Advanced Prostate Cancer

After Xtandi, 177Lu-PSMA-617 or BAT?

My PSA has been doubling every two months since September 2016 while on Xtandi. What do you think I should do next?

1. 177Lu-PSMA-617 -

2. Bipolar Androgen Therapy -

Clinical trial options are

1. Lutetium-177 (Lu177) Prostate-Specific Antigen (PSMA)-Directed EndoRadiotherapy NCT03042312

2. RE-sensitizing With Supraphysiologic Testosterone to Overcome REsistant (The RESTORE Study) (Restore) NCT02090114

10 Replies

How high is your psa now? Two months is fairly quick, do you have any metastatic disease? Have you tried zytiga or chemo? I have been a fan of using up existing proven therapies ie zytiga,stand and dolce taxol chemo before taking a show on a clinical trial especially if it is radomized or stage 1 or 2. That being said, I am curious about the trial of pd1 inhibitor keytruda in mcrpc. I wish you the best. I just found out my recent psa wold put me at a little less than 2 month doubling with the psa currently at 92, I started docetaxol yesterday to try to beat it back.


1 like

My attitude is that all the "proven" therapies are proven to be only marginally effective, so I always choose the most promising experimental therapy available to me. I have done five clinical trials so far. See my profile for my history.


Thank you for helping with the research to find a cure. How do initial results look in testosterone trials?

Thought Gvax was stopped in clinical trials long time ago.I hope you can find a trial quick and get in with 2 month doubling time. I wish you well,look forward to hearing what you come up with.


Have you had a genetic blood test, like Guardant360? After all available drugs, my PSA began rising for 18 months. Guardant test revealed ATM genetic defect and I began oral Lynparza in 10/2016. PSA now declining.


Good question. I took the Color Genomics test and no known mutations were found.


The Lu177 is quite effective after Xtandi. I had 4 years plus on Xtandi and recently 4 infusions of Lu177. Some Mets disappeared some Mets static - PSA dropped significantly. Still waiting to evaluate the longer term impact of Lu177 treatment. Preliminary result must be considered very satisfactory.

Its not a forgone conclusion that you will be a suitable candidate for Lu177. This will only be determined when the initial PSMA/PET scans have been completed.

These will indicate if the PSMA expression on the tumors/mets is adequate for the Lu177/Ligand to be attracted to the metastasis in in sufficient quantity to be effective.

I would go for this before BAT - if you are a suitable candidate statistically you have more than a 50% chance that you will get an acceptable result.

If Lu177 doesn't work out as well as one hopes, it should not be too difficult to get on a BAT trial. BAT is my chosen backstop as it should be relatively easy to find a trial.

Vandy 69 (above reply) is on another treatment which is showing good results for CRMPCa and has made a very valid point - if you can get a genetic test done before you make a decision it would be beneficial. If you are found to have a genetic mutation Oliparab (Lynparza) could also be an option but its not always that easy to find Lynparza trials in a suitable location.

If there are no mutations then Lu177 is probably still a better proposition.

Good Luck - making your decision. it is not easy to predict which is the best way to go.


Do not fear chemotherapy.

Gourd Dancer

1 like

Get thee off Xtandi and onto Zytiga!


What do you base that advice on?


I am wondering the same. My uro said that the evidence suggests that Xtandi showed slightly better outcomes than Zytiga.


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