A Minimalist Real Time Empirical Look At Chemotherapy

Chemotherapy for advanced prostate cancer has an undeserved bad reputation.  Too many men believe that its side effects are just too terrible to be tolerated, so they decide, out of hand, to

forego this treatment option.

Yes, there are side effects, and yes some of them are not pleasant, but for most men, chemotherapy with Taxotere (docetaxel) is highly effective.  Most men, once they “bite the bullet” and go ahead do not find that the side effects are as bad is their expectations, and the results can be stupendous.

On a popular online support group, a spouse of a newly diagnosed man with stage 4 prostate cancer with bone Mets and a PSA of 571 shared that her husband has started Firmagon which has been very helpful in relieving his pain, but his cancer has continued to progress as demonstrated by scans. 

She also shared that he was scheduled to start chemotherapy and wondered about the logic of this step.  She asked, “Does chemo help? Any suggestions on that?”

There were some responses to her questions, which we found to be very informative, and worth sharing.

Reply 1

One man said that he was diagnosed eleven plus years ago, also with stage 4 prostate cancer. He told her that she was fortunate to be in a time with so many new treatments being available and with the paradigm shift of using early chemotherapy (as per the CHAARTED study) in newly diagnosed stage 4 prostate cancer because it has demonstrated its ability to extend survival.  

He then shared that he is now on his eleventh chemotherapy infusion.  He mentioned that he has been using ice to soak his fingers and gel packs or frozen pea bags while having his infusions on his feet to prevent toenail problems and the development of neuropathy.

Reply 2

In reply 2 the following enthusiastic response was made. “Chemo was the best thing I ever did.”   This gentleman said that his situation was the same as the husbands. 

Reply 2 reported that he was diagnosed with four bone Mets and a PSA of 850.  He immediately began early chemotherapy along with ADT using Lupron and Casodex. He then added that his diagnosis was 2.8 years ago and that his scans still are negative and his PSA remains at 0.09.

He added another noteworthy piece of advice, he urged her not to Google the life expectancy charts. He said that his charts all projected different numbers of years for him to live.  They ranged from 3 years to 6.5 years. He then added, “The world is full of men with stage 4 prostate cancer that live for many, many years, like decades. Don't freak out.” (Read our page on Survival statistics.)

Reply 3

The third man to reply said that he had a PSA at 840 with a Gleason of 7 (4+3), as well as Mets to his ureter and lymph nodes.

He started hormone therapy (ADT) with Lupron and Casodex as well as early chemotherapy.   He reported that he did 15 rounds of chemotherapy in 2015 and achieved a PSA nadir of 0.2. 

He also shared that in August of 2016 he was able to drop his PSA even lower, to 0.1 with supplements and intermittent fasting. He also shared that he fasted for two days before his chemotherapy sessions.

Reply 4

Reply number four started out his response by saying that he swears by chemotherapy. Had reported that he had 40 bone Mets when he was diagnosed in Oct 2014. He began ADT with Zoladex and added ten rounds of chemotherapy. His follow-up scans showed only one visible tumor and no soft tissue involvement.

Reply 5

Reply five also reported a positive chemotherapy response.  This man reported that he had just completed his 12th infusion of Docetaxel and Carboplatin.

He also is on ADT using Firmagon. He reported that his Mets have been “kept in check.”  

Reply 6

Reply 6 was the last response to this string.  This man stated that chemotherapy is working for him at this time.   Like the fifth Reply, his chemotherapy has included both Docetaxel and Carboplatin.

He was on his 6th dose of chemotherapy when he replied. His PSA has dropped to 0.5 and has been falling by 40% at each visit.

He reported some additional history.  He said that he has had prostate cancer for five years and that he has been successfully treated with Xtandi (enzalutamide) for 32 months.

After two days, these were the only response to the questions,  “Does chemo help? Any suggestions on that?”  They all were overwhelmingly positive.  I am sure that with some additional time there will be some men who will share a different story, one where the side effects were too severe for the chemotherapy to be continued.

We have no idea how to pre-determine who will have what level of side effects, given these overwhelming endorsements it is hard not to consider using chemotherapy.  If the side effects are too severe, you can stop the treatments.

Joel T. Nowak, MA, MSW wrote this Post.  Joel is the CEO/Executive Director of Cancer ABCs.  He is a Cancer Thriver diagnosed with five primary cancers - Thyroid, Metastatic Prostate, Renal, Melanoma, and Appendiceal Cancer a rare cancer.