Stage 4 prostate cancer treatment options

Posted by safari1949 @safari1949, Nov 17, 2019
  1. I have recurring prostate cancer and it has found its way to 5 different bones, including my left shoulder and two ribs on my right side. I started 6 month Lupron shots but have been told that because it is stage 4 I need additional treatment. My oncologist is recommending either Abiraterone (Zytiga) for 33 months or 6 treatments of Docetaxel chemo. She says that they look to have very equal success. With the Zytiga I will also have to take steroids, probably prednisone which I understand includes possible liver damage. Six chemo treatments seems like a better approach but I have heard Zytiiga talked about in a very positive manner. I understand it can be expensive and I do worry my prescription drug coverage could change its formulary and raise my cost significantly as well. I’ve already had that happen with a drug I take for Parkinsons.. Just looking for some general input regarding peoples actual experience either way.
@semeon

I have been on Lupron for18 months really not affected too much by weight gain. My issues have been fatigue, hot sweats then cold, and sore joints.

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@semeon Thank you. Your experience is helpful and encouraging.

Liked by Lisa Lucier

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@vernonkent

@philnob I am wondering the same about weight gain. I started Lupron a couple weeks ago. Within a week noticed weight increase of 3-4 pounds. Now watching diet and exercise carefully, but wondering what to expect.

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I haven’t been on Lupron for quite some time, but the weight gain continues to be a problem. I was able to lose 7 lbs. while dieting, but the weight gain around the waist doesn’t change. I plan to increase my exercise routine to see if it will help.

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I started abiraterone / Zytiga in August, and so far I am having good results. My PSA number is 0.84 my side effects are muscle and joint stiffness. I have my liver enzymes checked every 2 weeks, so far they are within acceptable limits. I hope this helps.

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I have been receiving Lupron injections every 6 months for the last two years and have tolerated it well. See my post from Nov 22, My PSA has stayed at less than one but not zero during this time. PSA was not all that high before starting, about 8, but it had doubled over the span of about a year. I believe exercise needs to be incorporated into your activities, It will help you in a variety of ways. Both safari1949 and healer74 seem to have the right regimen. My activities not as aggressive as safari but I include light weights, stretching and treadmill. Not all of this every day but some form of those just about every day, any where from 5 to 90 minutes. Practice reasonable eating habits, a visit with a nutritionist is an excellent idea to help you define what is reasonable. Be aware that Lupron, as i've been told, can deplete calcium levels, take your calcium pills. My doctor asks me every visit if I'm taking calcium. You might also ask your oncologist if you should be taking Alendronate, ( for bone health) I started this about 5 months ago on his advice. I wasn't excited about taking it but he seemed pretty adamant. No problem with weight which I owe to the exercise and eating habits. Zytiga may be in the future but all seems to be going well for now. For safari can you tell us how you are able to keep the med bills for Zytiga and Predesone so low? Are these both generics? Appreciate this blog and all this information you are willing to share.

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Hello, this in philnob. I am happy to hear that you are doing well with Lupron. I was not that fortunate, and had to switch to Zytiga, and prednisone.
My PSA number is 0.84. Every 2weeks I have blood work done to make sure my liver enzymes are normal. Due to the joint stiffness It takes an effort to motivate myself to exercise, so I start with Yoga, and work my way up to a stationary bike, and stair climber. I wish you continued success with your treatment.

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My stats:
I am 59.
Cancer stage – 4( based on Gleason score – 9, a hip lesion, tumor near the bladder, enlarged lymph nodes, it is considered metastatic)
Cancer detected – December 2019 (PSA 9 started the chain reaction)
Staged – Jan 2020 ( after biopsy, MRI, bone scan, CT abdomen)
Treatment started Jan 30.

Well, it has been 2 weeks since I got 22.5 mg of Lupron Depot, deposited into my right buttock. I was anticipating the backseat driver to takeover my life. I was thinking, my life, going forward, would be like sitting in a driverless car and wondering when the AI- based driver is going to crash.
Well so far so good. No major reactions yet! Feels like steering is handled by a nice Uber driver!

I have been exercising regularly for the last couple of weeks by walking/running for an hour daily on the treadmill. I have been using the Activity app to keep track of the exercise minutes and to keep up the motivation.

Just because I got Lupron under my belt, I can’t rest yet. My lifeboat is getting rocked again tomorrow!

I am going to start Chemo with Docetaxel( Taxotere). My oncologist recommended this therapy in place of taking Zytiga and Prednisone pills life long. If I go through this – once every 3 weeks, six session chemo, I don’t have to take those pills I believe.

I would be interested to know your experience with Docetaxel.

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@sannira

My stats:
I am 59.
Cancer stage – 4( based on Gleason score – 9, a hip lesion, tumor near the bladder, enlarged lymph nodes, it is considered metastatic)
Cancer detected – December 2019 (PSA 9 started the chain reaction)
Staged – Jan 2020 ( after biopsy, MRI, bone scan, CT abdomen)
Treatment started Jan 30.

Well, it has been 2 weeks since I got 22.5 mg of Lupron Depot, deposited into my right buttock. I was anticipating the backseat driver to takeover my life. I was thinking, my life, going forward, would be like sitting in a driverless car and wondering when the AI- based driver is going to crash.
Well so far so good. No major reactions yet! Feels like steering is handled by a nice Uber driver!

I have been exercising regularly for the last couple of weeks by walking/running for an hour daily on the treadmill. I have been using the Activity app to keep track of the exercise minutes and to keep up the motivation.

Just because I got Lupron under my belt, I can’t rest yet. My lifeboat is getting rocked again tomorrow!

I am going to start Chemo with Docetaxel( Taxotere). My oncologist recommended this therapy in place of taking Zytiga and Prednisone pills life long. If I go through this – once every 3 weeks, six session chemo, I don’t have to take those pills I believe.

I would be interested to know your experience with Docetaxel.

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I was 57 when diagnosed. Stage 3. Had high dose brachytherapy and external radiation. Just received my last dose of Lupron a couple weeks ago. On Lupron for 2 years. Keep exercising as much as possible. It really helped me keep my sanity and feel like I had some sort of control. Best of luck with your journey.

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@sannira

My stats:
I am 59.
Cancer stage – 4( based on Gleason score – 9, a hip lesion, tumor near the bladder, enlarged lymph nodes, it is considered metastatic)
Cancer detected – December 2019 (PSA 9 started the chain reaction)
Staged – Jan 2020 ( after biopsy, MRI, bone scan, CT abdomen)
Treatment started Jan 30.

Well, it has been 2 weeks since I got 22.5 mg of Lupron Depot, deposited into my right buttock. I was anticipating the backseat driver to takeover my life. I was thinking, my life, going forward, would be like sitting in a driverless car and wondering when the AI- based driver is going to crash.
Well so far so good. No major reactions yet! Feels like steering is handled by a nice Uber driver!

I have been exercising regularly for the last couple of weeks by walking/running for an hour daily on the treadmill. I have been using the Activity app to keep track of the exercise minutes and to keep up the motivation.

Just because I got Lupron under my belt, I can’t rest yet. My lifeboat is getting rocked again tomorrow!

I am going to start Chemo with Docetaxel( Taxotere). My oncologist recommended this therapy in place of taking Zytiga and Prednisone pills life long. If I go through this – once every 3 weeks, six session chemo, I don’t have to take those pills I believe.

I would be interested to know your experience with Docetaxel.

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follow all instructions,keep your spirits high,eat well and exercise

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@philnob

Hello, I was wondering if anyone had experienced any weight gain on Lupron. If so, are you able to control it by dieting.
Looking forward to hearing from you. Philnob.

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Yes, 2-months ago quickly gained 11 pounds in one month and not just from holidays! Trying to shed them and work out 30 minutes each day. Was told to expect gaining around the gut. Watch my food, but need new approach. All the best…OUMike

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@herbg

I am currently in my third cycle of taxol after diagnosis with metastatic disease. The literature is clear that taxol+ADT is effective. There is also literature on the newer agents that suggest efficacy, but there has been no clinical trial comparing the two head to head. It is also the case that Zytiga can be used if the cancer progresses to castration resistance after taxol. I am not enjoying the side effects of taxol, but I have only three cycles to go, and I am hopeful that the therapy works to reduce tumor burden.

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Hi @herbg
Is taxol same as Docetaxel? Can you send me the link to the literature you mentioned about taxol+ADT?
I started chemo with Docetaxel( brand Taxotere) last week. I am supposed to go through six sessions, one every three weeks.
Have you had any side effects with chemo? I am having muscle pain and random shooting pains all over the body. ( I also started Lupron shots 2 weeks ago)

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I am scheduled to start Lupton next week, but I'm a bit apprehensive about going that route after reading all the side effect reviews on various sites. Folks here seem very positive, so if appreciate any input on how this regiment effects quality of life. Just diagnosed date 4 Gleason 10 PSA 15. I'm 72 this Monday. Have been on bicalutamide for just one week and I'm scheduled for a CT abdomen and Pelvic bone scan in about two weeks. Any input would be appreciated. Just new to this. Thanks PapaBill

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Hi, this is Phil. I was on bicalutamide, and lupron for about one month. Due to the side effects my Oncologist discontinued the treatment.
I have been on Zytiga and prednisone since Aug. 2019, and am able to tolerate it much better. My PSA is less than 1 and my liver enzymes are doing well. I can certainly understand your concerns. Side effects can be difficult to tolerate as they were in my case, but we won’t know how it will work out until we try it. I have heard from others that they have had only minor side effects on Lupron. Everyone is different. If you haven’t already tried it I would like to recommend the National Cancer Institute website. I wish you the very best of luck in your treatment.

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@papabill

I am scheduled to start Lupton next week, but I'm a bit apprehensive about going that route after reading all the side effect reviews on various sites. Folks here seem very positive, so if appreciate any input on how this regiment effects quality of life. Just diagnosed date 4 Gleason 10 PSA 15. I'm 72 this Monday. Have been on bicalutamide for just one week and I'm scheduled for a CT abdomen and Pelvic bone scan in about two weeks. Any input would be appreciated. Just new to this. Thanks PapaBill

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I had elevated PSA (541.0) in February 2019 (also at age 72) and immediately started bicalutamide. After biopsy one year ago today, the diagnosis was official with Gleason of 10 in all samples. I received my first lupron shot on March 19, 2019 . Radiation followed in the summer (44 sessions of external beam radiation).

Side effects are what I understand to be generally experienced–hot flashes, muscle weakness and general fatigue along with total lack of sex drive. The side effects are manageable especially when I consider what we are fighting. I figure I can put up with these side effects so long as we see positive results.

My PSA dropped to 2.8 just before completion of radiation. Unfortunately it has increased since. Rising to 46.0 before we could figure out what was causing increase. Another PET scan with axumen isotope revealed prostate cancer cells in my spine so we are now using enzalutamide rather than bicalutamide. We'll see how that works later in March. We do know lupron is continuing to keep the testosterone levels low so that is definitely working.

Good luck with your journey Phil. It's not much fun but I think it is important to stay positive. Stay active with your work, and/or your volunteer activities, see your frieds and neighbors. Try to get out and about everyday, even if just for a coffee club gathering. Get exercise (I'm not too good about that). The side effects will come, but I haven't found them to be unbearable. Good luck.

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I was diagnosed with PC about a year ago.. Mayo MN verified the local doc.. Mayo said they wanted to give me a Lupton shot to shrink the postate..
20 high dose Radiation Oncology treatments followed in 2 months after shot… Before the Radiation they inserted a spacer between the prostate and bowel/rectum…I had no hot flashes, I am 82.. so the lack of sex drive really wasn't a big consideration…all went well .. no real urinary irritation… Some bowel irritation, but I have Gastropaneisis (a GI problem).. so the cause of diarrhea is undetermined. Had some fatigue. Otherwise 3 month check ups are looking great . PSA way less than 1… Good luck..get a good doc..

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@philnob

Hi, this is Phil. I was on bicalutamide, and lupron for about one month. Due to the side effects my Oncologist discontinued the treatment.
I have been on Zytiga and prednisone since Aug. 2019, and am able to tolerate it much better. My PSA is less than 1 and my liver enzymes are doing well. I can certainly understand your concerns. Side effects can be difficult to tolerate as they were in my case, but we won’t know how it will work out until we try it. I have heard from others that they have had only minor side effects on Lupron. Everyone is different. If you haven’t already tried it I would like to recommend the National Cancer Institute website. I wish you the very best of luck in your treatment.

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Thanks Phil. I'll check out that site as well. Appreciate the quick reply. Blessings Bill

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