Advanced Prostate Cancer
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What next after chemo fails

Hi

This is my first post, we live in UK and my husband Steve was diagnosed with aggressive prostate cancer in 2011 with lymph node involvement. PSA 14, Gleason 10,

Started 3 monthly zoladex injections straight away which he still has and also 40 radiotherapy treatments which kept his PSA to around 0.6 for 4 years.

He then started Casodex but it did not work so he was prescribed Enzalutamide, this worked well for almost 2 years but then PSA started to climb and scans revealed bone mets and he had 5 Radium 223 treatments. Further scans showed spots in the abdomen.

Last October he started chemo (Docetaxel) but PSA continued to rise and after 4 cycles oncologist said it was not working and changed to Cabazitaxel. PSA dropped after the first few cycles but then began to rise after cycle 4 and 5, PSA currently 20.

The oncologist is very negative and implies that there are very few options remaining, he has not had Aberiterone but onc says this rarely works after enzalutamide fails because thay work in a similar way. Has anyone experienced this?

Any advice or suggestions would be so appreciated as I am very worried that we are running out of treatment options

Jen

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Sometimes Zytiga will work again if it is tried after Jevtana. He can try estrogen patches too. If you can afford to go to Germany for treatment, they have had some good success with some radiopharmaceuticals (eg Lu-177-PSMA).

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Thank you so much, will look into this, any idea of a good cancer centre in Germany?

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There are several in Germany, and I think that the top centers cooperate on nuclear medicine, but the one that seems to have the most experience is Uwe Haberkorn at the University of Heidelberg. Contact details on the following:

pcnrv.blogspot.com/2016/12/...

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You might also look into some more "out of the box" things in the UK research specialist world for advanced prostate cancer. Perhaps seek a second opinion from the very top prostate cancer research specialists in the UK as to your Options. There might also be possibilities for genetics testing of cancer tissues for possible matches to certain actionable genes with drugs or agents still in Clinical Trials. These links might help facilitate such conversations and searches.

foundationmedicine.co.uk/

ukctg.nihr.ac.uk/home/

Just some thoughts...

Charles

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after zytiga there is Apalutamide, Darolutamide, and Proxilutamide

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Your oncologist may not be aware that after Chemo--having had 2 types now, that Xtandi[Enzalut.]--- Pca may become sensitized again and the drug may work once more. Or Zytiga may now work. It is usually true if one fails the other will not work either. So your Oncologist was pretty right there. But not necessarily so after Chemo. In the States we are doing a lot of Targeted Drug therapy, based on identified Gene Mutations. I do not know if you can do this in the UK. Certain PARP Inhibitors are selected against your Gene Mutations. I know 'Foundation One' in the States does Testing World Wide. And can have results in 3 weeks with recommendations world wide as to Trials with these PARP's

Your not at the end of your rope. In Munich--they are the capital of the world when it comes to treatment with Lu-177. I have no contacts but you are close by and thru the Web, you can locate Oncologists there using Lu-177. We are now trying to catch up with the Germans. Trials and Right To Use applications taking place.

We are also having some good results--a little less than 50% of the time in late Stage Pca with BAT---High Dose Testosterone, followed by Androgen Deprivation/cycles.

There is also CAR-T that we are doing in the States--an Immunology Technique of retraining the bodies T cells to fight the cancer.

As an aside, your description makes me suspicious that there may be Neuroendrocrine Pca involvement. A Chromogranin A blood test can verify that. Would not hurt to know.

Best Prayes and Wishes

Nalakrats

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Have you experienced these yourself?

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No---it is from my research.

Nalakrats

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I'm having trouble finding research that shows Zytiga or Xtandi being effective again after it stopped working. Can you give me a source? I'm in the same situation as JanJames' husband.

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We have individuals here on this site that the Pca got resensitized and their drugs worked again. My Geneticist, told me about it a long time ago--but some have posted here on the site. How about putting out a post looking for men when after Chemo Xtandi and Zytiga that had failed, they began working again after the completion of Chemo.

Nalakrats

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Thanks that is a great idea

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Thank you very much so much useful info to follow up

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Also have a look at care oncology clinic in London

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Sorry to hear of your roller coaster ride of emotions. Zytiga with predisone. Has that option been presented to you.

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No because oncologist believes it will not work because enzalutamide failed eventually

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Hi where are you in England my hubby is Steve also x

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Hi We are in Somerset not far from Bristol

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Hi where are you in England my hubby is Steve also he is on chemo we are in West Yorkshire

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This desease is so bad hubby just been taken to hospital not been eating so tired I just don't know what to think anymore

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My husband was diagnosed with stage 4 with bone Mets from the beginning. They put him on docetaxel first which only lasted and few months, then he went on Zytiga for only a month- cancer spread like crazy for him on that- did not with for him. He's now taking a new chemo drug called cabazitaxel and this seems to be working very well for him right now. PSA dropped from 1098-34 after 4 treatments. Best of luck, and God bless!

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