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Early Chemo in non-metastatic high risk cases.

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Posted 1/16/2017 9:53 PM (GMT -5)
So should you do docetaxel based chemotherapy early in cases where the disease has progressed to low volume metastatic disease or in high risk non-metastatic disease? It depends on who you ask. These articles specifically attempt to answer this question for non-metastatic cases.

I have provided a link to my website where I have attached two viewpoints published this month in the Journal of the American Medical Association (JAMA). These viewpoints cite the recent three trials that have published results. CHAARTED, STAMPEDE, and RTOG-0521.

Here's the link to this information and the viewpoints:
advancedpcatalk.freeforums.net/thread/270/jama-viewpoints-early-use-chemotherapy
Posted 1/16/2017 11:48 PM (GMT -5)
This is exactly the questions I have regarding early chemo for high risk PC. As a low PSA/ G9 guy that has perineural invasion 0.02 mm from mature adipocytes wonder if this is something I should consider.

Thanks for the post Tony
Mark
Posted 1/17/2017 1:56 PM (GMT -5)
Thank you Tony. This was a very timely post for me as I am stuck right in the middle of the debate. I've got one doctor telling me that chemotherapy as part of my initial treatment is absolutely needed, and another doctor telling me that early chemotherapy in my case would be "crazy" and reckless. Both doctors are highly regarded. Fighting the PCa is bad enough, getting differing advice really adds to the stress.
Posted 1/17/2017 6:41 PM (GMT -5)
Hi school psych,
You are smack dab in the middle of this discussion for sure. And at both side of the viewpoint are highly regarded oncologists. I too was smack dab in the middle but when I was at the point of decision I was asked to join a trial that would include docetaxel and HT versus HT alone. This was 2007 when we didn't have the early chemo option as there was no evidence to support it.

But as you can see the controversy is not solved as yet but my suspicion is that early chemo will help to some degree in these patients. But is it worth it? That stated, my friends in the industry state that younger men will usually tolerate docetaxel well and JEVTANA is another option that has considerably less morbidity. I was 44 at the time of my diagnosis and I've asked what would be that age cutoff point. LOL, and the answer was debated. You certainly are young. The question for the "reckless doctor is two fold:

1. Is it reckless ignoring the STAMPEDE trial data and the RTOG-0521 trial data and missing an early opportunity?

2. Is it reckless trending to over treatment of men that it will not benefit from the small increment realized in the trials?

What's even more interesting, it may also come down to insurance being willing to pay for early treatment with chemo in these cases because we do know that not only are the doctors debating this, so are the carriers. We are still finding men that would qualify under the CHAARTED trial being denied service even though they were perfect candidates.
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