Chemotherapy an option for prostate cancer?

@7506ian, getting an opinion from an oncologist isn't a bad idea. Knowing what option is best for you is a hard choice. You want to get all the information you need to make an informed choice. I'm tagging a few other members like @round5 @ncoic @hundzow11 @kujhawk1978 and @ken82 to share their thoughts about chemotherapy as a treatment option.

Here's some info from the American Cancer Society https://www.cancer.org/cancer/prostate-cancer/treating/chemotherapy.html
"Chemo is sometimes used if prostate cancer has spread outside the prostate gland and hormone therapy isn’t working. Recent research has also shown that chemo might be helpful if given along with hormone therapy. Chemo is not, however, a standard treatment for early prostate cancer."

@7506ian , welcome to the discussion none of us "want" to be in. Knowledge is power so you are doing the right thing in raising questions early.

In my case. I have been on the journey since February 2019 when first diagnosed. My PSA was then 197.6 or so. Chemo was not my first treatment option. Rather, we started ADT immediately with bicalutimide the first drug of choice. We added Eligard (Lupron) a month later and I have been on it since. Bone scans, CT scans, Pet scan with Axumin indicated metastatic disease in several area especially my spine. We started zolodronic acid every 3 months to help repair bones. We added radiation later in 2019. Next move was to enzalutimide instead of bicalutimide. Then we began radium223 treatments.

Only in very early 2022 did we go to chemo (docetaxel). The result was a drop in PSA to about 27 at the end of July 2022. We felt very good about the progress. However, the PSA started to rise again and two weeks ago was up to 1011. We tried enzalutimide again but I reacted badly to it this time (very weak especially in my legs and no stamina).

So, this was been a week of tests --MRI, bone scan, CT scan, with an endoscopy and a colonoscopy for good measure. I get all the results next Tuesday November 1. Then, with multiple data points in hand, we can look to our next treatment option.

This is a long story with a couple of takeaways. First, everyone's cancer is different and each journey is different. Second, get an oncologist, radiation oncologist , a urologist and your PCP assembled as a team to get you the best advice possible. Third, make your treatment choices based on a solid knowledge base. Fourth, be patient as you proceed. It is very unlikely this cancer will be so aggressive as to be life-threatening quickly. You have time to make decisions. Fifth, stay positive in your thoughts as much as possible. I have had many low periods, especially this fall, but I think I am back on in a positive frame of mind again. Sixth. Stay active with the things and groups that give you enjoyment and strength. Personally, I find prayer to be a powerful tool.

Is chemo the right first step for you? I cannot say. Take your time and do your research. The Prostate Cancer Foundation (pcf.org) has a good free Patient Guide you may find helpful. Other resources also exist.

Good luck on this journey. Post other questions, others will share their experiences with you as well.

hmm...

First question, not sure why a radiation oncologist for hormone therapy. Generally, you're going to want three specialists on your team.

Urologist
Radiologist
Oncologist

Someone should quarterback the team, most likely that's you though at some medical centers they do have multi-disciplinary teams.

Do some reading. Consider starting with the NCCN Guidelines - https://www.nccn.org/patients/guidelines/content/PDF/prostate-advanced-patient.pdf

With your clinical data you may want to discuss with your medical team triplet therapy. Here's a couple links to get started:
https://ascopost.com/issues/march-25-2022/triplet-combination-of-darolutamide-docetaxel-and-androgen-deprivation-therapy-extends-survival-in-metastatic-hormone-sensitive-prostate-cancer/
https://www.esmo.org/oncology-news/triplet-therapy-with-adt-docetaxel-and-abiraterone-plus-prednisone-improves-survival-in-de-novo-metastatic-castration-sensitive-prostate-cancer
Keep in mind that your PCa likely has heterogenic cells, some will die off when the testosterone is shut down, others may become resistant to it. Chemotherapy though indiscriminate in what it kills, does generally kill off those cells who adapt to a low testosterone environment. The 2nd line DT agents act to shut down the testosterone produced by the adrenal glands or prevent the testosterone from binding with and thus used by the PCa cells .