What’s Next

Well, scan from Dec 30 shows that the pelvic mass has increased .5 cm. Two lung nodules have gotten smaller while others have gotten larger. I’m so frustrated and worried. I have seen, and read, that when docetaxel stops working, or fails, that Cabazitaxel is the next step. Again, my Dad is 78 and has been using a walker since August because of losing so much strength. Started Docetaxel in August, has had 5 rounds, and October scans showed lung nodules decreased in size and pelvic mass was stable. He’s also on Eliquis for afib but we’ve had to stop that due to blood in the urine. We hope to start it up again at some point. If he does take Cabazitaxel next, how long does he have to wait to start? Suggestions in treatment?

I sure appreciate everyone’s input. I’m a realist, as much as it hurts sometimes, and understand that he is 78 and more fragile than he was when he started this fight around 13 years ago. I watched my vibrant, beautiful 50 year old sister dwindle away to melanoma and honestly that is always in the back of my mind. Such a terrible disease and I’m confident that my Dad will tell us if and when he is tired of fighting. I hope and pray that we find something that will help him. I will happily research any ideas you all might have. From what I have read on cabazitaxel it can work when Docetaxel fails. I can’t find direct information on when that could be started tho since he’s had 5 rounds of Docetaxel to date.

N, I hear you. I lost my dad to this disease when he was 78, 20 years ago. In his case, it came back with a vengeance 10 years after his primary treatment, and got into his spine. At that point, 20 years ago, there was nothing left to try.

As long as he wants to keep pushing at it, then keep doing what you're doing. What does his MO say?

I ran the report findings through AI Chat so I could quickly understand it better. Looks like plenty to talk about next week.

1. **Interval notable progression of most of the pulmonary metastatic disease. There are one or 2 nodules that are decreased.**
- This means that there has been a significant worsening of the cancer that has spread to the lungs (metastatic disease) since the last evaluation. However, there are one or two nodules that have reduced in size, which is a positive finding amidst the overall progression.

2. **Interval decrease in size of right paratracheal lymph node.**
- The lymph node located near the trachea on the right side has become smaller, indicating a potential response to treatment or improvement in the condition.

3. **Interval development of bilateral pleural effusions, small on the right, trace on the left.**
- There is fluid accumulation in the pleural space (the area between the lungs and the chest wall) on both sides. The effusion on the right is small, while the one on the left is very minimal (trace).

4. **Interval increase in size of right pelvic sidewall mass.**
- A mass located in the right pelvic sidewall has grown larger, indicating potential issues that may require further evaluation or treatment.

5. **Interval development of moderate right hydronephrosis. Correlate clinically for ureteral stent occlusion.**
- Hydronephrosis is the swelling of a kidney due to a build-up of urine, which can happen if there's a blockage. In this case, the right kidney is moderately swollen. The mention of "correlate clinically for ureteral stent occlusion" suggests that the healthcare provider should check for a blockage in the stent that was placed to drain urine.

6. **Interval placement of left double-J ureteral stent.**
- A double-J ureteral stent has been placed on the left side to help maintain urine flow from the kidney to the bladder, often used in cases of obstruction.

7. **Mural thickening of the urinary bladder, likely unchanged.**
- There is thickening of the bladder wall tissue, but it appears to be stable, meaning there hasn’t been any new progression.

8. **Stable sclerotic lesions within the pelvis.**
- There are areas of increased density (sclerotic lesions) in the pelvic region that have not changed over time; they are stable and not indicating any new activity.

9. **Cholelithiasis.**
- This refers to the presence of gallstones in the gallbladder, which could potentially lead to pain or other complications.

10. **Diverticulosis.**
- This condition involves the formation of small pouches (diverticula) in the colon wall. It is relatively common, especially in older adults, and may not cause symptoms by itself.

### Summary:
Overall, the report reflects a complex situation with both progressive and stable findings across various anatomical structures. The presence of metastatic disease requires management, while improvement in some areas (like lymph nodes) is noted. Several conditions are present that may need further attention and monitoring, including hydronephrosis and gallstones. This report will guide clinical decisions for treatment moving forward.

There are a fair number of papers and articles about Docetaxel followed by Cabazitaxel and other drugs. The reading can be quite technical as the referenced paper shows.

https://pmc.ncbi.nlm.nih.gov/articles/pmc3547543/

There are also simpler summaries if you look long enough.

I think the basic problem is differences are typically measured in months, not years, so no one is expecting a cure or durable remission once you get to that point. It is a sad fact with cancer that there is no great solution after it reaches the point where nothing works well on it.

It is really up to your father if and when he wants to give up the fight. I am a little surprised that he has not tried the PSMA seeking drugs like Pluvicto yet. None are easy treatments so that has to be considered on his current state.