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Advanced Prostate Cancer
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Friend with advanced Prostate cancer

Good friend with advanced prostate cancer has failed ADT. Cancer spread to bones and is being treated with Xgeva. Was treated with taxotere but cancer spread to liver. Was then treated with jevtana and psa climbed to 1000. Not sure of Gleason score. He sees his hematologist/oncologist tomorrow. That guy has already told my friend, Bob, and his wife that he has not had much success with immuno therapies.

Are there treatments available for someone like this? I am sure the next step is to get another opinion from someone at a highly regarded cancer research center but was curious if others have insight here.

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Two options are: Chemotherapy with Carboplatin and Etoposide

ncbi.nlm.nih.gov/pmc/articl...

and SIR spheres: You can do a search on google to get more information

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Your SIR spheres link is a deadend.

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He should begin Xofigo (are his bone mets lytic or blastic or both?) or second-line hormonal therapy (Xtandi or Zytiga) immediately. He should also add Celebrex to his Xgeva. He should discuss getting a tumor biopsied for pathological and genomic analysis.

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He tried xtandi and zytiga but his oncologist decided to dc both because the psa continued to rise and the cancer spread.

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Then Xofigo seems like the best therapy.

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Why should he add Celebrex to xgeva? Also he suffers with a lot of nausea. What causes that and any suggestions on how to remedy?

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He should add Celebrex to Xgeva because the combination (of Celebrex and Zometa (a similar substance)) increased survival by 22%. Nausea is a common side effect of many of these drugs. He should ask his oncologist if he should take an anti-nausea medicine. Or he can try eating some fresh ginger root - some studies say it is beneficial, some don't - worth a try.

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Try 8 mg. Zofran Rx in melt form for nausea.

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Tall_Allen

Is there a substitute for Celebrex, if it causes blood pressure spikes?

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I have only seen the combination tested - neither had any benefit to survival when used alone.

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Thanks

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If the cancer is PSMA positive, he could try Lutetium 177 PSMA . There are several clinical trials (clinicaltrials.gov) in the USA or get treated in Europe and/or Australia .

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Good Thursday Morning kpurcell,

I have been in this battle for almost six years (please see bio for complete treatment history).

For nausea during my chemo, Med Onc prescribed a drip of Aloxi, which prevents nausea and it worked.

Google Mayo Clinic and Wisconsin American ginseng to learn benefits from their trial.

Best wishes. Never Give In.

Mark, Atlanta

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Thank you all for your help! I really appreciate it

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God Speed for your friend (and you're a friend in need is a friend indeed).

Good Luck and Good Health to your friend (and you too).

j-o-h-n Thursday 07/12/2018 2:38 PM EDT

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I begin taxotere next Tuesday. Psa is about 8, Pca is in bones in many tiny mets but none seen in organs - yet-, which means it could be in organs, but mets are too small to be seen in scans.

The docs said taxotere is first level of chemo and there are 4 levels so I have no idea what other chemo I may need.

So far, it seems most of my mets if not all produce Psa so the big mets all show up in MpSa gallium scans so if I have Lu117 radiation I might reduce the size of many tumours and thus extend life by maybe a year or more. Psa can rise to 10,000, and I have heard of fellows getting quite a long life after psa reaches such a high level. Your friend needs courage to try more drastic treatments, and nobody can really know what the outcome will be. We all wish to get better, and wish our friends to get better.

Patrick T.

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To kpurcell:

Have had CASODEX, XTANDI, and ZYTIGA pills, but they all stopped working. Mets to lymph nodes and bones started appearing in April 2017. Had PROVENGE immunotherapy in the Fall of 2017. Started chemo in January 2018 but all 3 types didn't work: TAXOTERE, JEVTANA, CARBOPLATIN. My PSA went from 30 in April 2017 to 4200 most recently in June 2018. So now looking into a clinical trial. The chemo caused extreme fatigue and shortness of breath. Ron in Connecticut, 203-767-1123.....

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Which trial are you looking at?

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I don't know the details of possible trials...am waiting for an appt to discuss options with the top onc doc at yale new haven hospital..

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Does he still have his prostate? Or was it removed?

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Yes. He has elected to be treated with palliative care....

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