I'm sorry to hear this Glen. As you know I'm on the same path as Hubby, the main difference in our treatments is I haven't had any form of Chemo yet. I've prepared a list of questions for when the day arrives that the magic beans are no longer working for me. I list them below in case they may be of help to you. One thing you need to know in assessing the questions I will be asking my Onco is that from the point of diagnosis I stated that I prioritise quality of life over quantity of life. Best wishes. David.
Questions for when Enzalutamide ceases to be effective
Are there any other treatments left apart from chemo?
· Stilboestrol (oestrogen)?
· Abiraterone (I know the CDF ruling is one of Abiraterone or Enzalutamide, but not both. If you could prescribe it, would you do so? If so, we’d consider funding it ourselves).
· Radiotherapy?
· Radium 223 (I have the impression that this is the last throw of the dice after chemo has failed)?
· Immunotherapy trial (PROSPECT)/other trials ???
If Yes, discuss those treatments and put this paper to one side.
If No, continue.
1. Prostate cancer (PCa) kicked aside my first two defence lines (Zoladex and Bicalutamide) without breaking sweat. Enzalutamide held it up for n months. Is chemo likely to prove any more effective a defence?
2. PCa Chemo treatment takes seven months. Obviously it affects quality of life (QOL). The table below shows some measures of what quality of life means to me together with what I think (I may be wrong) will be adversely affected or not.
Measure of QOL Affected or not? Result
Enjoy a pint of real beer Affected Chemo messes with the sense of taste
Enjoy a glass of good wine Affected Ditto
Enjoy an excellent meal Affected Ditto
Take a plane journey Affected A plane journey is a sure fire way of picking up a respiratory disease
Have a workout in the gym Don’t know May be OK if care taken to sanitise equipment used
Walk the coastal path from Budleigh to Exmouth Not affected Should be OK on the ‘good’ days
Partake in a good conversation Not affected OK
Play a game of croquet Probably not affected Probably OK on the ‘good’ days provided I don’t play someone with a cold/flu
3. I haven’t learnt much about Chemo but I have the impression that assuming it works then once the 7 month course is over you get a couple (?) of months before the PSA takes off again. Then it’s time to start another course of Chemo, which may or may not work as effectively as last time. Eventually the Chemo will cease to work. After how many cycles typically?
4. How and when will we know whether the treatment is working?
5. How will we know when it stops working?
6. What would your advice to your husband be if he were in my position?
7. Typically, how long after a course of Chemo before the sense of taste returns?
8. If I turn down Chemo and opt for palliative care how long is it likely to be before I start to deteriorate and how long from there until death?
9. If I go the Chemo route, once it ceases to be effective, how long is it likely to be before I start to deteriorate and how long from there until death?