‘Big Guns’ - Triple Therapy with Double Chemo - How to prepare?

I haven't had chemo myself (yet), but I know my friend lost a lot of weight on it, so I think going in with 10 or 20 lb to spare can't hurt.

Sugar consumption has no demonstrated effect on prostate cancer, but reducing sugar intake can be helpful for avoiding secondary complications like diabetes. During chemo, however, he should probably eat an unrestricted diet of whatever he feels like (if he feels like eating at all) — confirm with his medical oncologist, of course.

Thanks for the reply - he is starting out at his lowest weight ever, so pushing more healthy eating. Its so odd, because he has no symptoms from the metastasis or ca (yet) and postponed a much needed hip replacement because of this recurrence. The hip is the true bother/pain/restriction at this point.

Lung nodules can be a little tricky to treat, but they can Use SBRT to eliminate them. It is recommended that you start with ADT and abiraterone. For ADT you should request Orgovyx instead of Eligard, The daily pill is easier to manage and you don’t need to start off with Casodex To prevent a PSA flare. In some cases ADT and a secondary drug can reduce the lung metastasis so they are no longer visible. All depends on how they want to treat them.

It is recommended that people start with abiraterone and move on to a lutamide later. Here is an article that discusses this sequencing.
https://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(19)30688-6/abstract
If he has heart issues, then it may make more sense to go with Nubeqa. Abiraterone is tough on the heart and raises blood pressure for most.

Thanks, @jeffmarc. I have been a fan of SRBT from reading papers, but our team isn’t a fan of SBRT above the diaphragm unless it a solitary nodule… we had hope for some directed therapy and even wondered about Lutetium, but I guess the game is to save some tools in the toolbox for later. And we asked about Orgovyx and the response was ‘ we haven't used it in triple therapy before’ - it wasn’t a no, but it wasn’t a yes. We will finalize with our oncologist next week. Thanks for responding - it’s scary to be starting with so many things when he hasn’t even done ADT or radiation of any kind.

My chart says I got 20 gy of post-op SBRT to my middle spine (T3, well above the diaphragm) in 2021, after the surgery to debulk the lesion. It's very important that you stay perfectly still when they're working near so many vital organs. For me, they made a custom cage that held my head immobilised during radiation.

It was very uncomfortable, but on the bright side, I'm not aware of any side-effects from that round of radiation therapy.

Orgovyx is basically the same thing as Firmagon — a GnRH antagonist — but in pill form (at least that's what my oncologist told me), so if they're comfortable with Firmagon injections, Orgovyx shouldn't be a big departure for them, and in my experience it significantly cut down on the discomfort of ADT (vs injections).

I started with firmagon, chemo and prednisone, when I was getting chemo, nothing tastes good. Even water tastes bad. I used protein shakes. The longer I chewed food, the worse it tasted. My wife made my food "mushy". Anything that didn't take much chewing that you could just swallow fast. And of course people will say just eat it, well, not so easy. The shakes were a big help. Best to all.

I had the exact treatment you are referring to with Nubeqa I completed over a year ago. I immediately followed it with Pluvicto so I refer to my treatment with a prefix of Quad or Quinn(since there was Carboplatin and Pluvicto in addition to the triplet therapy so many refer to). I had my chemotherapy at Minnesota Oncology in Maplewood and my pluvicto at Mayo. I iced my head, my hands and my toes To prevent neuropathy And Hair loss. It was very effective. The Antiemetics Given worked great. I also wore the patch after to stimulate my white blood cell count, which worked great. I had about a week of mild nausea But had no trouble exercising and keeping my weight stable. But I was very healthy going into this. A long time runner and regularly lifted Moderate weights. I am one year out now, and my problem has been recovering my hemoglobin. I was at 10.3 A few months ago, and I’m scheduled next week for lab work. I have PET scans every three months and they have been pretty good stable at least, Some improved.

Great advice from the trenches, Steve. Just to add, I recently shopped for protein shakes for a friend who had a stroke.
Most of these are LOADED with sugar - like 30 grams/serving. Look for Ensure with no sugar.
It’s very high in protein but check with your RO if the sugar substitutes - usually mannitol or sucralose - will be problematic since they do cause gas in most people.
It seems that his radiation will be above the diaphragm so it should not pose a problem, but please check beforehand. Best,
Phil

Thanks - replies are SO helpful. I guess it is because its lung tissue and maybe the team would consider later if there is residual tumor...? And good to hear no side effects - and 4 years out!