Need some help

[siness]

Hi i am a after some help from across the pond on future treatments that i have been offered.

I was diagnosed December 2012 age 53 Gleason 9 PSA 3.6 no symptoms just the result of a well man check up

My bone scan at diagnosis is below, i will list my treatments so far

Jan 13, 9 cycles Docetaxel, Denosumab, Zoladex and 5 days of RT to pelvis to prevent fracture

After finishing Chemo i went straight on to Abiraterone and stayed on it until Jan 15 with my PSA remaining undetectable at this point i started getting very bad supraventricular tachycardia thought to be medication induced so all treatment was stopped except Denosumab to sort it out, trouble is i enjoyed being off treatment that i remained treatment free and undetectable PSA until November 16 when my PSA started rising i then restarted HT and in April 17 had six cycles of Cabazitaxel this stopped my PSA rising but i got progression on the scans.

I then restarted Abiraterone and had a good drop in PSA after 2 weeks but then i had three consecutive increases and Abiraterone has now been stopped with my PSA at 5

So my question is i have been offered treatment that i can not find much information on here in the UK and was after your thoughts, so

20 sessions of RT to the prostate

BAT testosterone flood and drought

mitoxantrone

Tumor biopsy and if suitable either Pazopanib or Carboplatin

Ra 223

Any thoughts on these treatment options would be a great help

Thanks

Simon

[Tall_Allen]

I think that's an excellent plan. The only thing you might consider adding is celebrex - it seems to synergize with Xgeva or Zometa. I talked to someone who had a good response to Mitoxantrone - an old drug that was scrapped when docetaxel came along.

I would be wary of BAT in your case. It has only been used in asymptomatic men (with equivocal results), and with your high bone met load, it could be dangerous. I don't know if the RT debulking will work, but if you aren't experiencing urinary obstruction, I think it's worth trying. Xofigo would be my first choice. There are some trials (perhaps in the UK - I haven't checked) that combine it with an immunotherapy, which may be a synergistic combination. You might also check if there are any open trials there of darolutamide.

[Scruffybut1 in reply to Tall_Allen]

Good morning Simon. Which hospital are you attending? I too am UK as are many of us and whilst there is a London based HealthUnlocked control section the Prostate Cancer charity and the Macmillan Foundation give first rate current advice on the phone. My hospital is Charing Cross and we meet up with guys from a number of London specialist hospitals i have been on this site for 3 years and the advice when given is invariably excellent. What stage were you diagnosed at,?

[Reptale]

Looks like a lot of bone mets, and I’ve just had a great treatment for bone mets: marketed here as Xofigo, it is Radium 223; the molecular structure looks like calcium to the body. So bones fighting the attacking cancer absorb it to replace depleted calcium and the sneaky radioactivity kills cancer cells. Treatment is administered by a fast intravenous infusion once a month, usually for six months. The main side effect is nausea and diarrhea about two days after treatment. This is usually over in a couple of days. In my case, the treatment seems to have been effective in that a recent PET Scan with the tracer Axumin showed a marked decrease in the bone mets. If this treatment is available in the UK, I suggest you ask your oncologist about it.

[dmt1121]

Others may be able to tell you more about those modalities but i wonder if genetic testing might benefit you?

Good luck!

[FISHLAND]

Hello Simon, did you get information about LU 177psma in Germany. Take care Anne-Marie

[siness]

Thank you for your reply's and sorry for my late one, i have not quite got the hang of this forum yet.

So after much discussions i decided to go for the BAT treatment, i had my first injection last Thursday my PSA then was 5 and testosterone was castrate level.

I will update as things progress

Again thank you for your reply's

Si

[snoraste in reply to siness]

Good luck. And please keep us posted

[siness]

Just had blood results after 4 days on BAT, PSA has gone from 5 to 9.9 and testosterone has gone from castrate to 38.9 nmol or 1121 ng

now just ride out the storm

Si

[siness]

Further bloods done yesterday

PSA now 19.9 Testosterone now 11.8 ALP 56, next injection in 2 weeks