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I think your question is a great one and I have often wondered why, if chemo does a good job of extending survival when there is a lot of cancer in the body, it would not be more effective when there are less amounts (i.e., starting before evidence of widespread metastasis??) I am not aware of the Stampede Trial, but have been wondering about early chemo for years now. If the study is credible (and I am not suggesting it might not be), why wouldn't oncologists embrace the results and treat accordingly I wonder. Any info from any members on this would be greatly appreciated.
I think it's an interesting discussion why chemo is used only in late stage cancer. Four years ago I was diagnosed with high risk (GS-8) PCa. I had done a bit of research and decided I wanted proton therapy. I discussed my options with the folks at UFPTI. While they said the vast majority of their patients had only GS-6 or GS-7, they were willing to have me as a patient as they believed it was still capsule-confined. They also gave me the option of receiving a "low-dose" form of chemo. One each week for my nine weeks of proton therapy I would receive a 3-hour infusion of chemo. I asked the oncologist about the drug and he told me it was Docetaxel (Taxotere) at about 15%-17% of "regular (full) strength." I was told that unlike regular chemo, I wouldn't get sick or lose my hair. Well, they were partly correct. I didn't get sick but lost my appetite (lost 10 lbs) and only half my air fell out.
Four years later and my PSA is still low (.1) and my hair and appetite are back. In my 9 week stay at UFPTI I never met anyone else on chemo and I have never seen any study results comparing the impact of receiving low dose chemo. I am told the results of chemo vs. non-chemo proton therapy will be released "in the future" but I don't have a date.
My Onc, Dr. Leibowitz has been giving men with high risk or T3 disease ADT + Chemo for more than 15years. He gives a weekly lower dose and men tolerate this much better. No vomiting and little hair loss. He believes there is added benefit to doing ADT and Chemo simultaneously. I believe he is the only Onc that has been doing this over the last 15 years. His outcomes are the best I have seen. You can check his publications out at Compassionate Oncology.
BTW....The CHARRTED study also confirmed better survival with the early use of Chemo + ADT.
I had a chat about this last week to my oncology nurse as we discussed possible next steps. I've had a couple of months now where my PSA is rising modestly 1.2 to 1.3 to 1.7, so there is no doubling time, but I'm assuming that my abiraterone/prednisone treatment may be nearing the end of its usefulness. It will take a little while until Taxotare is licensed for use in this situation in England (by NICE) but I may well have that time available. It may also be the case that in the meantime Taxotare can be used "off-label" as they say over here. That is where the treatment is approved and safe but has not been cleared for this particular application (I have no distant mets).
I shall be seeing my oncologist next month and will see what he suggests. The low dose/longer application route looks interesting. I'm not clear what alternatives would be available if my present treatment has to be junked, although I was told that there are six possibilities. Apparently enzalutamide would not be offered after abiraterone, that much I do know.
I'd be interested to hear more from others who have been down this route, presumably in jurisdictions unencumbered by a drug approval regime like that in the UK.
I've just discovered that there is a new trial arm to STAMPEDE which combines Zoladex, Abiraterone and Enzaluamide, so perhaps I was wrong to accept at face value that the two expensive treatments (the last is even dearer than the second last) would not be offered together. I shall talk to my oncologist about this too and report back.
(BTW, please forgive my misspelling of Taxatere!)
One of the senior oncologists at my cancer center said that it is an interesting study but they are trying to figure out why one study showed no improvement and two studies did show dramatic improvement in longevity (2 years and with a relatively cheap drug).
Just a minor update - my PSA was unchanged this month at 1.7 and nothing odd in my blood data so treatment continues unchanged. It seems that any failure in the medication would show in a major increase in PSA with other indications in the bloods. What I've experienced has been put down to "minor fluctuations". Relief all round!
Hi jj and welcome. I see this is your first post on Yana, and you raise a good question, worthy of considerable debate and perhaps therein lies the problem.
Currently in academic circles there is a wealth of data from numerous trials being reported. The dilemma medical oncologists currently face is that no bio makers currently exist to indicate in what order treatment should be given to maximise therapeutic effect for the patient. Needless to say those bio makers will come to fruition over time and treatments able to be staged accordingly. We also need to remeber the metastases variance between visceral and bone.
But back to you question re early use of chemo. First up chemo does not cure prostate cancer. It most cases it does help to slow disease progression in identified PCa mets. Most medical oncologists would only would only introduce chemo after mets are confirmed. But chemo taxenes are more and more are being staged with abiraterone and enzaluamide, plus radium and other agents. It is the combination of these treatments that are bringing about good outcomes in inhibiting disease progression.
I had a private appointment at LOC in London yesterday with Dr Harper and he said that the results from the stampede trial were exceptional and in line with the kind of results where chemo is given early in other cancers, (breast, colon, bladder etc). He said that my questions are ahead of the curve in terms of high risk non metastatic cases like mine but suggested that everyone already knows that it will be standard procedure in 5 years or so but due to lack of clinical trials it is not yet offered by the NHS.
Its a single acting agent and although obviously poisonous and not without risk it is not as bad as many others. As a T3N0M0 with an initial PSA of 100 and Gleeson 7b he reckons after my surgery and Radiation/hormones that there is maybe a 20% chance of non recurrence. With docetaxel taken now (6 cycles over 18 weeks) this could perhaps enhance this to 50%.
I realise that this is all guesswork but I have made the decision to go for it as my only hope for a cure or at least a very lengthy remission. I don't know the cost yet (as its private) but will post when I do.
I think everyone in my position should re evaluate and question what we have all been told about Chemo and the stage when we should have it in light of these new, large and statistically significant trial results.
They are saying its a game changer, however NICE and the NHS are too slow to change their game for my liking
My reading of the stampede trial early results seemed to indicate that there may be merit in offering docetaxel to men with
advanced, nonmetastatic prostate cancer. That view came about based on an increased time to relapse in men with metastatic disease. The increased overall survival rate with metastatic men was in the order of 10 months. Let us hope you are on a winner with this approach jj. Do keep us informed.
I have almost the identical diagnosis to you. 3.5 years in after Radio and Hormone Therapy, PSA currently undetectable. However, Hormone treatment still in my system for the rest of the year apparently and Testosterone recovery not yet in sight.
Therefore I am thinking very much along the lines you are, seeking the very best chance of long remission.
Please keep us as informed of your progress as much as you are able? I watch with great interest.
Cheers .. John.
I had a Gleason 9 score and had surgery 7 years ago. I followed up the surgery immediately with radiation, hormones and chemo.
It seemed to make sense to me that hitting the disease hard early on was the way to go. There were few studies available at the time to shed any light on this. Anyway, 7 years later my PSA is zero. This is just one data point and doesn't prove anything but I am pleased that I took the course that I did and with the outcome.
What was your PSA? Did you have any lymph node involvement or seminal vessel invasion?
You have a great story, I didn't think there was anyone else out there that hit hard early. It just seems so right to cut it, burn it, starve it and then poison the bastards before they take control (at least with high risk guys like us).
The MDT people at Marsden NHS have just said no way. I had a meeting with the private LOC and their 3 specialists also don't recommend it so Im not as confident as before.
The cost privately is about £18000, thats US 30k (sorry don't know where you are from) which is neither here nor there if it works.
Was the chemo bad? I am getting scare stories of septicimia, death etc which is putting me off a bit.
You can look up my story here under "Ed Julius" for the details. Basically PSA 10.9, no lymph node involvement, capsular penetration both sides, Gleason 9 (5 + 4) and seminal vessel invasion.
All of that put me in high risk territory.
The chemo was not too bad. The worst part, as I said in my story, was my reaction to the steroids that they gave me prior to the chemo-three days with no sleep. They adjusted the dose and it was much better.
There are side effects associated with any treatment. There are also potential BIG side effects in not taking any treatments! You sit as many risks as you run.
We all have to weigh the odds and make our choices. Once I learned the odds it was pretty easy decision for me. Fortunately I didn't have to spend $30,000 for treatments, but that amount divided by potential added years of survival could well be less than the cost of cable television.
In hindsight, I am pleased that I took the chance.
Please let me know if I can tell you anything else.
I wondered if you had gone ahead with the docetaxel. Following a Gleason 9 diagnosis, I had surgery in July 2013, started ADT in November 2013 followed by 33 cycles of pelvic radiotherapy in July and August 2014.
I also raised the stampede trial and the possibility of early stage docetaxel at the same NHS hospital as you in July 2015 and received the same response. Following the article in the Sunday Times today ( NHS denies Englishmen low cost cancer drug by Sarah-Kate Templeton) I thought I would raise the issue again at my next appointment later this month.
I would be grateful for any information that helps me decide whether to pursue the option of early chemotherapy.