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Why no chemo ?

User
Posted 05 Apr 2025 at 19:53

Hubby diagnosed Dec 24 T3b4/N1/M0 PSA 451.  Treatment plan treating as oligmetastatic (due to pelvic lymph nodes involved no other evidence of metastatic) .  Prostap every 12 weeks, started Apalutamide 4 weeks ago, radiotherapy (possible Sabre to prostate only due to high PSA level and side effects to rectum n bladder lymph nodes involved involves.  My hubby is fit 60 year old no other meds/health issues.  My question is why would he not be offered chemo in addition? Thanks for reading 

User
Posted 06 Apr 2025 at 00:01

Great question, and the answer is actually good news for him. With oligometastatic cases, radiotherapy is often preferred as it's a more targeted, localised treatment, meaning they can target treatment to the problem areas - whereas chemotherapy is whole body, it's 'systemic' and harms healthy cells too. Chemotherapy makes sense where there's a lot of metastases around the body, rather than oligometastatic cases where that is by definition not the case. 

Some oligometastic cases are actually (theoretically) curable, I believe, with radiotherapy. 

Also worth noting if he doesn't need chemo, probably better to not have it now so he can have it if/when he needs it in future. Once you've had chemo, the second time around tends to be less sensitive to the treatment and more resistant and so people tend to have worse outcomes with their 2nd try of chemo. 

So if his Oncology team are recommending radiotherapy only (without chemo) despite his fitness, it's probably just because they don't think he needs chemo and that this will be the best treatment option for him at this time.

Edit: also, if you haven't yet, probably just worth posing the question to his oncologist, they should be happy to explain their decision.

Edited by member 06 Apr 2025 at 00:03  | Reason: Not specified

User
Posted 06 Apr 2025 at 11:01

Up-front Apalutamide has been used instead of up-front chemo in this case. It has fewer short term and long term side effects.

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User
Posted 06 Apr 2025 at 00:01

Great question, and the answer is actually good news for him. With oligometastatic cases, radiotherapy is often preferred as it's a more targeted, localised treatment, meaning they can target treatment to the problem areas - whereas chemotherapy is whole body, it's 'systemic' and harms healthy cells too. Chemotherapy makes sense where there's a lot of metastases around the body, rather than oligometastatic cases where that is by definition not the case. 

Some oligometastic cases are actually (theoretically) curable, I believe, with radiotherapy. 

Also worth noting if he doesn't need chemo, probably better to not have it now so he can have it if/when he needs it in future. Once you've had chemo, the second time around tends to be less sensitive to the treatment and more resistant and so people tend to have worse outcomes with their 2nd try of chemo. 

So if his Oncology team are recommending radiotherapy only (without chemo) despite his fitness, it's probably just because they don't think he needs chemo and that this will be the best treatment option for him at this time.

Edit: also, if you haven't yet, probably just worth posing the question to his oncologist, they should be happy to explain their decision.

Edited by member 06 Apr 2025 at 00:03  | Reason: Not specified

User
Posted 06 Apr 2025 at 07:49

Thanks for that, much appreciated 

User
Posted 06 Apr 2025 at 11:01

Up-front Apalutamide has been used instead of up-front chemo in this case. It has fewer short term and long term side effects.

 
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