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

[Beauxman]

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 - ncbi.nlm.nih.gov/pubmed/270...

2. Bipolar Androgen Therapy - ncbi.nlm.nih.gov/pubmed/273...

Clinical trial options are

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

clinicaltrials.gov/ct2/show...

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

clinicaltrials.gov/ct2/show...

[Dan59]

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.

Dan

[Beauxman in reply to Dan59]

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.

[Dan59 in reply to Beauxman]

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.

[vandy69]

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.

[Beauxman in reply to vandy69]

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

[Barree]

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.

[Hidden]

Do not fear chemotherapy.

Gourd Dancer

[celler6]

Get thee off Xtandi and onto Zytiga!

[19don36 in reply to celler6]

What do you base that advice on?

[cfrees1 in reply to 19don36]

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

[The_Don5 in reply to cfrees1]

not according to Affirm trial and the Prevail trial it doesn't. our doubling time was 3 months for xtandi in the first three months of use.