Chemotherapy ...Scared

I'm so sorry to hear that. I haven't had chemo yet, but I know that some oncologists now believe it's better to combine medication, radiation, and chemo right up front for a 1-2-3 knockout punch, and I'm hoping that's what happens for your husband.

Have both of you discussed other options with the oncologists, like Pluvicto?

Many people in the forum have read and recommended this book. It's a good overview of the different situations and treatments to discuss with your husband's care team:
https://www.amazon.com/Patrick-Walshs-Surviving-Prostate-Cancer/dp/1455504181

Chemo works quite well for many people. If he doesn’t want to lose his hair, get a cold cap which you use when having chemo and it can prevent the loss of hair.

Some people have very uncomfortable side effects from chemo other people have very little. It could take a few days before the side effects hit you.

What was your husband’s Gleason score, that can make a difference in how he responds to treatment Compared to others. Did he get a decipher test? Did he have intraductal or cribriform? Those can make the cancer more aggressive. These Things could be the reason he didn’t stabilize compared to other people.

Some people have to go into triplet therapy Right after they get diagnosed, Usually because they have extensive metastasis. Triplet therapy is ADT plus apalutamide or equivalent and chemo. They do that to try to knock it out early and completely.

This whole subject of cancer is scary in general, but please don't let "chemo" alter your necessary path. A million or more people have been through it, so there is a lot of first hand information available.
I've been through it twice for stage 4 prostate cancer about 7 years ago, first Taxotere then Jevtana. It kicked the perverbial can down the road for about 5 years, then I had other treatments. Prior treatments included the standard protocol of drugs, some surgery and targeted beam radiation. After chemo, Pluvitco which did the most good. With chemo, I lost my hair, but it much of it is back, a little thinner and whiter. I'm 73, so that's a small price to pay. I had periods of nausea, but over all it was tolerable.
My personal thoughts, do what you need to do. Arm yourself with hard, factual scientific information, options and a surround yourself with a good medical team. Knowledge will reduce the fear. Don't procrastinate, cancer doesn't go on vacation.

I'll add one point. When my friend was going through chemo, he loved mint tea (made with fresh mint leaves from my yard) and Peek Freans assorted creme biscuits, even when it was challenging to keep other things down. If nausea hits (and it doesn't always), it's sometimes selective, so look for what still appeals.

First diagnosis I started with stage 4 metastasized to the bone. Started with 10 rounds of chemo and firmagon. Yes the chemo is rough to go through but for me the sides are all the same. You can do this. As for my hair, started falling out with treatment, I shaved it off,,year later its all back, small price to pay. I like to laugh so during treatment I wore shirts, Chemo, breakfast of Champions, My Oncologist does my hair, to make me smile. When I finished last treatment, Dr said I was done,,, for now. If down the road I have to do again, so be it. Much better then the alternative. For me with so much focus on fighting the side effects, I don't really focus on the fact I have cancer. Hope this makes sense. I wish you the best on this journey. Best to all.

Over the years since 2017 P radiated out, I had in 2020 Xtandi, then Radium 223 then 2 rounds of Docitel Chemo this October as other failed. I got PSA flair on fist chemo the process was easy . Google PSA flair
On the second chemo my excellent immune system fought the Chemo and I got fluid in the lungs as well as a small blood clot. Been on 80, then 40 mg Prednisone for 6 weeks now as fluid reduces. Resperologist prescribed POA portable Oxygen Generator for walking under load and going outside. Airplane approve

December MRI, CTCAT and then may put me on Zytega or Appalutimide to control prostate metastasized in T 5 L3 and lower spine BONES only slice 2020.

Which drug is best?? Cant do chemo even if Cobistan as poises me.

@melcanada Apalutamide is much newer than Zytega, and the "-lutamides" in general are a bit like miracle drugs for some cancer situations (that may or may not apply to yours).

Apalutamide is also, unfortunately, very expensive. In Canada, it costs nearly CA $5,000 (US $3,500)/month; in the U.S., it can cost 4 or 5 times that much. Ontario did add Apalutamide to the formulary in early 2022, so it's covered by the Ontario Drug Plan, the Trillium Drug Benefit, and most private insurers. There's also a patient-access programme that your oncology team might be able to enroll you in, if there's some issue with coverage.

From what you describe, he may now be castrate resistant - After a year of apalutamide and the Eligard shots with Stage 4 Prostate Cancer...the hormone therapy isn't working anymore..."

You ask two questions, about chemotherapy and what is going to happen next...

The forum is responding based on the clinical information you provide, more would strengthen the responses - Gleason Score, Grade Group, has he had surgery, if so, the pathology report, treatment timeline, age, overall health, any co-morbidities

Generally, chemotherapy works to reduce the cancer burden. I did six cycles of Taxotere starting in January 2017, I was 61 and in pretty good shape both physically and health wise.

I assume they determined his ECOG status:

The Eastern Cooperative Oncology Group (ECOG) Performance Status (PS) scale is a tool used to assess a cancer patient's ability to function and care for themselves:
What it measures
The ECOG PS scale measures a patient's ability to perform daily activities, walk, work, and care for themselves. It also describes the patient's symptom status.
How it's used
The ECOG PS scale is used to help guide clinical decisions and prognostication. It's also used to select patients for clinical trials and standard cancer treatments.
How it's scored
The ECOG PS scale uses a 5-point scale:
PS 0: Normal activity
PS 1: Some symptoms, but still near fully ambulatory
PS 2: Less than 50% of the day in bed
PS 3: More than 50% of the day in bed, but not bedbound
PS 4: Completely bedridden

I did lose my hair, it grew back, a few of the nails turned black and blue, they came back, I had chemo mouth but ate pretty much normal diet. I did continue to work, went to the gym, did yard work, rode my bike...My infusions were on Thursday, with the anti-nausea medications they put in first to prevent vomiting from the Taxotere infusion, I felt "pretty good" the first 24-28 hours, then would crash for the next 72-96 hours, then feel better for the next two weeks and start over again. The side effects are cumulative, the fatigue hit hard on the 4th infusion.

As to what's ahead, the possibly many treatment choices to manage his prostate cancer (see the article I attached). If you have not already, familiarize yourselves with those. Reading through the NCCN Guidelines for Advanced PCa and the Prostate Cancer Foundation which has excellent resources can inform you of those treatment options so you can discuss with his medical team.

It's not over!
https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1459
https://www.pcf.org/
Kevin

I finished 6 rounds of Docetaxel and I would not be afraid to do it again but would not necessarily want to. I’m 58 and have stage 4 PC with many metastasis, PSA at diagnosis was 60 and by the time I left Mayo Rochester it was 120. Gleason 8. My local oncologist and my Mayo oncologist (Dr. Orme) agreed that triple therapy was indicated in my case. I started chemotherapy a month or so after starting hormone therapy. My first infusion was fairly uneventful and the side effects were not felt until day three, those steroids work wonders right after infusion! The second treatment was a different story, I had an anaphylactic response to the chemo, which was extremely scary. The infusion team handled it with very rapid and calm response and within 15 minutes I was back to normal and the infusion resumed. The third infusion the team made some changes but again I felt the anaphylactic response beginning and the team again dealt with it. For the remainder of the treatments they gave me double the amount of Benadryl and halved the speed of the infusion so each treatment took 4-5 hours total.

I was advised to take Claritin during the entire time which I did, not medical advice, ask your oncologist. I found the side effects did increase over time and had to fight through the fatigue. Started losing my hair after the second treatment so had the remainder cut off. I found after treatment I was very constipated and needed a laxative to “get things moving”, again, please ask your doctor if this is right for you. Luckily I wasn’t nauseated but the metal taste made enjoying eating a challenge. What tasted good changed after each treatment, and I had to force water because it was very metal tasting. I did / do have peripheral neuropathy in my feet and finger tips. I purchased a device (from Amazon) to hold the sheets and blankets off of my feet because the weight of them would aggravated my toenails and keep me awake, the device was a game changer! Still have some finger and toenail issues but they are decreasing. The most annoying issue is nasal drip and a cough I can’t seem to completely kick, not sure if this is chemo related but started during treatment. Hopefully we can find the cause and heal it, currently managing the effects with cough syrup at night.

I did make a conscious effort to avoid crowds and drank bottled water during treatment to try and avoid illness, didn’t get “sick” during the treatment which I was happy about. I didn’t eat deli meat, shell fish or sushi.

My PSA went from 120 to >=0.1 within 4 months so all of the side effects of triple therapy have been worth it for me.

One thing to keep in mind is that chemotherapy for PC is less toxic than other chemotherapy treatments so the side effects are somewhat less. I tired to remember that and I think it helped.

I wish you the best and hope if you do choose chemotherapy it will kick some PC arse!