Chemo, Lupron & Nubeqa (Triple treatment) Outcomes

There is no rule of thumb that can apply to how long you will be able to be in remission after chemo. As you may have heard every single case of prostate cancer is different, So somebody telling you about their chemo experience won’t give you any idea how yours will proceed.

Lupron and Darolutamide Should keep your PSA undetectable for quite a long time, But you never know when it will stop working.

Do you have more than that one metastasis on the hip? Is there some reason your doctor wants to do chemo instead of just zapping the one metastasis with SBRT, which is pretty much the standard for how it’s handled now. Usually, you don’t go to chemo unless you have multiple metastasis, Something you do not appear to describe.

What type of doctor are you seeing to treat your cancer? You’ve reached the point where you should be speaking to a center of excellence or a Genito urinary oncologist, The ones that specialize in prostate cancer. If you are just working with a medical oncologist, you may want to talk to a different doctor for a second opinion. Chemo may be right for you, But with only one metastasis, that is questionable.

I also have stage-4 prostate cancer, and I'm also on ADT + Apalutamide for life (or at least until they discover new alternatives). As I've written elsewhere, my PSA has been undetectable (< 0.01) for 3 1/2 years. If I were to stop hormone therapy, my castrate-sensitive cancer might come back as castrate-resistant, and that's not worth the risk to me. If it's working, why mess with it?

As @jeffmarc mentioned, it's common with oligometastatic cancer (just a few metastases) to use radiation directly on the metastases rather than administering chemo, but obviously that varies from case to case, and you did mention the "potential for other metastases" — do you mean ambiguous spots of concern on the PSMA PET scan, or just a worry that there's more happening than PSMA PET can detect yet?

Thank you both for the helpful comments and questions. I very much appreciate your responses to my questions as well as when I have read your insights to other posts.

With this last reoccurrence, I was scheduled to have ADT and radiation to the hip by Mayo. When starting Lupron again, my local oncologist reviewed my PET scans back to 2022 and worried that while the most recent PET scan only clearly showed evidence in part of the hip, she saw evidence of multiple areas of bone metastases when comparing scans over the past few years. She worried that even though there was very low PSMA uptake in other areas, there were increases in size and location over the years. Based on my age (58, diagnosed at 51) and fitness level, she suggested hitting it hard. I also have had a low PSA since inception (it only peaked at 2.0 before surgery in 2017). I spoke to Dr. Kwon and he agreed with the strategy. So as much as I would have preferred radiation again, having two great minds align convinced me to take on the triple therapy.

That makes a lot of sense. When I was diagnosed at at age 56 with one huge bone metastasis, we also decided to throw the kitchen sink at my cancer, though that didn't include chemo (in 2021 the manufacturer of the radioactive agent for PSMA PET hadn't gotten approval yet in Canada, and the bone scan, MRI, and CT showed no other metastases).

It’s good to hear you’re speaking to the right people and getting good advice. In many cases people are relying on a urologist or radiation oncologist for answers. You have gone a step beyond that. Hopefully it will give you many more years.

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 a friend with just one metastasis (per PET) - to a lymph node. Does anyone know why they would not target that node with therapy or surgery? I read that there was a recent study showing good results from removing a single metastasis surgically (or maybe, don't remember, via radiation).

He is just on ADT.

Reply to @rotate
Some lymph nodes are really close to other organs and radiation can damage them. Ask your doctor, Speak to a radiation oncologist and find out what the issue is.

It.s not for myself. But thanks for the info - good to knoow. I've already suggested my friend ask his oncologist (or urologist - not sure who's handling it for him).

There might be very good reasons for leaving the lymph node alone, as @jeffmarc mentioned, or it might just be a case of an individual urologist still doing things the way they did 10–20 years ago.

It's tough that it's on us to try to figure out which of the two situations applies. Thats why so many forum members encourage cancer patients to get to a multidisciplinary cancer centre, centre of excellence, and/or major teaching hospital, just so that they don't have to keep second-guessing their treatment. 😕