when is chemo advised these days

I remember when I was first dx. and failed surgery, then SRT.
I remember chemo seemed like my next tx. after HT. Not a good thought.

But then a few other txs came to pass (Zytigia, Xtandi). That put chemo further down. I LIKED that.

But then we had studies that indicated early chemo was better (adding 17 months to overall survival as I recall).

My question: what is the cohort here? Is it anyone on HT? Is it HT with Mets (if so, do local mets like pelvic node(s) count). Is it those who are castrate resistant?

Seeking answers.

(This is a Tall Allen type question!)

Mel

Thanks Jack.

The headline talks about combining chemo with HT, at the start of HT.
It then says: "The study enrolled 790 men with metastatic prostate cancer "
Later it says:
"approximately two thirds of patients had a high extent of metastatic disease which, according to the study, meant the cancer had spread to major organs such as the liver, or had spread to four or more bone sites, or both."

It later mentions that the combo is recommended for those in the more advanced mets group as they received the most benefit.

The differences were quite significant.

But I wonder if that is the current status

Mel

Unfortunately, I think it may depend on who you ask. I'm currently in process of getting multiple opinions for treatment. I have G9 and one confirmed positive lymph node. An RO I spoke to last night told me that with my condition, there is no doubt that I should get Chemo immediately after radiation. The first RO and surgeon I spoke with initially said that I should chemo with my initial treatment but later said "more information from Stampede" suggested that I didn't need it because I have only the pelvic lymph node met. Another RO and Uro I spoke to looked at me like I was silly when I asked about Chemo and said that "wouldn't apply to you until way down the line if ever".

Tony just told us that the latest CHAARTED update confirms a benefit (of about 17 months) only in the cohort that had multiple mets. STAMPEDE hasn't provided a secondary analysis of that. The situation is M1 (distant mets) and hormone-naive. By the time the cancer has progressed to castration-resistant and M1, the benefit falls to about 2.5 months, if I recall correctly.

Schoolpsych-

None of this applies to men in your situation (M0, N1, high risk - never treated). There was a trial (RTOG 0521) of chemo+radiation for high risk men. Chemo conferred only a very small benefit. Personally, I don't think it was big enough to justify the risk, but that's up to you. It specifically excluded men with positive LNs (N1).

/pcnrv.blogspot.com/2016/08/docetaxel-with-primary-radiation.html

I have a definition question. When they say "hormone naive", does that mean only guys that never had any kind of hormone therapy? Some of us have hormone therapy as part of our primary treatment, usually in addition to radiation therapy, some for as much as 3 years. Having thus been treated with "curative intent", the hormone therapy is eventually stopped. With luck, this can provide at least a durable remission.

Some time later, if the PSA should start rising in a biochemical recurrence, is such a person considered "hormone naive"? Does it just mean a case that still responds to hormone therapy, as in not "castration resistant" yet? Treatment options sometimes mention applicability to those who are "hormone naive".

This is all hypothetical for me right now, fortunately. But I do like to look ahead to see what options there might be.

Tall:

Oh, I thought hormone naive simply meant the PC was not resistent.
Thanks for the clarification.

I;m not sure where that puts me regarding whether or not to do chemo if Mets show. Sounds like I don't fit the cohort and should just go back on HT???

Am I missing something?

I know Dr. Lam has hinted at the possibility of chemo.

Mel