Anyone have experience with Triple (Triplet) Therapy?

Hi, Anne. I think we met in the fediverse (where I use my real name). I'm glad you're here. You'll find lots of existing discussions (and video links) if you search for "triplet therapy" — it's the state of the art right now for treating polymetastatic prostate cancer, so it sounds like your husband has a good, up-to-date oncology team.

Search link:
https://connect.mayoclinic.org/group/prostate-cancer/
I had doublet therapy myself (which is state of the art for treating oligometastatic prostate cancer), and I've been very pleased with the results over the past nearly 4½ years.

I'm sure members who've had triplet therapy will chime in soon.

I went through it, actually quad therapy is what I called it because I also got carboplatin. They’ve come a long way with the anti-nausea and the stimulator for white blood cell count they give to keep your neutrophils up. People couldn’t even tell I was getting chemotherapy. I had some mild nausea when I went home intermittently for about a week then I couldn’t even tell I’d had anything. Of course later in treatment tiredness set in more as red blood cell count dropped. I followed all of that with Pluvicto and I’m now in remission.

Hi. I was recently put on triple-therapy, including Lupron shots every 3 months, Nubeqa twice a day, and I just finished 6 chemo infusions between 6/20/25 and 10/8/25. I have had 3 reoccurrences since diagnosis in late 2017. The last time it showed up on my hip during a PET scan. One opinion from a reputable urologist was to just radiate the hip. But another doctor, who spent much more time reviewing my past scans, tests, treatments, etc., recommended triple-therapy based on my age, fitness level, and to give me the best chance going forward. Then I went back to the first doctor and he agreed with her.

I was fortunate to have minimal side effects from the chemo and historically on the hormone therapy. I think daily exercise and diet is key. On chemo, I never needed to take the 3 prescriptions I was given for nausea/vomiting or for mouth sores. Never any hands and feet problems. Lost 85% of my hair and was certainly tired for 7-10 days between infusions, but I walked or did some exercise each day (weights 3-4X week, cardio, yoga, etc.). When I felt better, I exercised more, sometimes for 90 minutes a day. I was able to travel between each infusion, flying to see family, to the beach to heal, etc. My diet is mostly vegan with some seafood when I go out to dinner. There are other Mayo posts about Dr. Robert Newton's exercise for cancer book. I am reading it now, but he recommends exercise strategies before and after chemo and radiation that are definitely worth reading.

I also fasted before, during and a day after each infusion (3 day water or 5-day Prolon fasts). There are numerous studies pending around this strategy that you can research (Dr. Valter Longo at USC is big on this). I fasted to lessen the side effects and possibly increase effectiveness of the chemo.

I hope this helps. I wish you and your family the very best!

I know a number of people that have had good experiences after triple therapy. The drugs are so good now that people live much longer than they used to. After chemo, there’s even Pluvicto For further treatments. The guy that runs the reluctant brotherhood advanced prostate cancer. Forum has had chemo a few years ago and just went through two sessions of. Pluvicto. His PSA dropped to .05 and has stayed there. That’s after 12 years with a serious case. He’s holding off the other four sessions of Pluvicto Until his PSA starts rising again.

Most people die of something other than prostate cancer, and your husband has a good chance of living many more years.

Hi Anne. I am a wife in a very similar situation. The details are in my bio. One thing I can say to you that might help is that it is all very shocking and frightening and confusing at first but those feelings can change as time goes on. I have found that learning as much as I can is super helpful because I can talk with the doctors comfortably, support my husband, and get better at accepting the reality of the situation. This forum is great for both learning and support. There are other partners and wives (and gentlemen) here who have been very generous sharing their knowledge with me. They will do the same for you.

Hi Anne. First let me say it's wonderful that he are on this forum supporting your husband. He is a lucky man!

I was diagnosed with G9 (high grade, aggressive) prostate cancer in August 2021. I underwent surgery in October 2021 and unfortunately was diagnosed with limited metastatic disease (spine) in March 2022. Targeted radiation therapy took care of that metastasis but 4 months later the cancer had spread to local lymph nodes and my PSA increased from 0.37 to 4.5.

I did my research and settled on a medical oncologist at Johns Hopkins. He immediately started me on triple therapy (Lupron, Darolutamise and Taxotere chemotherapy) in October 2022. My PSA went to undetectable after the 3rd chemo cycle and is currently undetectable as of this week. I have been off all medications for 2 years with the exception of replacement testosterone therapy.

I had the usual side effects with Lupron (fatigue, hot flashes, some mood alteration, loss of libido) but it was manageable. I did not experience any significant side effects from the 4 chemo cycles with the exception of decreased white blood cell count which was managed. No side effects from the Darolutamide.

I wis both you and your husband the best. If you have any more questions I would be glad to answer. If either/both of you would like to talk please private message me and I will give you my mobile number. Best of luck!

Hi and welcome to this "club"
My husband got diagnosed a year ago, symptoms were frequent bathroom trips and a bit of ED, he's 55 so we figured it was just the age and a little pill usually worked plus we had a lot of stress the year before (his parents were elderly and declined and passed away in the fall of 2024) So finally in January 2025 he went to the doctor and the doctor surely thought it was just an enlarged prostate but did a PSA test, it came back around 300! devastating!! That triggered a pelvic CT scan which showed it outside the prostate so ADVANCED cancer, THAT triggered a biopsy and gleason scores were mostly 8 and 9s- so advanced cancer cells! A long wait for oncologist and also scheduled a PSMA Pet scan and that showed it all over his body! Lymph nodes, lungs, spine, pelvis, bones etc....Oncologist said usually you start Lupron and Zytiga pills and chemo (the triple therapy) but because the PSA is so high he started with a Firmagon shot instead.... Getting my husband to do that was a nightmare, it's his manhood! He'd rather die than lose his manhood! I told him that I'd rather have a husband and no sex life than a dead husband and still no sex life! and I called him a coward! (we've never fought like this before after 27yrs of marriage!) He finally relented.... Firmagon is a monthly shot and he was supposed to switch to Lupron after that but never did, he was afraid of manboobs and other reasons, if you look online the side effects are worse on Lupron- others might disagree, but my husband is a tough nut to crack so the doctor is fine with him continuing this! We have hot flashes and night sweats together and can cry over different things....
He was supposed to start Zytiga pills (and prednisone) but his liver numbers weren't great, because the two months we had waited to see oncologist, he of course researched lots of things online and started supplements like Iver....and fenben... and others like curcumen, well those wrecked his liver! to the point of blood work saying he was in liver failure! THAT triggered an ultrasound but everything was fine, and he quit everything, except for dandelion tea and things like that. Finally he started Zytiga. Over the summer he did chemo and did extremely well! only symptoms were tiredness and that was only after the last few doses! I don't mind snuggling on the couch while he takes a nap! He did get a bit tingly toes and fingers but that's all fine now and hair grew back though more gray!
He works out every day and eats right, a PSMA scan after the chemo only showed a few tiny spots! so a GREAT improvement! He doesn't look or act tired at all, other than a bit more sleepy in the afternoon and he doesn't sleep good at night. No sex life... we've tried a happy pill but he said there was no drive behind it and it gave him a terrible headache, so....
Other than night sweats and hot flashes he's doing GREAT!
Mentally I'm NOT! but that's another story. I try to do things to keep myself busy and occupy my mind.
This club sucks! but we're in it!! Hang in there!

Thanks everyone! Hearing from all of you helps and it helps me feel more optimistic.

He was diagnosed at the beginning of January and within a week was on hormone therapy. The first drug caused some side effects and they switched him over to relogolix - his PSA reduced by 2/3 in two weeks.
He made the decision to do the triple therapy - relugolix, docetaxel, and darolutamide.
Chemo is to start within 2 weeks.
Bone scan today, MRI on Monday to make sure no metastasis too close to the spinal column (yikes - but glad they are checking everything) and biopsy next Thursday.
The month has been a constant stream of tests and appointments - it feels positive to have a plan now.
The medical team have been amazing (with the exception of his GP, but that’s another story).

One day at a time!

@canadaanne Glad to hear he's on Orgovyx (Relugolix). It became available in Canada only in early 2024, and it was a huge quality-of-life improvement for me switching from an injectable (Firmagon in my case) to the daily pill.

In the U.S., Orgovyx is very expensive — around US $3,000/month — so insurers sometimes try to steer patients away from it unless the patients put up a fight. In Ontario, Orgovyx is priced competitively with Firmagon — about U.S. $215/month — so private insurers or the Ontario government have no issue paying for it.

Because Orgovyx is so new, though, it still doesn't get prescribed too often, just because it's not on Canadian oncologists' radar yet. I was lucky to have a very up-to-date Canadian oncologist, and it sounds like your husband has been too. Everything he's getting sounds like newest/best treatment.

@canadaanne
Great choice of drugs. I’ve been on Orgovyx (relugolix) and darolutamide for about three years. They work real well together and Darolutamide has the least side effects of any equivalent drugs. I was on one of the equivalent (ARPI) drugs, Zytiga, for 2 1/2 years and it has a lot of side effects.

You say you’re having a bone scan, but you should make sure that you have a DEXA Scan which is a bone density scan. Orgovyx (ADT) weakens and thins bones. The DEXA scan checks your bone density and gives you a good benchmark for what happens in the future if you’re on ADT for a while.

Some information on ADT drugs you may not be aware of

Due to their different mechanisms of action. ADT which includes Orgovyx, Firmagon, Lupron, Eligard, Prostap, Camcevi, Lucrin, Zoladex, Trelstar, Pamorelin, and Decapeptyl can cause numerous side effects. Actually due to a lack of testosterone.
Hot flashes
Fatigue
Muscle deterioration
Bone weakening
Brain fog
Depression
Weight gain
Joint pain
Difficulty in breathing

Not all of these side effects occur to everyone on the drugs. Most of them are just things you have to be aware of and circumvent. I run on the track twice a day, 1 mile at least, to help prevent bone weakening, fatigue and muscle deterioration. I also go to the gym three days a week (usually) and spend an hour with all different types of weight exercises. One thing that happens is people get a beer belly from the muscle deterioration, I do a lot of sit-ups to offset that.

Some people get depression but it is not common. It is easily treatable, according to people that have reported it on here and on Online Meetings I have participated in. If he has that problem Come back and ask for help, Or see a psychiatrist about doing something to relieve the depression.

Some people get no hot flashes at all. Others only have a few hot flashes and they are very minor. I had severe hot flashes for the first year on Lupron. As a hot flash was hitting I would feel a lot of fatigue. After a year, my oncologist prescribed a depo-provera shot every three months and it really stopped those hot flashes on Lupron. There are other hormones that can do this, speak to your doctor.
I know one person that says eating tofu every day really controlled his hot flashes, another person in this forum said the same thing. Tofu does have properties similar to endocrine hormones but a lot weaker. Can’t hurt to try it. Seems they ate it daily.

There are other solutions to hot flashes. If you’re husband has a lot of problems with them come back and ask we can let you know what they are.

According to a doctor that spoke to a recent webinar, many people on ADT, if they are staying on ADT for an extended period or have become castrate resistant should be taking bone straighteners. I took Fosamax for six years and I’m now on Zometa. That along with calcium and vitamin D taken daily helps keep your bones strong. Ask your doctor about this.

Some people gain a lot of weight from ADT. I have never gained any weight while on ADT, And I’ve been on it for eight years. . I get on the scale every morning and base what I eat on what I weigh. Skip lunch at times.