seen and a larger left
periaortic lymph nodes measured 1.2 x 1.2 cm and now measures approximately 9 x 9 mm, though still demonstrating intense PSMA localization (SUV max 10.1). Similar mild improvement is also noted within the other nodal basins previously involved including the bilateral iliac, subcarinal,
bilateral hilar, pretracheal, prevascular, and bilateral supraclavicular nodes. Persistent
radiotracer uptake is also noted within the multiple scattered osseous metastases, most prominently involving C2 vertebral body (SUV max 12.2), T10, L1, L2, and L5 vertebral bodies as well as multiple ribs and involving the pelvis. The the largest osseous metastasis continues to be in the L3
vertebral body filling almost the entire vertebral body (SUV max 25.7).

Hello, Island ~

Mayo Clinic in Rochester has also played a significant role in my treatment plan.

At Mayo Clinic, I consult with Dr. Eugene Kwon.

I am so thankful that your PSA is low.

I remember when I reached the "halfway done" milestone when I was pursuing chemotherapy infusions (6 infusions of TAXOTERE ~ given 3 weeks apart ~ over the course of 18 total weeks).

Mentally ~ being halfway through was HUGE!

Another treatment, and then there's just two treatments left.

That's when I KNEW I could forge through the rest of the treatments.

Beyond that, you already are having proactive conversations with your medical team about the future.

I do think LUTETIUM-177 holds tremendous promise.

Are there any ways to possibly get these treatments here?

Dr. Kwon, during our consultations, has always been a strong advocate for taking a multi-layered treatment approach for cases with complexities.

He is also a strong proponent for using scans & diagnostics to stay on top of everything.

Stay the course with your current chemotherapy treatments, Island.

I'm mindful of you, and I found that taking life "one day at a time" got me through the treatments.

At first, I looked at the totality of all the treatments ahead ~ weeks and months that loomed ahead of me. That was overwhelming!

I soon found that I just needed to focus on ONE DAY ~ and to just stay focused on the next treatment, and not the whole series of treatments.

It was a paradigm shift in my thinking that really pulled me through the whole series of infusions. I took care of myself, kept life simple, drank extra water, and set an earlier bedtime.

I continued to teach full-time during all those treatments, and evenings and weekends were essential for relaxing.

Each chemotherapy infusion reduced my PSA, so I continue to believe that chemotherapy infusions played an important role in my treatment plan.

Stay in touch with us here, and please know you have fellow compadres standing alongside you, as your treatments continue.

With my best sent to you ~ from "one battle brother to another" ~

CYCLONE ~ # Iowa State University

I know your last chemo infusion was scheduled for February 28, so I will be thinking of you this week, ISLANDBOY!

Chemotherapy isn't an "easy row to hoe" as Midwestern farmers say, but I know Dr. Kwon at Mayo Clinic is famous for his "chemotherapy cocktails" ~ tailored to each patient's needs.

I know chemotherapy infusions reduced my PSA, with each subsequent treatment.

I'm hoping you reap the benefits from your treatments.

Here's to "ringing that bell!"

In fellowship ~
CYCLONE ~ # Iowa State University

Islandboy, I traveled for chemo as well. Not the easiest way to do it, I know but with this beast you need to do what you've got to do. Exercising and eating better has worked to help me feel better. If nothing else, it is a piece that you know that you have control over. Hope it is helping you feel as good as possible as well. Good luck with the remainder of the treatments. I got the ice recommendations from the guys here as well and got through with zero neuropathy.

Bill

Hello, Island ~

Hoping you are feeling more rested, reinvigorated, and restored following your chemo infusions!

Full energy resurgence wasn't an overnight thing for me, as I needed to conserve my energy for teaching school.

But, there came a day when I suddenly realized my MOJO was really returning, and I could feel that steady flow of energy returning.

We both have met with Dr. Kwon at Mayo Clinic. It's quite a place.

I'm hoping subsequent lab tests and scans have brought you good news ~ and truly hope your treatments have paid dividends already.

Hope this finds you feeling your best ~

CYCLONE ~ # Iowa State University