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Offense or Defense for Advanced PC?

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Prostate Cancer
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Posted 7/14/2018 11:07 PM (GMT 0)
Finished Taxotere 5/23/18, PSA now down to 0.68 from a high last Sept of 58. First C-11 scan showed 10+ mets in lymph & bone; last scan shows over 90% of PC is gone. No lymph mets now and only a couple bone mets.
We've just consulted two of my 4 ONC Docs to get a "What's Next?" plan of action. If I were coaching a football team, I'd have and Offensive Coordinator, a Defensive Coordinator, and a couple Special Teams Coaches (though punting I'm told is a bad strategy for advanced PC).
My defensive doc says to stay on Lupron, Casodex, and xGeva (for bone mets)--and watch and wait. The larger bone met in the hip could be radiated if it gets worse. PSA's at 0.68; if it starts to go up if/when HT stops working, we could start Zytiga.
My offensive coach says start Zytiga NOW. And strongly consider radiation for the hip met. He wants my PSA to get to 0.1 and the only way that's likely to happen is if we do Zytiga now.
I know some of you have had similar play calling challenges and would love to get your feedback. Thanks to ALL for your support.

-Steve
Posted 7/14/2018 11:48 PM (GMT 0)
Because you're still hormone sensitive, I think starting Zytiga now is a great idea. If you're already taking Xgeva to maintain bone density while on ADT, you should add Celebrex to it. I don't think there's any justification for the idea of saving stuff for later - the survival increases are generally much larger when used earlier. Later, there will be other medicines.

You might also consider the clinical trials described here:

/pcnrv.blogspot.com/2017/06/newly-diagnosed-metastatic-m1-but-still.html
Posted 7/15/2018 1:28 AM (GMT 0)
Yup, for what its worth, I'm with TA and your Offensive Coach on both scores . . . Zytiga and RT for the hip met, now! Don't even let it up for air.
Posted 7/15/2018 4:27 AM (GMT 0)
Thanks TA and Balladeer. Great link to trials. Right on point. It’s taking a bit of processing time to jump into another treatment right after Taxotere but my doc in LA is saying that’s the recommended path in order to get PSA to 0.1. I didn’t know that was the goal, but I do now. Thanks again, guys.
Steve
Posted 7/15/2018 3:05 PM (GMT 0)
Hit it as hard as you can with everything that's available to you..If you complain about pain from that hip met they will Zap it (SBRT?) with just a few treatments and no squawks from your insurance company..

Many of the guys don't seem to realize that both Xtandi and Zytiga are just advanced Hormone treatment..They don't attack the cancer directly.....
Posted 7/15/2018 4:04 PM (GMT 0)
Fairwind,

It's off-topic somewhat, but I'm curious . . . your signature area states that your CT/PET scan of 11/2017 was "clear", yet it also states that there were "4 new bone mets". Could you please clarify this for me? Specifically, if the scan(s) were clear, how did you or they discover new bone mets? Thanks.
Posted 7/16/2018 5:07 AM (GMT 0)
Thanks all. Fairwind, how are you doing with taxotere?
Posted 7/16/2018 2:31 PM (GMT 0)
After 4 rounds of taxotere my PSA has dropped from 200 to 140...At least it's moving in the right direction...Last Novembers bone scan looked good, but by January this year, the Xtandi stopped working and my PSA skyrocketed, doubling time less than 30 days..By June it was over 200..Fortunately, few of us have to fight the Gleason 9 (or 10) dragon......I'll take a look at my signature and make sure the time-line is correct...
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