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Difficulty deciding Which way to go.

User
Posted 10 Oct 2021 at 09:28

Any advice on how to choose a direction? as I am provaroacating and put this off for a couple of weeks..

age 54. Gleeson 3+4. PT3aN1.

Bone scan April no evedence of skeletal metastatses.

CT May - cheast abdomen, pelvis no evedence of metastatic disease.

Following a robot assisted radical prostectamy in june two PSA tests 3.4 and 3.8 showed my cancer had spread.

A pet scan indicated that I have widespread active pelvic and retrpperitoeal lymphadenopathy. indicating that i have cancer in my pelvic and tummy lymph nodes.

I have started hormone therapy

I need to decide if I should have chemotherapy or enzalutamide/apalutamide.

Both options have side effects 

I am told that the data in studies will not allow me to draw direct conclusions to my self as those in the trails will have very different conditions. I am also told that no study comparing Chemo against enza/apal has been conducted. I was initially favouring Chemo on the basis that if I am going to have it it is best done now when I am at my fittest. Rather than later.

Any advice on how to reach a swift decision would be apprechiated.

User
Posted 10 Oct 2021 at 12:22
If you were my brother or father, I would be steering you towards enza or apalutimide. Technically, both are chemotherapies but not as brutal as traditional chemo like docetaxel or cabazitaxel, there is a lower risk of dying as a result of an infection (particularly covid) and this window of opportunity may be quite small ... they have only licensed enza as a first line treatment because of the need to reduce number of patients visiting hospitals (and possibly contracting Covid) so there is a possibility that once the NHS is less overwhelmed, enza will be pushed back into the post-chemo slot
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 10 Oct 2021 at 13:50

I watched a lecture by Heather Payne (prostate oncologist at UCLH) which was sponsored by PCUK (so I hope it's OK to mention her name in this context).

Heather talked about quality of life comparison between early chemo versus early novel ADT drugs (mainly Abiraterone as it's been around the longest so we know more about it, but also Enzalutamide and Daralutamide).

This showed a quality of life dip during early chemo, which recovers afterwards, but it never gets back to the same level as those on early Abiraterone instead (and you can probably assume all the *utamide drugs are similar to Abiraterone in this respect). This was not a comparison of survival and Heather didn't compare survival of early chemo versus early novel ADT drugs, other than to say that either of these add years over the previous standard of care which was just the traditional ADT drugs (Zoladex, Prostap, Decapaptyl, or Degarelix).

Because of your young age, you are probably considering longevity as well as quality of life, and one consideration is that you will probably have chemo at least once some point, and it can be easier to handle at a lower age when you're fitter, but can have ongoing impact on quality of life. Also, as you get older (typically from around age 70), men are less likely to be healthy enough to have chemo.

I'm not recommending one way or another, but just some things to consider, and to discuss with your oncologist and maybe clinical nurse specialists too.

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User
Posted 10 Oct 2021 at 12:22
If you were my brother or father, I would be steering you towards enza or apalutimide. Technically, both are chemotherapies but not as brutal as traditional chemo like docetaxel or cabazitaxel, there is a lower risk of dying as a result of an infection (particularly covid) and this window of opportunity may be quite small ... they have only licensed enza as a first line treatment because of the need to reduce number of patients visiting hospitals (and possibly contracting Covid) so there is a possibility that once the NHS is less overwhelmed, enza will be pushed back into the post-chemo slot
"Life can only be understood backwards; but it must be lived forwards." Soren Kierkegaard

User
Posted 10 Oct 2021 at 13:50

I watched a lecture by Heather Payne (prostate oncologist at UCLH) which was sponsored by PCUK (so I hope it's OK to mention her name in this context).

Heather talked about quality of life comparison between early chemo versus early novel ADT drugs (mainly Abiraterone as it's been around the longest so we know more about it, but also Enzalutamide and Daralutamide).

This showed a quality of life dip during early chemo, which recovers afterwards, but it never gets back to the same level as those on early Abiraterone instead (and you can probably assume all the *utamide drugs are similar to Abiraterone in this respect). This was not a comparison of survival and Heather didn't compare survival of early chemo versus early novel ADT drugs, other than to say that either of these add years over the previous standard of care which was just the traditional ADT drugs (Zoladex, Prostap, Decapaptyl, or Degarelix).

Because of your young age, you are probably considering longevity as well as quality of life, and one consideration is that you will probably have chemo at least once some point, and it can be easier to handle at a lower age when you're fitter, but can have ongoing impact on quality of life. Also, as you get older (typically from around age 70), men are less likely to be healthy enough to have chemo.

I'm not recommending one way or another, but just some things to consider, and to discuss with your oncologist and maybe clinical nurse specialists too.

User
Posted 10 Oct 2021 at 17:40
Up front Enzo AND chemo,?
User
Posted 10 Oct 2021 at 23:43

If you're up for that, it's worth asking. There is a school of thought that the more things you hit it with at once, the better. May have a larger impact on quality of life though.

Edited by member 10 Oct 2021 at 23:48  | Reason: Not specified

 
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