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Advanced Prostate Cancer
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Cabazitaxel failing- what's next?

My husband's cancer seems to be progressing once again. He's had 3 very short lived treatments in 1 year- docetaxel 6 rounds, Zytiga 1.5 months and cabazitaxel 7 rounds. The cancer has metastasized to his lungs besides being in the bones, so radium 233 is out of the question. He's started to have shortness of breath on exertion. His PSA went up from 34 round 4 to 348 round 7. His alk phos and other blood makers are above normal again as well. We have an appointment this Thursday with his oncologist to figure out what the next steps are. Has anyone been down this road thus far? Are there other approved chemo treatments out there- we live in πŸ‡¨πŸ‡¦.

Thank you all,

God bless

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As far as chemo goes, there's Carboplatin for PCa that's metastasized to organs and soft tissue (visceral mets). There is Xtandi, another androgen-based treatment. It can work after Zytiga fails. There is also LU-177, but I don't know its status in Canada. It is available in Germany, but fairly expensive.

I wish you the best.

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Thank you for your reply. It's been a busy, hectic week. I'll keep this in mind .

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This list of approved drugs in Canada might be used as a basis for your next discussion with the oncologist to explore all available options.

prostatecancer.ca/Prostate-...

You might find some benefits in a Canadian Prostate Cancer Support Group, too.

prostatecancer.ca/Supportin...

This link from Health Canada will also show 80+ clinical trials if you search for "prostate cancer", and can be used to zero-in on trials more specific to individual situation/location.

health-products.canada.ca/c...

Good luck with the up-coming appointment.

Charles

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Thank you for the links. Will discuss these with the oncologist.

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Hi there.

Firstly, I would like to say how sorry I am that you are finding yourselves in this situation.

It sounds like your husband has gone through a lot of treatments; two different Chemotherapies and the other medications he has had, they all weaken the body, a body that is already weakened by the cancer itself. So that perhaps explains to a certain extend the shortness of breath.

How is your husband feeling? Is he weak? What about his appetite? Any sickness?

I suppose your next step would be Carbo Platin. It may be able to control the cancer for a number of months. However, your husband's body is weakened from the previous treatments and that will very much influence how well he can take the Carbo Platin.

So, yes, there are other treatments out there and other things you can try.

Good luck and please keep us posted!

Mel.

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Hi Mel,

It's been such a whirlwind of emotions. His energy is not the greatest, but he manages. Will do laundry (laundry mat), take the dog for small walks, and still working his pt job, shuttling guests to their car 3 evenings a week. His appetite could be better. He complains a lot that the food tastes off, so we are sticking to the things he really likes, and added Resource (boost) back into his diet. He's lost 7 pounds in 2 months from his lack of taste, so I'm trying to boost up his calorie intake at the moment. He has shortness of breath when he gets to our bedroom on the 3rd floor- his O2 sat drops to the 80's, but he recovers quickly and back up to mid to high 90's.

Did bloodwork and saw the oncologist on Thursday. His PSA dropped from 348 to 208, his Alk Phos, ALT, LDH and A ST are either normal or dropped lower again.

The oncologist still considers him stable, although his PSA went from 34- 348 after 3 chemo treatments. She's happy about his numbers, and said he could be fighting a virus do not to get too concerned about his SOB on exertion. She's ordering another CT scan and pelvic and abdominal x-ray.

She's keeping him on the same chemo regimen for now.

Thank you for the reply and your support. It's all about taking it one day at a time.

God bless

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Sorry to hear about the progression.

I'm surprised Zytiga stopped working after only 1.5 months, but then again everyone is different and respond to a drug better than the other.

Did he try Xtandi (Enzalutamide)?

It's similar to Zytiga although it works a bit differently and he might respond to it, might be worth a try.

For chemo there's Carboplatin but it'll have its side effects sadly.

Did he also try Immunoterapy with Provenge (Sipuleucel-T)?

Also ask for radiopharmaceuticals and get him scanned with a PET PSMA for more targeted treatments, like Lu177 (Luthatera).

Also ask for clinical trials.

Good luck and best wishes.

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Thank you- unfortunately some of the options you mentioned are not available in Canada, and we can't afford traveling and paying for care elsewhere. I'll definitely ask about these options though. Who knows, maybe some of them are in clinical trial here.

God bless

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I completely understand what you are going thru. My husband is also being treated out of Toronto Princess Margaret hospital. After 5 years on LUPRON, XTANDI was added and although we had immediate results it stopped working after a short 5 months. After 3 cycles of docetaxel it was determined it was simply not working. He had his first treatment of cabazitaxel this past Friday. He has multiple bone and lymph mets as well as a couple spots on the liver now. Psa out of control jumping from 1900 to 2250 in just one week. There are a number of trials running especially in immunotherapy. LU-177 is our next option. There are a number of trials running in the US now but Germany is also an option if one can afford it. I spend a good part of every day researching what is available out there and thank god this forum has so much support and information available. Sometimes it feels like we are losing the battle but then I read of success stories here and believe it is finding the best drug therapy that works for the individual as everyone is different and reacts differently to a variety of drug therapies. Hoping you find the one that works for your husband as I wish the same for husband before we lose the battle.

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Hi Rose,

Thank you for taking the time to reply. So sorry to hear about your journey as well. Immunotherapy and LU-177, are they trials at PMH?

Doctor believes he's stable and is keeping him on the same chemo regimen for now. His blood bloodwork came back good. PSA dropped over 140 points and his other bloodwork dropped as well or are still normal. She's not concerned for now.

Keep fighting the fight! I believe only God knows our final time, it's our job to fight, and to love and appreciate each other to the fullest each day.

You are your husband pillar of strength. He's blessed to have you in his corner.

God bless

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The Lu-177 trials are not here in Canada. We are looking at one in Phoenix as we have a winter home there. The immunotherapy trial is out of PMH. The immunotherapy trial requires a biopsy and there is a 2 week window where the treatment is delayed until the biopsy can be done. The LU-177 trials usually have an 8 week delay as they require multiple testing before treatment can begin. We simply do not have time to wait out the waiting periods until cancer is under control. God bless as you both journey on.

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I've been on a similar course. I've not developed mets in my organs but my spine lights up all the way up and down. Jevtana is slowing down my rising PSA but I'm at 620+ now and see about a 30 point rise every 3 weeks.

We have started looking for clinical trials in earnest. Lu177 does appear to offer hope. Trials of Lu177 are numerous Look it up in clinical trials.gov. They are routing good results for up to 70% of me treated. Here is a review article, summarizing results in studies

onlinelibrary.wiley.com/doi...

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Thank you for your reply. Wishing you nothing but recovery and a pain free journey. Keep up the fight!

God bless

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I'm curious as a bebavioral economist and having studied single payor health care systems around the world, are you experiencing any medical care restrictions due to older age or with the system itself? I'm part Canadian but I'm a citizen of the U.S. and covered under under Medicare and a Medicare supplement policy.

Ive had several Canadian friends tell me they have been on waiting lists for certain medical proceedures.

Thank you.

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It all depends on your perspective of what good heathcare is.

I've found in the cancer world in Ontario, things move quite quickly. It does take a little longer than I guess then the US to book certain appointments. CT scans can take about 1 or 2 weeks to get, unless it's an emergency. My husband was in the hospital for 3.5 weeks in Feb and they did tests within 1 day. Normal CT or MRI scans can take up to 2-4 months to get for non time sensitive issues, such as rotator cuff issues.

All of his treatment has been covered by OHIP thus far- with the exception of daily meds and Lupron shots. I'm blessed to have benefits from work which cover all but a $250 deductible. OHIP will cover Zytiga or Xtandi here if you can't afford it or don't have coverage, but you need government approval first (They don't assess your income, they just need doctors approval and proof you've tried conventional treatment first). However that could take up to 6 weeks to get approved.

It seems we are behind with treatment options. I don't think immunotherapy is approved yet by the Canadian FDA as standard treatment, it might be in clinical trials.

As far as non life-threatening care, things are much slower. Being referred to a specialist can take months, then booking surgery can take months as well.

I hope this answers your questions.

God bless

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