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What does failed chemo mean?

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Posted 4/13/2013 8:44 PM (GMT 0)
My dad had successfull chemo back in 2005 while he started hormone therapy. He started on chemo again in october 2011, because his PSA started to rise. At that point his PSA was 150. He stopped the chemo in february 2012, because he was tired of the side effects. In april 2012 his PSA was 50, and then it started to rise again, and in august 2012 his PSA was back on 150. So it took 10 months before his PSA was back to 150, and he had 6 symptom-free months (feb-august). He took a MR in august 2012 and the bone mets was the same as before he started chemo. Doesn't that mean that his chemo was successfull after all?

Now he's been on Zytiga since october 2012.
If his PSA starts to rise again, can he start chemo again if he wants to?
what does it mean that you are immune to Taxotere? How do you know that?

Post Edited (smurfine78) : 4/13/2013 3:03:32 PM (GMT-6)

Posted 4/14/2013 6:52 AM (GMT 0)
Doctors determine failure of therapy when there are 3 consecutive rises in PSA. Some doctors also compare scans, and if they see progression on therapy, they will move onto something else even if PSA is holding. But most doctors will use PSA as an indicator. Sometimes doctors will play with the dosages in order to get a response. Just recently an article was posted on HW forum about increasing doses of Zytiga having a continued response (same is true, for example of Casodex). He may or may not be immune to Taxotere at this point in time, it may be worth a try again. There are certain medications that increase responsiveness to Taxotere you can google it.
All the best to you and your Dad!
Posted 4/14/2013 8:34 AM (GMT 0)
But when we talk about failure of treatment I think we talk about two different things here. What I think you meant is that when you see 3 rises in PSA they call it failure in treatment because you then have to move to another treatment. But if the treatment has kept the cancer under control for several years and then the PSA starts to rise, I wouldn't excactly call the treatment for a failure. It's just that it doesn't work anymore and you have to progress to a different treatment.
In my dad's case, he was back at the starting point after 10 months, and I would say that his treatment was successfull for 10 months, but then he had to move on to a different treatment. Not that it was a failure. Do you agree?

Is it possible to never get immune to chemo? And how do you know that you are immune? Is it just that you don't get a response anymore?

And what does it mean that the body can't tolerate anymore chemo? Is it just that the side effects are too hard to tolerate?
Posted 4/14/2013 12:54 PM (GMT 0)
Smurfine, yes, you are right, perhaps it is an unfortunately coined expression "treatment failure" because the treatment may have actually worked very well for several years. PC is a heterogenous disease with many types of cells, PSA-producing cells, stem cells, PSA-negative cells, and three consecutive PSA rises are showing that the therapy is not working so well anymore (although it may still be working against some of these cells) but it signals to doctors to try a new approach. Some cells when exposed to a certain medication find a mechanism through mutations to grow despite therapy. But even in these situations men will start a new medication and the cancer will be put in remission again and again. Combinations of medications are encouraged to prevent cells from becoming "immune". The goal of treating advanced PC is putting the cancer in remission for as long as possible. Eventually PC cells do find a way around the treatment, but by then a person may die of something else. Many men will be put back on therapies that they had years ago, and still get a response, just like your Dad who responded to chemo twice. Medicines and combinations are limitless, so it is important to have a good oncologist who will be an artist at his job of keeping advanced PC patient in remission.

As to your last question, I suppose it could be side-effects or some blood values (liver enzymes too high, too few WBC, etc).
Posted 4/14/2013 1:08 PM (GMT 0)
I think the term "failure" is mis-used in this context, and we have had several sometimes contentious threads about it. But I can't change what terms the doctors use, so ...

Surgery is not a failure in a layman's sense if they actually take out your prostate and put you back together without seeing you die on the table. But if the surgery fails its objective of curing the cancer, even months or years later, it is tagged as "failed". That is the sense in which you have to read the word.

So in those terms my surgery and RT both "failed". I won two major battles, but the war rages on. MY HT is also now at issue. My PSA is undetectable, but the side effects are so significant that we have stopped the HT. Again, "side effect" is a word to use in context. My worsening osteoporosis would be a major issue by itself, but being caused by the HT, it becomes a "side effect".

Posted 4/15/2013 7:34 PM (GMT 0)
I see, thanks

Just another question. If you are immune to one chemo (Taxotere) it doesn't mean that you are immune to other chemos (Jevtana) as well?
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