Plenty of options!

[Craigslife]

My DH won’t see his oncologist for 4 more weeks. He is BRCA2 and been taking olaparib for about a year and a half. His Recently had 15 radiation treatments to his L5. His PSA is rising, but the doctor doesn’t think that is a great indicator of disease progression anymore.

When we get back to Pittsburgh in about three weeks, he will begin Keytruda. After discussing his testosterone levels on this site, I have talked him in to starting the Lupron injections again when we get back home. He can not walk very far without pain. He rests a lot. Because of a bad family incident with prolia (broken femur) he has rejected the bone meds. I am thinking he needs to revisit xofigo type meds. He has had prostate cancer since 2004, Gleason 9. So basically, in 4 weeks, I think he should add the following to his olaparib - Lupron, Keytruda and xofigo. Is anyone else out there doing all of these?

[Tall_Allen]

Is he MSI-H/dMMR? How is he able to get Keytruda? How are the side effects of olaparib? I think Xofigo (or chemo) may combine particularly well with Keytruda because it presents a lot of cancer antigens to his T-cells, and the Keytruda amps up his immune response that the Xofigo (or chemo) may diminish.

[Craigslife in reply to Tall_Allen]

I wrote back earlier, but I don’t see it. I’m not sure if he is MSI-H/dMMR. Is that a question I can ask his oncologist or the genetic doctors that did the BRCA testing? Olaparib SE for my husband was severe anemia that landed him in the hospital for blood transfusions. He immediately reduced the amount he took and that helped with the anemia, but who knows how it affected his results, as it is now failing. His onc plans to keep him on olaparib when he starts Keytruda. I’m not sure how he is able to get keytruda for him. I always appreciate your responses. Thank you.

[Tall_Allen in reply to Craigslife]

MSI-H/dMMR is a thing that would only show up in testing a biopsy sample from a tumor. The oncologist maybe got Keytruda through a clinical trial - or sometimes an MO can convince an insurance company. I've learned not to ask too many questions about how drugs get approved

I've heard from other patients too that the PARP inhibitors can have severe side effects. There are some hints that carboplatin (or similar) may work in the same situations and may have lesser side effects. There are clinical trials to help determine that.

[Stelle]

I was on Lupron for six months and I hated it. Chronically and feeling generally unwell. PSA started rising after having been stable for several months. My MO decided to put me on Xtandi which has given me a new life for the last eight months. PSA now down to 0.13 and less fatigue. I believe that Xtandi will replace Lupron as a first line drug within the next few years. According to FDA Xtandi initially could only be used after failed chemo. Then it was changed to only when there are mets. Last spring they decided that it could be used when there are no signs of mets. It's more expensive than Lupron and your insurance may not be a liberal as Medicare But for me Lupron sucked and so did Casodex.

[Craigslife in reply to Stelle]

I am glad that xtandi is working so well for you. My husband was on zytiga for about 3 years before his psa started to rise. Next was Xtandi , but that did not work for him. Thank you for your response and I wish you many more good years on xtandi.

[charlesmeyers1964]

wow i must live in a hidden town. most of this stuff i have never heard of. my sx was lupron/eliguard, then radiation good for 2-3 yrs then ups and down with psa followed with different pills, zytiga which i can't find and finally PROVENGE. my psa dropped 30 points since going back on the painful shot and hopefully will find zytiga.

[Stelle]

Thank you. I know how worried you must be.

[George71]

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