Its an unfortunate and frustrating scenario where Docetaxel has not worked for this gentleman.
You can do lots of evidence based or non-evidence based stuff for this chap.
First of all, please assure me that his Monthly LHRH agonists Injections havent been stopped.
Secondly,the doses of Docetaxel prescribed were right at 75 mg/m2 every 3 weeks along with Prednisone 5mg BD.
Pray to god that the drugs "Leuprolide" or "Docetaxel" which this gentleman has had are not fake like simple saline injections.
Change the brand Leuprolide to Zoladex or etc.
(These latter 2 comments are not evidence based and should be confidential ie not on your records)
Simple practical things you could do
1. Consider 3rd line hormone treatment
Diethylstilboestrol 1-3 mg OD with Prednisolone and Asprin
High dose Ketoconazole 200mg tds with Prednisolone
2. If you are a chemo fan,
Traditional Chemo: Mitoxantrone 12mg/m2 q 3 weeks + Prednisolone
Estramustine 280 mg orally three times daily days 1 to 5
New licensed chemo: Oral Satraplatin 80mg/m2 for 5 days every 5 weeks + Prednisolone
( No improvement in OS, and a meagre 1.4 week improvement in PFS)
Unconventional Chemo (for enthusiastic oncologists)
Add Carboplatin to Docetaxel
http://www.ncbi.nlm.nih.gov/pubmed/18085595
This Ph 2 study showed a good response in 18% (> 50% decline in PSA) and some measureable response in 14% pts.
Experimental /Research Setting Chemo
Pfizer Sutent Prostate trial: Ph III RCT Sutent VS Placebo in pts who have failed taxanes.
Ph II trial with Ixabepilone: This is a new class of non-taxane tubulin polymerizing agents beloging to the group called EPOTHILONES and it has significant activity in men with castrate-resistant prostate cancer both in chemotherapy-naive and previously treated patients.
Meanwhile continue with Bisphosphonates.
Is Ibandronate licensed for HRPC ?
But whatever its doing, it sure is preventing skeletal related events in this chap.
Girish, i am sure you would be able to detect the serious component and the humour component of my comments.
One thing i like about you is your passion of not digesting the fact that Pt is symptomaticlly better but the damn PSA is rising.
Frustrating is nt it !
I sure miss Amit Jains comments here.