Immunotherapy vs Chemotherapy

User

Posted 14 Jan 2021 at 17:01

Hi everyone,

This is my first time posting on this forum. I have over the years extensively read the chats for information, advice etc and I have found it to be immensely helpful. Thank you to everyone for sharing your experiences!

I am writing today for some advice about my dad.

He was diagnosed with prostate cancer (T1c N0 M0, gleason score 4+3, PSA 21) in 2007.

He was treated with hormone therapy + radical external beam radiotherapy in 2008.

Unfortunately the PSA began to rise in 2014 (27.3) - prostate biopsy was negative. Scans showed some markers in his spine, shoulder and pelvis so he began hormone therapy. We tried getting him on the stampede trial but were unsuccessful. The PSA dropped to 0.1.

In 2016 the PSA began to rise again slowly and reached 3.36 in February 2017. PET scan confirmed disease progression and he was put on Abiraterone/Prednisolone. He has done fairly well up until now (2021). During the course of Abiraterone he has had some palliative radiotherapy to his pelvis, shoulder and jaw.

His PSA is starting to rise again and the oncologist has advised that now is the time to start chemotherapy (docetaxel). In the past month his PSA has jumped up from 2.6 to 4.2.

The oncologist has given us a month of Abiraterone and needs a decision by next month.

I have been researching immunotherapy and I have come across a clinical trial involving Pembrolizumab, which I believe my dad would be eligible for. The oncologist was not very forthcoming about it and indicated that immunotherapy has not shown promising results for prostate cancer. I felt he was pushing for chemotherapy. My dad is worried about the potential side effects and quality of life (he is very active and runs his own business).

The questions I have come to ask are:

1. What are everyone's opinions on chemo vs immunotherapy for prostate cancer? (I'm looking for advice or any knowledge on the subject)

2. We're not sure if my dad should go for chemo or wait a while?

3. What are other people's experiences of docetaxel x6 sessions?

Thank you all for your help and advice.

User

Posted 14 Jan 2021 at 22:29

Hi,

I can't answer any of your questions but someone else might.

You've obviously done a lot of research since 2007. T1c sounds very low although psa 21 doesn't seem as low. RT in 2008 followed by hormones after a recurrence in 2014. He's done very well which is optimistic for most of us.

If it was me I'd go with the chemotherapy and look into ways to minimise side effects. Although I'm sure I'd be looking at every other treatment available. If you're paying then there could be more treatments. You could look at the profile of Old Barry who's had several treatments, often overseas, mainly invasive so maybe not relevant.

Regards Peter

User

Posted 15 Jan 2021 at 02:06

Dad's situation has moved on from his diagnosis back in 2007 and his treatment options now require a systemic treatment, something others will be more able to comment on. The treatments I had were like the EBRT Dad had but with Carbon Ion boost and this is not repeatable although in some cases radiation can be directed at a few identified spots of cancer outside of what was previously treated. These are referred to as Oligometastases but it seems Dad's situation has been considered as not being suitable for this, although a dose of radiation might be given to provide pain relief to a particular remote hot spot at some point.

The other treatment I had was a focal treatment called HIFU which for PCa is given only when the cancer is within or very close to the Prostate. So Dad's spread is beyond where focal treatment would be suitable for him.

Barry

User

Posted 15 Jan 2021 at 15:12

Hi, cant answer anything on immunology but had 6 docetaxel in 2019. There's a long list of side effects published in various places and it's always in small print somewhere that says "not everyone will get all the side effects". I had very few side effects, and those were more irritating than debilitating. When the beast reawakens, I don't have serious concerns about having chemo again to hopefully put it back to sleep again.

Please bear in mind that chemo effects different people in different ways, so don't take the fact that I coped ok as meaning everyone will!

Small comfort but your Dad sounds like he's done well to be fighting this long, hope I'm still around 13 or 14 years after DX

Good luck to everyone coping with the insidious big C

User

Posted 15 Jan 2021 at 19:42

My father-in-law breezed through docetaxel at the age of 79 - his biggest issue was that his wife wouldn't let him go to the pub on days 5 - 8 in case of infection (clearly that wouldn't be an issue in the current lockdown).

We froze lots of fresh pineapple chunks for him to suck during the infusions - this helps to protect the taste buds from damage and reduces the problem of the horrible metallic taste. Not everyone can have a lot of pineapple so you would need to check with his doctor though.

Research shows that docetaxel can make the hormones work more effectively for longer. I think in the circumstances I would be tempted to hold immunotherapy back for later down the line as it only works on some types of prostate cancer.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 17 Jan 2021 at 11:30

Thank you everyone for your advice and input. I shall pass it on to my dad who can then decide how he would like to proceed.

I guess what we were asking for is near impossible now (some sort of treatment with minimal side effects that can control the spread). Dad is all about the quality of life over quantity and has always said to us that when it’s time to go it’s time to go.

We have been so lucky and fortunate that dad has been able to fight the disease for this long. When he was diagnosed (I was 18 at the time), we never thought that he would be here today.

On another note - does anyone know if you can get enzalutamide after having Abiraterone or is it generally not accepted?

Good luck to you all who are or have family members fighting this disease.

Thank you all

Sobia

User

Posted 17 Jan 2021 at 13:03

"On another note - does anyone know if you can get enzalutamide after having Abiraterone or is it generally not accepted?"

Not on the NHS - you might be able to get it on private prescription but it is about £2800 per month and unlikely to be successful. Trials have shown that once Abiraterone fails, enza will also fail very quickly and vice versa. If he has the docetaxel, he might find that the abiraterone works for a little while longer.

If he is suffering a lot with the bone mets, it might also be worth asking about Radium 223 - it doesn't treat the PCa as such but can reduce bone pain.

"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User

Posted 21 Jan 2021 at 10:22

Thank you Lyn for the information.

Luckily the bone mets are not so bad at the moment and tolerable with pain killer medicines. He has had palliative radiotherapy to the more painful areas (jaw and pelvis). We're saving the radium for when he does need it.

I think he's decided to give chemotherapy a go and see how it goes. Fingers crossed.

Once again - thank you everyone.

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