After Firmagon, what next?

[sujkap]

My dad is 87, one year since diagnosis of advanced PC. starting psa 2790, numerous bone lesions all over and lymph nodes too.He's been on Firmagon monthly shot, reached lowest of 33 and now rising again. psa was 89 last month and this month 133. What would be the next step? He has no co-morbid conditions and is fairly active though weak. We have to meet the Oncologist next week to discuss options.

[Tall_Allen]

Consider orchiectomy. If his comorbidities preclude docetaxel, he might be able to handle Xtandi or Zytiga. Xofigo BEFORE Zytiga might provide a lot of relief from painful bone mets. Provenge may be possible too.

[sujkap in reply to Tall_Allen]

can docetaxel be considered for his age? will discuss the above with the doctor

[Tall_Allen in reply to sujkap]

It depends on what comorbidities he has. The elderly are often undertreated for serious PC, overtreated for insignificant, indolent PC.

[GP24 in reply to Tall_Allen]

Why did you recommend Xofigo BEFORE Zytiga?

[Tall_Allen in reply to GP24]

Because you can't have them together and it's a shorter treatment, so you can do both more quickly if you do Xofigo first.

[charlesmeyers1964]

make him comfortable and let him enjoy what time he has left is my suggestion.

[kenner in reply to charlesmeyers1964]

I'm really with you on that statement. Life at all costs does not make sense to me.Quality of life is the most important ingredient.

[sujkap in reply to kenner]

Yes, I hope he stays active through these difficult months ahead.

[charlesmeyers1964]

as for tall allen lets say if one reads the facts about removing ones balls its not worth shit. maybe a few months and tha'ts all of low psa. your hormones aren't produced there they are produce in the addren glands not your balls that's where sperm is saved and sent down the tubes at 87 its about over. i've read men who have psa's of 1,000 and 2000 there really isn't much let to do he's 87.

[Tall_Allen in reply to charlesmeyers1964]

No - testosterone is mainly produced in the testes (that's why it's called testosterone). Small amounts of androgens (not testosterone) are produced in the adrenals.

[sujkap]

Thank you for the advice. Have to get all baseline tests, blood work and the PSMA pet scan before we meet the doctor. I agree, we have to make him comfortable at his age. However it is going to be so so difficult to stay positive and just watch him go. My heart breaks!

[Hirsch]

By definition,is he not castrate resistant. So time to try another approach. Please let us know what the oncologist says. Good luck.

[charlesmeyers1964]

dude make him comfortable there is no cure when ones psa is that high. he should ha e had zytiga xtandi, provenge if the psa was low maybe 4 more years but at that high???? charlie

[sujkap]

So the PSMA PET CT scan result is not very different from the last one he had a year ago on diagnosis.

Numerous skeletal and lymph lesions which have largely remained the same. No spread to lungs, liver or other organs. I’m surprised that the mets have not shrunk significantly though PSA went from 2790 to 33 !

The oncologist hinted he may look at Zytiga as there are no liver mets. We meet him on Monday

[sujkap]

We will be starting xtandi for my dad. Firmagon will continue. Doc wants to check if there is a gene mutation involved so that meds can be chosen keeping that in mind. Can anyone tell me how that is significant to the course of treatment?

Xgeva monthly will be added as there are extensive bone mets.

Thanks in advance for your help.

[ctarleton in reply to sujkap]

A test of inherited genes might discover a gene mutation associated with the prostate cancer that might be treatable with another drug. For example, perhaps around 5-10% of men might carry a mutated BRCA 1 or BRCA 2 gene. A doctor might try using a targeted treatment agent, such as a poly (ADP-ribose) polymerase (PARP) inhibitor like Lynparza (olaparib). (This type of information might also be of benefit to other blood relatives, both male and female, in assessing their own cancer risk profiles.)

[sujkap in reply to ctarleton]

Thank you , that’s very informative. I’ll read up more on this.