Chemo as a first response....???

Hello all- I'm new here. My dad was diagnosed a few weeks ago with Pca. Here's his stats.....Gleason 10, cancer has escaped the prostate near the bladder, several nodes look positive on CT scan, bone scan clean. His urologist immediately put him on HT.. Lupron? (injections under skin each month), and another pill he takes each day. Urologist suggested HT for 3 months, then another CT scan and radiation. My dad sought the advice of an oncologist this week. Onc wants to begin chemo earlier rather than later. He doesn't want to wait for HT to fail first before starting chemo. Onc is consulting with a panel of docs (radiation oncology, etc) to put together a whole game plan. My dad goes back to him in 2 weeks. I'm glad onc is being aggressive since my dad's Pca is G10. Anyone else have chemo right out of the gate like this? I'm having a hard time finding info about it.

Also, onc and urologist both say he is not a candidate for surgery. My mom said that the onc was unsure about using radiation....seems strange to me since it is used extensively to treat advanced prostate cancer. Maybe she got that part wrong. Any input??

I'm sorry to hear about your dad.

It sounds like there is a team in place working on your dad's case, which is great to have. The reason his RO may be unsure about whether to use radiation may be because with a Gleason 10 there is a significant chance that the cancer has already left the pelvic region, even if it does not yet show up on bone scans. In that case, radiation might be ineffective and might only add side effects.

A recent study showed that early chemo can increase survival when there are known bone mets and/or visceral mets, but that does not seem to be your dad's situation right now. Chemo (Taxotere) has not been shown to be of benefit when bone/visceral mets are not present. It can be very toxic, so it ought to be a carefully considered decision. It may be that there is suspicion of neuroendocrine prostate cancer, which might respond to early chemo. His biopsy report should mention that if that were the case. It may be a good idea to get a second opinion on the biopsy from Epstein or Bostwick.

In any case, hormone therapy - bicalutamide (the pill) and Lupron - is a good starting place. It takes a couple of months for it to sensitize the cancer to radiation, and keeps the cancer in check meanwhile, so he and his doctors can plan their therapy strategy. Your dad should let them know if he is interested in participating in clinical trials.

- Allen

Thanks, everyone! Your input is so very helpful. My mother battled (and won) stage 3B breast cancer 10 years ago. So upset that my parents have to endure another cancer diagnosis, especially one that is not curable. This is such a great forum, and I am so glad I found you guys. I've been trying to gather as much info as possible for them. Thanks again!!

I had accidentally posted this onto another thread, so moving the comment here.

In typical Dr Charles "Snuffy" Myers fashion, inhis weekly video he has a gut feel that eraly Taxotere while effective is no more effective than early Xtandi or early Zytiga would be, just have not had enough randomized control trials to prove his hypothesis.

/askdrmyers.wordpress.com/

TallAllen commented on that comment I had misplaced in the other thread ...

"Lupron Jim -
If you're talking about the CHAARTED study, it was a randomized controlled trial. Some were randomized to receive Taxotere+ADT, while others got ADT alone. Since Xtandi and Zytiga are alternate forms of ADT, they would not substitute for Taxotere, which attacks the cancer in an entirely different way than any kind of ADT.

A recent Phase II trial of Xtandi monotherapy in hormone-naive men demonstrated good efficacy in men with or without mets. There is a randomized controlled trial of Zytiga+ADT in hormone-naive metastatic men in the works. Since traditional ADT, Zytiga and Xtandi all target the androgen receptor in different ways, they could all potentially be used in a cocktail if they are safe and retain efficacy when used that way....

- Allen"

LupronJim