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Doctor says chemo is next for me

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Posted 3/24/2015 9:55 AM (GMT -5)

I just saw my medical oncologist here in Georgia and my PSA is 4.2, down a bit from 4.86 last month.  I asked him if Xtandi is next for me when Zytiga stops working. He said no, Chemo is next because if Zytiga stops working, Xtandi will not work either.  I think I have seen signatures here on the forum with treatments going from Zytiga to Xtandi, or maybe the other way around.  He also says provenge is out for me.  Not what I wanted to hear. 

He wishes my PSA would drop to zero. So do I. But isn't stable disease better than worsening disease?

I have trusted my MO so far. He did his fellowship at MD Anderson.  I have been there to MDA twice and still have a doctor there and we send results and lab notes to her.  But I was surprised to hear there is no treatment left for me besides chemo.  He did mention finding a trial to participate in. 

Any ideas or thoughts on this?

Posted 3/24/2015 10:33 AM (GMT -5)
"no treatment left but chemo?"

Is that how your MO phrased it? Because with the results of some recent studies that is getting to sound like a rather old-fashioned attitude. A number of studies have looked at moving chemo earlier in the sequence of treatments, rather than saving it for the end game, and have seen real survival benefits. The trial he is talking about is likely to be quite an attractive opportunity.
Posted 3/24/2015 12:57 PM (GMT -5)
He's right that there is usually cross resistance between Xtandi and Zytiga. There are other second line hormonal therapies - like estrogen patches and experimental drugs, that may continue to work for you. If you have a lot of mets, Taxotere should be tried sooner rather than later. There are some great clinical trials out there. Are you far from Augusta or Athens? There's one there for an immunotherapy combo I've had my eye on.

- Allen
Posted 3/24/2015 1:05 PM (GMT -5)
Peter- maybe he did not use exactly those words, but that is what I understood. When I first saw him back in June 2014 he put all available treatments on his white board starting with HT and ending with Chemo at the bottom of his list. Today he said chemo is next for me. I questioned him about any trials and he said he would find something. I mentioned immunotherapy. He did leave me with the idea that chemo is the last available treatment unless we qualify for a trial. He indicated that chemo is the 'best' treatment and I took that to mean it would do the most to treat the cancer.

Don't we have posters here who have gone from Zytiga to Xtandi?
Posted 3/24/2015 1:15 PM (GMT -5)

Allen, yes you posted something for me once about the trial in Augusta, GA and I mentioned it to him.  I should beat my self up for not having a printout in hand today.  I am in Athens, GA. And maybe that is what he has in mind, Taxotore first.  I had 3 bone scans last summer and they showed mets in 3 places which was no change from the previous year.  I got on a clinical trial of cabozantinib + zytiga but they cancelled the trial after 3 weeks in September 2014.

I am going to call the cancer center at Georgia Regents University in Augusta to see what they say.

Thanks

Posted 3/24/2015 1:42 PM (GMT -5)
Faustmann,
Did Dr say why provenge was not an option? Not many, but some have had success. We were scared of chemo, but it did end up keeping Gary's Mets at bay for quite awhile and the SE s were not as bad as we anticipated. Hope you find the right plan for you.
Best wishes.
Beth n Gary
Posted 3/24/2015 1:43 PM (GMT -5)
Faust...yes....I tried Xtandi after the Zytiga failed me...along with Xofigo AND HT.

My PSA went down just 2 from a 23 to a 21 and then stayed at 21 for 2 months so in reality Xtandi did stall it and gave me 3 extra months. My MO wanted to go to Chemo but after I asked him about Xtandi...he agreed to give it a try. I cant say I regret that even if it did work just 3 months
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