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A Quandry between two medical recommendations for mPCa to lung only

Posted by dpfbanks @dpfbanks, Apr 21 8:13pm

History is in profile and I have asked a few questions here already. The gist is we went to a large research center and got a recommendation for a pretty aggressive ‘quad’ therapy, I call it because it’s triple therapy adding carboplatin to the Docetaxil for the chemo portion. This is in conjunction with ADT (just received Firmagon belly shots) and Abiraterone (+prednisone). This is recommended due to the odd presentation of 3 lung nodules on PET and current PSA of 0.34, and low mutational burden from liquid biopsy. It’s seems it’s the odd unknown that is screaming for this non- traditional therapy (only found one other here with that tx…so far).

We met today with our local MO who is not embracing that ‘quad’ therapy as he states there are no clinical trials supporting it. He prefers the triple therapy..BUT, he is willing to start with the Docetaxil+Carboplatin and then do the ARPI (Abiraterone) when chemois finished in 4.5-5 mos.

So which do we choose? Triple or Quad with delayed ARPI?
Is delaying the ARPI to add carboplatin a detriment seeing how the trials with ARPIs are so beneficial? Is adding carboplatin really a benefit or where can I find info about adding it for PCa? That’s too many questions!Yet, I hope some of you in this wise & experienced group can shed some light. 🙏🏼

Interested in more discussions like this? Go to the Prostate Cancer Support Group.

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heavyphil | @heavyphil | May 2 6:59am
In reply to @dpfbanks "Update: Day 7 post Chemo #1/6. Doxetaxel + Carboplatin. He feels pretty good today and has..." + (show)
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Update: Day 7 post Chemo #1/6. Doxetaxel + Carboplatin.
He feels pretty good today and has been able to stay active, which we are told is key - slow walks, short bike rides, and some wood splitting! His worn out hip joint appreciated the steroid in the cocktail on day 2, even though it was a temporary reprieve. Yesterday was first day without deep long naps, yet sleep at night turned less deep. Appetite has been good, although he needed encouragement the first 5 days. I recommend the book, ‘Cancer Fighting Kitchen’ highly - good info on how to nourish for side effects. We don’t know what to expect but it seems the side effects and impact will be cumulative. We will see - so far, the plan is kicking it to the curb asap!

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The ADT can cause sleep issues - from insomnia to restlessness. My sleep was terrible while on Orgovyx but since I knew it was a SE I just took it for what it was and napped during the day.
It seems that he is doing pretty well, all things considered, so hang in there. It will be over before you know it.
Best,
Phil

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dailyeffort | @dailyeffort | May 3 9:42pm
In reply to @dpfbanks "Update: Day 7 post Chemo #1/6. Doxetaxel + Carboplatin. He feels pretty good today and has..." + (show)
Profile picture for dpfbanks @dpfbanks

Update: Day 7 post Chemo #1/6. Doxetaxel + Carboplatin.
He feels pretty good today and has been able to stay active, which we are told is key - slow walks, short bike rides, and some wood splitting! His worn out hip joint appreciated the steroid in the cocktail on day 2, even though it was a temporary reprieve. Yesterday was first day without deep long naps, yet sleep at night turned less deep. Appetite has been good, although he needed encouragement the first 5 days. I recommend the book, ‘Cancer Fighting Kitchen’ highly - good info on how to nourish for side effects. We don’t know what to expect but it seems the side effects and impact will be cumulative. We will see - so far, the plan is kicking it to the curb asap!

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So happy to hear that your husband is doing so well with round 1 of the chemo! You have certainly put your heart and soul into researching the very best treatment options for him. I admire your perseverance and the level of understanding you aquired of potential therapies, sequences and side effects.

Thanks for sharing your recommendation of 'The Cancer Fighting Kitchen' for suggestions on mitigating side effects through nourishment. It looks like there is a 2017 Kindle version which I will add to my bookshelf.

It brightened my day to read of your husband's walks, bike rides and wood splitting! Way to go!! Your collective cancer journey continues to be an inspiration to all of us. We are sending you positive thoughts for your continued success in "kicking it to the curb asap" (I love that!).
Bill

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dpfbanks | @dpfbanks | May 13 6:36pm

Day #20 - 2 days before Chemo round 2. He’s been very active since day 6ish and yet resting as needed. Labwork today show a 70% drop in PSA! From 0.36 to < 0.1. We can embrace that. WBCs ok, but Hbg/Hct and RBCs low. The interesting result is high Immature Granulocytes. This seems like it could be from chemo or the Neulasta, but not something everyone experiences. Will be interested in doc thoughts. Anyone have this blood count change?

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heavyphil | @heavyphil | May 14 7:33am
In reply to @dpfbanks "Day #20 - 2 days before Chemo round 2. He’s been very active since day 6ish..." + (show)
Profile picture for dpfbanks @dpfbanks

Day #20 - 2 days before Chemo round 2. He’s been very active since day 6ish and yet resting as needed. Labwork today show a 70% drop in PSA! From 0.36 to < 0.1. We can embrace that. WBCs ok, but Hbg/Hct and RBCs low. The interesting result is high Immature Granulocytes. This seems like it could be from chemo or the Neulasta, but not something everyone experiences. Will be interested in doc thoughts. Anyone have this blood count change?

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I’m not a hematologist but this seems like a normal bodily reaction to the chemo which lowers the well formed, mature granulocytes. His bone marrow is fighting back💪

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dpfbanks | @dpfbanks | Aug 9 11:17am

Update - We just finished 6 rounds of double chemo on the premise of a variant yet to be confirmed - all testing has shown typical acinar adenocarcinoma of prostate origin, but the lung biopsy samples were insufficient X2 for further testing. The 3 lung tumors were about 1 cm, which the urologist called ‘big’ and the GU Oncologist called ‘tiny’ - ha. Therapy began late April with Firmagon, then double chemo (docetaxel + Carboplatin) for 3 cycles. Nubeqa was added late just before the 4th round and 6th round completed this week. Given the unconfirmed variant, we requested liquid biopsy and are doing serial CgA somatic testing - nothing noteworthy showing. PSA dropped to < 0.1 within first 2 weeks and has remained there, although it was only 0.37 at the start of therapy. Follow-up visit for PET in one month with a recommended consult for SBRT to any residual lung nodules. I am grateful for a 4 week break from labs, appts, infusions, shots etc every week and you can bet he is even more-so.

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surftohealth88 | @surftohealth88 | Aug 9 3:26pm
In reply to @dpfbanks "Update - We just finished 6 rounds of double chemo on the premise of a variant..." + (show)
Profile picture for dpfbanks @dpfbanks

Update - We just finished 6 rounds of double chemo on the premise of a variant yet to be confirmed - all testing has shown typical acinar adenocarcinoma of prostate origin, but the lung biopsy samples were insufficient X2 for further testing. The 3 lung tumors were about 1 cm, which the urologist called ‘big’ and the GU Oncologist called ‘tiny’ - ha. Therapy began late April with Firmagon, then double chemo (docetaxel + Carboplatin) for 3 cycles. Nubeqa was added late just before the 4th round and 6th round completed this week. Given the unconfirmed variant, we requested liquid biopsy and are doing serial CgA somatic testing - nothing noteworthy showing. PSA dropped to < 0.1 within first 2 weeks and has remained there, although it was only 0.37 at the start of therapy. Follow-up visit for PET in one month with a recommended consult for SBRT to any residual lung nodules. I am grateful for a 4 week break from labs, appts, infusions, shots etc every week and you can bet he is even more-so.

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Thanks for the update : ) , I was thinking often about you and your husband and was wondering about his tolerance of chemo as the time progressed. It must have been exhausting and I hope that he did not lose a lot of weight : (.

That is wonderful that his PSA got so low and stayed there - yeayyyy !!! It is also great that liquid biopsy is not showing anything :), and I have a feeling that little zombie cells are now really wiped out once and for all 🍀 : ).

Yes, enjoy those 4 weeks and rest as much as possible and perhaps PET will also come clean with no need for SBRT so you will be able to put all for this behind and finally exhale. Sending you best wishes and healing vibes 💖

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