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Chemo decision

Posted 04 January 2018 03:29:04(UTC)
Hi, I am new here. My husband is 69 years old and diagnosed with stage 4 prostrate cancer two years ago. He had a Gleason score of 9 with bone metastasis. He has been through several hormone drugs. When one seems to stop working they switch to another. He is currently on Xtandi but may be switched to Zytiga later this month the doctor told him his only job was to eat. He also is taking Xgeva injections for the bones. Hopefully I have spelled all the drugs right. In December, he had another bone scan. We were told that the cancer continues to spread throughout the bones. We were told that it was in his L3 of the spine, hip, shoulders,chest,and knees. We are now facing the decision of whether to do chemo or not. From the beginning we were told that chemo would only be a last resort and that it wouldn't help. About 6 months ago the doctor began talking chemo as a possible treatment and said the side effects would be mild. Now 6 months later we are once again discussing chemo again. This time he says they will hit him hard and in all likelihood it will be bad but that he will try and put him with an oncologist that can get him through it. We are confused and wondering if it is worth it.
Posted 04 January 2018 08:30:30(UTC)

It sounds to me like your urologist was a bit out of date with his knowledge and then found out about some new research and has advised you correctly.

Chemo does not cure prostate cancer so until recently it was only used when all other treatments had failed, and its main use was to try to extend the man's life a bit. But recently, trials have shown that chemo used earlier makes the hormone treatments more effective for longer and so some men are offered chemo as soon as they are diagnosed. There are lots of member threads on here describing the chemo treatment - some find the side effects very mild while others have a terrible time. You are being offered it and nothing else is working - what is there to lose? If he finds it too gruelling the medics can always reduce the dose or he can stop having the treatment - he doesn't have to have all 6 or 10 sessions if it is too awful.

What surprises me is that your husband isn't already under an oncologist!

NB - generally, if Xtandi fails then Ztyiga isn't very successful either - so much so that unless you are on a trial, the NICE guidelines say a man can't have one if he has already tried the other. Chemo might make the difference you need.
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

Posted 04 January 2018 10:23:28(UTC)

I am amazed that your husband was not referred to an oncologist on diagnosis with metastasising cancer.

As Lynn says, depending on the chemo, and your husband's general health, and, to some extent, luck, he may find it easy or very tough. And as the doctor said, the best outcome would be buying a little time, and that benefit isn't guaranteed.

If it were me - as it likely will be one day - I'd agree to one course if I was feeling strong and positive; and see how it goes. But if I didn't feel pretty positive, I wouldn't put myself through a few weeks of possibly awful side effects for the mere possibility of extending my 'life' by a few weeks. And if the one course was OK, I'd consider the second. I'd refuse to get on the roller coaster of 'I've started so I'll finish'.

What I definitely will do, when my turn comes, is get my GP to refer me to the local hospice. They do outreach  (almost all do now), and their job is symptom control. They can advise on pain and anything else that's an issue, and are pretty expert in other local services. And anyone with  a stage IV cancer would be eligible.

We get fixated on time, but it's quality of life that counts. There comes a time, for everybody, when the priority needs to be enjoying the life you have, not making yourself miserable by trying to get a little more. I'm not saying that your husband has reached that point: that's for him to decide, and he'll know, not by the number of metastases, but by how they are affecting his life.

But whatever you decide, good luck - and it'll worth hearing what an oncologist thinks.


-- Andrew --

"I intend to live forever, or die trying" - Groucho Marx
Posted 04 January 2018 13:51:46(UTC)

I have had a total of 12 Chemo cycles so far and it is likely that i will have more.

If I am truthfull, it has been easy for me so far, with very few side effects, but you must treat it with respect, insofar as recognising that days 2 to 6 of the cycle can be tiring and i have always rested well on those days, days 7 - 10 are the days when the white bloods are low and you have least resistance to infections. On those days I remain indoors mainly and never go to work (i still work part time) , but days 14 to 21 have always been a breeze to me. One thing I always do is take my temperature daily as any change can be dangerous.

What i do know is that in my case it is effective in controlling the cancer. As my Oncologist says, as long as we control the cancer we are fine, it is when the cancer controls us that we have a problem.

Good luck and best wishes


"Incurable cancer does not mean it is untreatable and does not mean it is terminal either"
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