4th chemo infusion: Anyone had worsening symptoms with chemo?

Some clarification needed here. Originally diagnosed (Gleason 4+3) four plus years ago. Had prostatectomy, about a year of remission, then recurrence (.2 PSA), then salvage radiation with ADT. Had been < 0.1 PSA ever since (2 years +) until it jumped to 0.1 in late August ‘25 and then across the 0.2 clinical recurrence threshold just last month. PSMA in three weeks. ADT didn’t fail me. Rather I stopped doing it. The current standard of care pairs the ADT with the salvage radiation, but the ADT is stopped once the salvage treatment scheme ends.

I learned about the ARASAFE study in the course of general research because chemo, Docetaxel in particular, could conceivably be part of my treatment scheme down the road. Pending the PSMA outcome, my doc is currently thinking I may well go back on ADT. He says it could be aimed at reducing testosterone production OR at reducing T production AND inhibiting it from getting through the cell malignant cell barrier.

Hope this helps a bit, Colleen. If not, let me know.

@reil
When your PSA starts rising after you go on Lupron (or stop ADT)you are supposed to go on an ARPI, or back on ADT. I went on Zytiga for 2 1/2 years and it kept my PSA quite low, After that, I went on Nubeqa And it has allowed my PSA to stay undetectable for the last 24 months. Two years ago, I did have a metastasis zapped on my spine with SBRT radiation. That’s one of those things PSMA PET scan scans can find. They don’t normally do chemo until after they do an ARPI, Since it can keep you going for many more years without needing chemo.

Since you don’t want to be on ADT, And your PSA is rising if you aren’t on it, you could go on Nubeqa (Darolutamide). It is an ARPI drug that has very few side effects for most people. It can work even though you have testosterone. It does not pass the blood brain barrier so it doesn’t cause brain Fog. Ask your doctor about it. A lot of times they like to put you on Xtandi (Enzalutamide) But it has a lot more side effects than Nubeqa.

I’ve done some research on the chemo treatment and have learned that it is possible to receive lower doses more frequently (like once a week for three weeks instead of once every three weeks) with the same efficacy. Apparently the side effects are greatly lessened. I asked our doc about this and he said sure he can order it that way. I am preparing for the day if/when chemo is the next step for my husband. Just FYI, not saying others should do it.

@ucla2025. You are correct. See the ARASAFE study