Chemo, Lupron & Nubeqa (Triple treatment) Outcomes

Colleen - My situation was similar, but occurred over a short period of time. I had a Gleason 9 (4+5) after prostatectomy in July 2024 with rising PSA after surgery, 3 small lung nodules appeared with PSMA and after Eligard injection nodules disappeared by December 2024 and PSA was undetectable. Nubeqa was added to Eligard and one oncologist offered/encouraged adding Chemo (Docetaxel) but I declined for now, as no other metastasis was found and I feared neuropathy complications, as I already have that in my feet. Another reason I declined the "Triple" is that I was told, with or without chemo I would still remain on hormone therapy, Eligard plus Nubeqa or another combination, for the rest of my life. In my opinion and from what I have experienced, side effects of hormone therapy alone are daunting, over time, not to mention the effects of chemo. Another oncologist recommended if the hormone therapy alone is working to keep PSA undetectable and future scans show no metastasis, keep the "Triple" at bay until warranted. I realize the cancer will re-occur, regardless, but less likely with Triple. Quality of life vs. a few more months of life need to be weighed as well - again in my opinion. Other thoughts?

I have posted my journey several times in other threads, but since you specifically asked about triple therapy outcomes I will give a synopsis again.

I had a RP in 10/21 for G9 at age 68 without known metastasis at that time. Unfortunately, 6 months later my PSA began rising and PSMA PET disclosed a single T8 met. It was treated with SBRT only. Four months later a rapid doubling of my PSA prompted me to seek care with a MO and after considerable search I went to Johns Hopkins. A repeat PET revealed a new pelvic node although there was certainly additional micro metastatic disease below the resolution of the imaging. The previous T8 lesion showed no uptake.

My MO immediately began triple therapy (Lupron, Docetaxel and Darolutamide). He gave me only 4 cycles of chemo as he stated there was scientific evidence that additional cycles were beneficial. My PSA went undetectable after the 2nd chemo cycle (every 3 weeks) and has remained that way. He discontinued the Darolutamide after my chemo, a total of 3 months. He discontinued my Lupron after one year. He recommended I have whole pelvic radiation between 8-12 weeks following the chemo as this was the optimal kill time for the tumor after triple therapy. I did as he suggested.

As of July, 2023 I have been off all treatment for my prostate cancer. Mt testosterone never recovered. He started me on TRT (testosterone replacement therapy) 6 months ago under the care of an endocrinologist. After 6 months on TRT my PSA remains undetectable. My low T symptoms have all resolved (fatigue, mild depression, muscle atrophy, loss of libido and hot flashes. I now remember why I liked sex!)

I realize my MO at Hopkins has an unconventional approach. He gave me the options every step of the way. I took his advice. He did advise against staying on Lupron and Darolutamide indefinitely. He has his reasons. He has been dong prostate cancer research for 30 years as well as treating patients (mainly those with oligo metastatic disease). He is the Director of the Brady Urologic Cancer Institute at Hopkins and is Professor of Medical Oncology, Urology and Molecular Biology. I say this because I understand his treatment protocols differ from SOC and putting his patients who do not recover testosterone on TRT is also controversial.

His protocols are tailored to the individual. These protocols may not apply to others. When I had my initial consultation I told him I wanted aggressive therapy with reasonable risk ratio. He believes some patients with oligo metastatic disease can be cured. I would like to believe that as well.

Having practiced medicine for 40+ years I made a decision when I was diagnosed with PC. Do my research to find the best physicians I could to treat my cancer and then follow their advice. I realize others prefer to be more involved in directing their treatment and that is fine. That doesn't mean that I am not informed as to the decisions. I basically ask " what do you believe is the optimal course of treatment?" and then follow his advice. His knowledge in this field so far surpasses mine that I would be unwise to elect a different course of treatment.

Just my opinion, of course.

I have posted my journey several times in other threads, but since you specifically asked about triple therapy outcomes I will give a synopsis again.

I had a RP in 10/21 for G9 at age 68 without known metastasis at that time. Unfortunately, 6 months later my PSA began rising and PSMA PET disclosed a single T8 met. It was treated with SBRT only. Four months later a rapid doubling of my PSA prompted me to seek care with a MO and after considerable search I went to Johns Hopkins. A repeat PET revealed a new pelvic node although there was certainly additional micro metastatic disease below the resolution of the imaging. The previous T8 lesion showed no uptake.

My MO immediately began triple therapy (Lupron, Docetaxel and Darolutamide). He gave me only 4 cycles of chemo as he stated there was scientific evidence that additional cycles were beneficial. My PSA went undetectable after the 2nd chemo cycle (every 3 weeks) and has remained that way. He discontinued the Darolutamide after my chemo, a total of 3 months. He discontinued my Lupron after one year. He recommended I have whole pelvic radiation between 8-12 weeks following the chemo as this was the optimal kill time for the tumor after triple therapy. I did as he suggested.

As of July, 2023 I have been off all treatment for my prostate cancer. Mt testosterone never recovered. He started me on TRT (testosterone replacement therapy) 6 months ago under the care of an endocrinologist. After 6 months on TRT my PSA remains undetectable. My low T symptoms have all resolved (fatigue, mild depression, muscle atrophy, loss of libido and hot flashes. I now remember why I liked sex!)

I realize my MO at Hopkins has an unconventional approach. He gave me the options every step of the way. I took his advice. He did advise against staying on Lupron and Darolutamide indefinitely. He has his reasons. He has been dong prostate cancer research for 30 years as well as treating patients (mainly those with oligo metastatic disease). He is the Director of the Brady Urologic Cancer Institute at Hopkins and is Professor of Medical Oncology, Urology and Molecular Biology. I say this because I understand his treatment protocols differ from SOC and putting his patients who do not recover testosterone on TRT is also controversial.

His protocols are tailored to the individual. These protocols may not apply to others. When I had my initial consultation I told him I wanted aggressive therapy with reasonable risk ratio. He believes some patients with oligo metastatic disease can be cured. I would like to believe that as well.

Having practiced medicine for 40+ years I made a decision when I was diagnosed with PC. Do my research to find the best physicians I could to treat my cancer and then follow their advice. I realize others prefer to be more involved in directing their treatment and that is fine. That doesn't mean that I am not informed as to the decisions. I basically ask " what do you believe is the optimal course of treatment?" and then follow his advice. His knowledge in this field so far surpasses mine that I would be unwise to elect a different course of treatment.

Just my opinion, of course.

I’m a little confused about one statement you made

“ MO immediately began triple therapy (Lupron, Docetaxel and Darolutamide). He gave me only 4 cycles of chemo as he stated there was scientific evidence that additional cycles were beneficial.‘

Did you mean to say that additional cycles over 4 were “not” beneficial? Or was he just holding off the other two for later if something happened?

I have posted my journey several times in other threads, but since you specifically asked about triple therapy outcomes I will give a synopsis again.

I had a RP in 10/21 for G9 at age 68 without known metastasis at that time. Unfortunately, 6 months later my PSA began rising and PSMA PET disclosed a single T8 met. It was treated with SBRT only. Four months later a rapid doubling of my PSA prompted me to seek care with a MO and after considerable search I went to Johns Hopkins. A repeat PET revealed a new pelvic node although there was certainly additional micro metastatic disease below the resolution of the imaging. The previous T8 lesion showed no uptake.

My MO immediately began triple therapy (Lupron, Docetaxel and Darolutamide). He gave me only 4 cycles of chemo as he stated there was scientific evidence that additional cycles were beneficial. My PSA went undetectable after the 2nd chemo cycle (every 3 weeks) and has remained that way. He discontinued the Darolutamide after my chemo, a total of 3 months. He discontinued my Lupron after one year. He recommended I have whole pelvic radiation between 8-12 weeks following the chemo as this was the optimal kill time for the tumor after triple therapy. I did as he suggested.

As of July, 2023 I have been off all treatment for my prostate cancer. Mt testosterone never recovered. He started me on TRT (testosterone replacement therapy) 6 months ago under the care of an endocrinologist. After 6 months on TRT my PSA remains undetectable. My low T symptoms have all resolved (fatigue, mild depression, muscle atrophy, loss of libido and hot flashes. I now remember why I liked sex!)

I realize my MO at Hopkins has an unconventional approach. He gave me the options every step of the way. I took his advice. He did advise against staying on Lupron and Darolutamide indefinitely. He has his reasons. He has been dong prostate cancer research for 30 years as well as treating patients (mainly those with oligo metastatic disease). He is the Director of the Brady Urologic Cancer Institute at Hopkins and is Professor of Medical Oncology, Urology and Molecular Biology. I say this because I understand his treatment protocols differ from SOC and putting his patients who do not recover testosterone on TRT is also controversial.

His protocols are tailored to the individual. These protocols may not apply to others. When I had my initial consultation I told him I wanted aggressive therapy with reasonable risk ratio. He believes some patients with oligo metastatic disease can be cured. I would like to believe that as well.

Having practiced medicine for 40+ years I made a decision when I was diagnosed with PC. Do my research to find the best physicians I could to treat my cancer and then follow their advice. I realize others prefer to be more involved in directing their treatment and that is fine. That doesn't mean that I am not informed as to the decisions. I basically ask " what do you believe is the optimal course of treatment?" and then follow his advice. His knowledge in this field so far surpasses mine that I would be unwise to elect a different course of treatment.

Just my opinion, of course.