Living with Prostate Cancer
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Starting chemotherapy is not the end of the world. In fact, many men who are suffering from symptoms from their cancer will experience a rebound back into the world after starting chemotherapy as these symptoms diminish. For example, pain is often reduced in men starting docetaxel, and quality of life is generally better for men with cancer-related symptoms who receive chemotherapy as compared to no therapy. Currently, the standard of care for men with metastatic prostate cancer that has spread and is progressing despite low levels of testosterone is every 3 week docetaxel, given with prednisone. If cancer has spread to the bones, giving zoledronic acid with docetaxel is recommended. The decision on when to start chemotherapy is difficult and highly individualized based on several factors:
- What other treatment options or clinical trials are available.
- How well chemotherapy is likely to be tolerated.
- What prior therapies you have received.
- If radiation is needed prior to chemotherapy to relieve pain quickly.
Often chemotherapy is given before pain starts, with the goal of preventing this pain from cancer spreading to bones and other sites. Discuss the use of chemotherapy with your medical oncologist early and often, and keep an open mind. We know that using docetaxel has extended life, reduced pain, and improved quality of life, but it does not cure prostate cancer. For this reason, exploring clinical trials of docetaxel combinations or other promising therapies is a high priority in this setting.
There are many clinical trials ongoing in the US and worldwide, and are further described on the following webpage:
http://www.cancer.gov/clinicaltrials/search. We encourage men to discuss these options with their doctors.
Questions to Ask Before Starting Chemotherapy:
- Since my PSA is rising again, do we discontinue the androgen deprivation therapy ("hormone therapy")? Why or why not?
- Are there additional hormone therapy approaches that we should explore?
- Should I get a bone scan or CT scan to determine if the cancer has spread to my bones? What will the bone scan tell us?
- Are there therapies that might help slow down the disease progression, especially to prevent the spread of the cancer to my bones?
- If there is evidence that the cancer has spread to my bones, how can we treat it, slow down the progression and/or prevent bone pain? Am I a candidate for radiation to these spots?
- What are all of the treatment options available to me at this time?
- Is it important to consider the sequencing of treatment options so that we preserve as many options as possible in the future? Are you recommending any treatments that might prevent me from qualifying for a clinical trial in the future?
- Should we consider chemotherapy?
- What other treatment(s) might be appropriate and why?
- What are the side effects of the treatment plan that we have selected?
- Are there dietary changes that I could or should make to optimize my treatment?
- Are there any other specialists that we should or could add to my treatment team to gain an additional perspective on treating my disease?
- Should I consider joining a clinical trial?
Finally, do not be afraid to talk to you doctor about looking around for other therapies. There are many exciting clinical trials ongoing around the country, involving novel agents that have great promise to help men with prostate cancer and many may be appropriate for your current condition. Take your health care into your own hands, as no one can be as strong an advocate for you as you or your family can.