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Taxotere Treatment #3 yesterday - Questions for the Chemo Brotherhood

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Posted 6/16/2016 6:17 PM (GMT 0)
So yesterday was #3 and things went along smoothly as they have for the previous 2. No issues at all.

Only weird thing that I may have mentioned earlier is that at about day 12-15 from #1 I started losing my hair. The day before #2 I had my head shaved with a straight razor, and immediately after that it started to grow back and has kept on growing. The hairs on my arms lose a little over the bathroom sink, but I still have plenty. I am still not having any of the other SEs at all, so I am waiting for the other shoe to drop on those.

My question to those of you that have much more knowledge of this Lupron and Tax treatment relate to changes in the PSA. Here is a history of my PSA and Treatments to date and the perplexing changes in PSA:

1/25/16 PSA 118.56
2/22/16 PSA 143.05

3/6/16 Lupron Shot

5/4/16 PSA 58.10 prior to Tax #1
5/25/16 PSA 45.75 prior to Tax #2

5/31/16 Lupron Shot

6/15/16 PSA 45.65 prior to Tax #3

So I was seeing a great response to the Lupron before the Tax treatments and fairly good drop in PSA between #1 and #2. But this change between #2 and #3 is puzzling to say the least. I mean a .10 drop is next to nothing.

I am the first to admit I don't know shinola about the interaction of the Lupron and Tax, but this just seems plain weird. Any of you Chemo brothers have any ideas on this one? Input would be welcomed to say the least. I have reached out to my Onco and asked for his input but no reply as of yet.

In the meantime, Every Day is Still a Bonus and I am planning an RV trip the day after #4 for me, Sherry and the 8yr old grandson to Biloxi MS for a gathering of BBQ cooking brothers.

I just want to put this little bit of doubt and confusion to bed so I can concentrate on living life large.

Thanks,
Sonny
Posted 6/16/2016 9:43 PM (GMT 0)
Sonny:

A related question: what is the relationship between chemo and PSA?
I mean what response/TIMING constitutes good news/bad news.

Mel
Posted 6/16/2016 9:45 PM (GMT 0)
I just heard back from the Oncologist office. He said that he usually waits until after treatment 4-5 to determine if the chemo is becoming ineffective. So I guess it just a wait and see for the next 6 weeks.

Well anyway, here's hoping,

Sonny
Posted 6/17/2016 7:55 PM (GMT 0)
Sonny, here is the abstract from a study that may answer you question on chemo and psa.

A rapid PSA half-life following docetaxel chemotherapy is associated
with improved survival in hormone refractory prostate cancer


Abstract
Introduction: Docetaxel chemotherapy prolongs survival in metastatic
hormone-refractory prostate cancer (mHRPC), but many patients
fail to respond to this therapy and there is potential for serious
toxicity. Patients differ in their percent prostate-specific antigen
(PSA) decline and rate of PSA decline following treatment. We
propose that patients who achieve a rapid rate of PSA decline,
measured as a shorter PSA half-life (PSAHL), may experience a
longer overall survival (OS) than those who achieve a slower rate
of PSA decline.
Methods: A chart review of patients treated with docetaxel for
mHRPC in Alberta from January 2000 to May 2006 was performed.
At 42 days (after 2 cycles) and 84 days (after 4 cycles) following
chemotherapy, PSA response and PSAHL were determined. PSAHL
could only be determined in patients with a PSA drop from baseline.
Optimal PSAHL values for OS stratification were determined
using the log-rank chi-square statistic. Survival analysis was carried
out using Kaplan-Meier curves and regression analysis.
Results: There were 154 patients who fulfilled the inclusion criteria.
Using 42-day postdocetaxel data, no associations with OS
could be demonstrated. Using 84-day postdocetaxel data, patients
stratified by PSAHL demonstrated a significant difference in OS
(15 months vs. 25 months) and this relationship remained following
multivariate analysis (hazard ratio 0.08 [0.021-0.34]).
Conclusion: A more rapid rate of PSA decline (PSAHL <70 days)
measured after 4 cycles of chemotherapy was associated with a
longer OS. This result was independent of other known markers
of survival and allowed for a greater survival differentiation than
PSA response.
Can Urol Assoc J 2009;3(5):369-74

Don
Posted 6/17/2016 10:07 PM (GMT 0)
Thanks Don. How are you holding up? Are you still being hit by every imaginable SE that is on the list for the drugs combo?

Sonny
Posted 6/18/2016 12:29 AM (GMT 0)
Sonny,
We are basically on the same schedule. My PSA is not dropping much either but MO say's wait antother cycle or two (on #3). My blood work concerns me more..wbc is very high with no infections and Anion gap is super low without any other factors that could make it low.
Doc says TBD whether or not chemo and Lupron are working. My dilemma is my IDC-P which has zero detectable markers like Psa rise but is very aggressive. Are they measuring testosterone as well? my MO wasn't but they are going to starting next week.
Posted 6/18/2016 1:09 AM (GMT 0)
I want to lend morale support to you guys managing cycles of chemo at this time.

I am a bit behind you, but real close in schedule with John16- my first docetaxel infusion is next week. I have decided that although numbers are always easy to compare and we always want to know the explanation for them (I do...eh?), our bodies often take a circuitous rout in responding to the exotic drugs we have to take. Through six cycles of docetaxel, it is very possible that your metabolism and external factors will combine to deliver a very good punch in the nose to PCa one round, and maybe just a slap in the face in the next round. As example, 2011 paper at this link tells me I could get more exposure to docetaxel if I drank grapefruit juice (which I do a lot).

www.ncbi.nlm.nih.gov/pmc/articles/PMC3244646/

As the likely effect of GFJ would be toxicity that forced me to stop chemo, I will avoid this for at least 72 hours before infusion. Taxotere appears to clear out of the serum in about 4 hours w/o GFJ, but with GFJ it is still present at 6 hrs.

such variables like this might give us reason for non-linear changes in very important numbers- as always, more time...


Anyway, I am charging ahead as you have Sonny; I head to Texas to see family in first week of July (post #1) and camping/inn-ing in Utah in last week of July (post #2). I will finish my last cycle in early October.

be calm and be strong
rf
Posted 6/18/2016 1:14 AM (GMT 0)
Question: What determines if one needs chemo in addition to HT? I am G9 and had prostatectomy in 2010, undetectable for about 4 1/2 years. Now has risen to 14.5. Whole body and chest scan clear. But Onc. wants to throw chemo in with the Lupron. Kind of confused.
Posted 6/18/2016 1:35 AM (GMT 0)
Sonny my dad is on taxol/carbo so a bit different mix and also still gets the Lupron shot. He had 6 weeks of 20-25% PSA reductions 1900-down to 580 or so. He had a week off and resumed 3 straight weeks. However at treatment 8-9 the PSA went up 200 points. Dr was not bothered since it was not a trend. Since then the 20% reductions have continued on down to the mid 300's last week. His dr basically would keep the treatment the same until PSA rose 3 treats in a row. I also am not totally sure but I thought he said when dad got his lupron after third treatment that it would slow the effects of the chemo- something with the hormones? But the it was a needed evil. Dr has a guy or 2 that have been on this regime for over a year with PSA near 1.00. Dads side effects are thinning hair and hands and feet feeling like they are burning all the time. He takes ha painting for that and a Percocet a day. Hope this adds some insight. i think you are on a good path for some time!!
Posted 6/18/2016 12:22 PM (GMT 0)
Sonny, yes it seems the chemo has it in for me. Resigned to feeling like poop for two weeks out of three for the rest of the summer. One interesting side effect is chemo induce keratosis. I have it below my left eye and about three days after dosing it turns a bruised color and develops scaly skin. Looks like I have a black eye. Then about the ninth day in it starts to clear up and by day 12 it is pink and smooth again. My onco (or his PA) says he has never seen this. My skin doctor says it is common.

One SE that I have not gotten is hair loss and it appears to be growing. But there is not a lot there anyway.

Going for round three on Monday.

Hope your good fortune continues and you have a great response to the treatment.

Don
Posted 6/19/2016 5:54 AM (GMT 0)
Sonny
It's great to hear that your side effects are minimal to nonexistent. That has to make this whole process a little easier. I remember seeing a couple guys getting chemo when I was and they kept their full heads of hair. Mine started falling out in clumps which is when I just shaved my head like you did. My facial hair and body hair just fell out too. I didn't have to shave once for at least 6-8 months after my chemo finished and my face was as smooth as a baby's butt. Still don't have any hair below my neck.
I don't know about the PSA change for sure in your case but I have seen PSA's plateau before dropping again. And it looks like your 0.10 drop wasn't even a full month so hopefully you'll get another drop next time.
Enjoy your travels and keep up the the good reports!
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