Why do some people get offered chemo

Hi Anna,

Welcome to this forum though sorry for the reason that brings you here.

There are different schools of thought regarding about when chemo should be given and it may well be the your Dad's consultants decided the approach they have opted for is best for him, at least for the time being. Certainly the drop in his PSA is very considerable. One could always ask about chemo but it may well be that with Dad's current response to what may be HT plus steroids, they may be satisfied with what he is having at present.

The Gleason score indicates how far cancer cells have deviated from normal on a scale of 1 to 5. The higher the number, the greater the deviation. Two figures are given, the number of most deviant cells is given first followed by the next greatest number of deviant cancer cells. These two numbers are then added together to arrive at a Gleason score. Thus for example a 4 + 5 = 9 is the same overall Gleason figure as a 5 + 4 = 9 but the latter has more of the further mutated cells. The cancer cells are usually taken from the Prostate in a biopsy to decide Gleason. However, in your Dad's case he has spread and where this is so there is a strong possibility that those cancer cells have further mutated so his original Gleason may not apply if a biopsy was taken from where the cancer had spread, which they are unlikely to biopsy if widespread.

Hope Dad is coping well with his treatment

Edited by member 25 Feb 2016 at 21:01  | Reason: Not specified

However .....
You don't (now) have to join a trial to get early chemo. As soon as the first trial results were available, late in 2014, some hospitals started offering it to newly diagnosed patients (my husband was one, although it hasn't apparently helped much). Since then, this treatment has now become officially approved and endorsed.

But it is still not offered to every patient. The evidence from the trials related to newly diagnosed patients, and only up to a certain age (70?). It may be that your father's hospital didn't have permission to give early chemo until recently, by which time he would no longer count as "newly diagnosed". Or he may be outside the optimal age range, or have some other health complication that means chemo is not a good idea right now.

Whatever the reason, it sounds as if your Dad is responding very well indeed to the treatment he's having, with that huge reduction in PSA. He could ask about chemo, but they may well say he's no longer at the stage where it's of any proven benefit. He may not even want to undergo what can be an intrusive and tiring few months of treatment with possibly unpleasant side effects - some men who are offered early chemo refuse it.

By all means talk it over with your Dad, but there may be good reasons why he hasn't been offered this treatment. It's not a "silver bullet" , and the treatment he's having already seems to be working well. He may well be offered chemo further down the line, when other drugs start to fail, but that's not something to concern yourself about yet.

What Ian says makes sense to me, Anna. If your Dad is taking part in a clinical trial (probably Stampede) this would be an alternative to early chemo. Tony, my husband, was also offered this option; he chose the chemo because he didn't know which arm of the trial he would be put on (allocation is randomised).

It sounds as if your Dad, like Ian, may be on the Enzalutamide + Abiraterone arm of the trial, which gives him two very effective (and expensive!) drugs, not normally taken together. If this is the case, I think he's getting the best treatment possible at the moment, and it seems to be working well.
Marje

Good response AC!! Live life to the full stay positive and deal with things as they occur do not worry about things until they need worrying about.

Chris/Woody

Life seems different upside down, take another viewpoint

Ah well if he has had a biopsy he can ask the trial nurse what his Gleason score was. Alternatively he could ask the GO next time he is there as it should have been sent to the GP in a letter.