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What would you say on a podcast about PCa?
Prostate Cancer | Last Active: Aug 27 8:19am | Replies (27)Comment receiving replies
John
I asked for triplet therapy.
At the time, the two studies, STAMPEDE and CHAARTED showed a "benefit" for use of chemotherapy in high risk patients.
I first went to to see the Director of Urology at the nearby NCCN Center. I laid out my clinical history and my rationale for doing chemotherapy, that being while I might not meet the criteria in those two studies at the moment, given my PSADT and PSAV, I would be shortly!
He dismissed the idea, said he would treat me using mono-therapy, ADT, continuous.
He left, I told his PA I wasn't doing that and would go elsewhere to get the best treatment.
I went to Mayo in Rochester where Kwon recommended the triplet therapy based on my clinical history and the results of a C11 Choline scan.
I agreed. He asked if I had a medical team here that would do it. I said yes.
Aggressive PCa necessitates aggressive treatment decisions. Those decisions often don't fit neatly inside guidelines such as NCCN and AUA, thus making some doctors unwilling or reluctant to prescribe them. In a way, I understand, given malpractice issues, if they venture outside the box, are they subject to risk of the patient turning on them..!?
If I understand correctly, those two studies have refined their data and the general consensus is that chemotherapy may have a benefit in high but not low volume prostate cancer.
So, back to the dilemma, standard of care or...fortune favors the bold.
Kevin
Replies to "John I asked for triplet therapy. At the time, the two studies, STAMPEDE and CHAARTED showed..."
I'm in exactly that place. Gleason 9 with adverse factors like cribriform, multifocal, bladder neck invasion and so on. Aggressive. Surgeon said it could have been fatal if not removed. Second post-op PSA was low - 0.02. Urologist and second opinion at looked at PSA and said no need to do anything more right now even though recurrence is likely. I'm getting one more opinion, and if he agrees with the first two I'll be calm until my next blood work in about a month. They're preaching patience, and my mind is racing. If radiation is likely, why are we waiting? This PCa thing is much harder mentally than physically, at least for me. Grateful for everyone's comments.
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Thanks Kevin!
I agree with you 100% I’m trying to be aggressive as possible. Had prostatectomy in May, started Firmagon 3 weeks ago, staring zytiga in 2 weeks, starting radiation in about 3-4 weeks. I believe I have to hit the cancer as hard as possible now to ensure “many years” of survival and I will continue to ask my MO about chemo and other treatments, but I expect she will push back in the short term for all the reasons you wrote above.
Thanks!