I saw my MO last week, and unfortunately PSA is starting to rise again after Docetaxal Round 8
- After Round 6, PSA had declined from 47 pre-chemo to 1.8
- After Round 7 it had ticked up to 2.34
After Round 8, another increase to 3.1
Well docetaxal killed of 95% of the bastards and PSA is back where it was March 2017, so I guess that counts as a good outcome.
MO said "Let's finish Round 9 (due in 3 days) and if it goes up again we start Abi or Enza."
Now I would prefer Enza. Since I started Docetaxal + pred I have put on 8kg. Pred makes you hungry! I have previously lost 20kg since I started ADT in May 2017 based on vegan diet and daily exercise and feel great despite ongoing ADT, chemo and rising PSA. I would love to get my weight back down, and of course Abi comes hand in hand in with Pred. Yuck!!
But more particularly I want a course of Lutetium. I enquired about this last year before I stared ADT but was warned away - I was told that there was a high risk of Leukemia in 3 years. BUT - all my mets are are soft tissue, in liver and mysentry, bone scan is clear, so I believe that there should be little uptake of lutetium in bones hence small risk of leukemia. Does anyone have experience with Lutetium and could comment?
There are local trials for lutetium in Oz, but these are randomised, patients receive either cobazitaxal of lutetium. MO wants to get me off chemo for a while as he is worried about toxicity so that counts me out of the trial for a wee while. He also won't let me have carbo-platin for soft tissue mets, again because he is worried about toxicity of this drug.
There is a private supplier of lutetium in Oz, and since I am both castrate and chemo resistant then i should be able to access this. Yes it will cost me money (approx AUD8k per shot) but I would rather hit the cancer hard while it is still down. Lets see what happens after next clinical review.
How extensive are are yout liver and soft tissue mets?
From what I understand, LU-177 effectivity depends on PSMA expression because that's the target of the treatment. So you would need to get imaging to check that first.
Thanks Greg. My last PSMA Ga-68 scan was Dec 2017, before chemo. In summary it says:
"Current scan finding is suggestive of soft tissue metastisis involving a left mesorectal node, right hepatic node and and mesentry with only modest PMSA expression."
- Mesorectal node "mostly avid" (SUVmax 11), corresponds to 24mm x 18mm soft tissue abnormality seen on CT scan. No other avid nodal abnormalities seen.
- There are at least 5 PSMA-avid lesions of similar intesity seen in the right hepatic lobe. One liver lesion is SUVmax20.
- Numerous variably mild to moderately avid (SUVmax up to 7.5) nodules in the lower abdominal mesentry
So I have given this stuff a good nudge, but I hope that Lutetium (if I can get it) will be able to make further incursions.
Also, bone scan shows NO active osteoblastic boney metastatic disease.
Regards, Hazard