Surgery not possible for L1-L2 compression fractures related to tumors

Ex told today that because his significant tumors are both anterior and posterior vertebrae fractures, surgery is not possible to alleviate pain. Given stronger pain meds and will get direct and xofigo radiation soon. What should he expect? PSA is skyrocketing and because PSA and pain only increased in the 5 months of Xtandi, his chance of positive response to zytiga is only about 20%, according to research studies. Any advice on what to do now? Thank you for everyone's thoughtful responses and knowledge all things prostate cancer.

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  • I am having a little trouble following your post. If I understand it you are expressing concern that he can not have corrective surgery for the vertebrae fractures, he is also scheduled to start Xtandi and have radiation (I am assuming you are talking about targeted to the spine).

    Assuming I have distilled the issues properly:

    1- He needs to see another surgeon for a second opinion about the possibility of having surgery. Push the doctor for a solution. Spinal collapses are very serious, they can lead to paralysis and even worse.

    2- Get a second opinion from another medical oncologist from a different academic hospital. Ask about Xofigo instead of external beam radiation.

    3- You did not share his PSA numbers, but your description of the increasing pain and what sounds like an increasing PSA over five months while taking Xtandi does indicate that it has failed and there is little reason to continue it. Holding the Xfigo out of consideration (which I do not recommend) he could either move on to Zytiga or to chemotherapy (docetaxel).

    Personally I would elect to go first with chemotherapy then Zytiga as there is evidence that chemotherapy knocks down the circulating ARV-7 circulating tumor cells (CTCs). There is an untested, pre-clinical theory shared at last week's ASCO meeting that knocking down these CTCs might increase sensitivity to Zytiga. This is just a theory, it is untested, but it can not harm him if it doesn't work.

    Joel

  • Hi Joel,

    PSA is now 200, up from 99, 2 weeks ago. He just started zytiga two days ago and got a zometa treatment. Pain is better. He did 8 rounds of docetaxel last fall but PSA increased and he had progression on PET scan so he quit chemo at that point. Onc wants to do xofigo. He has an MRI on Monday to determine extent of vertabral damage before deciding what to do next. He does need a second opinion, but we live in a rural community and he has Medicaid for insurance. He was only diagnosed 14 months ago with PCa.

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