Disease progressed

[malihaamjed]

After 9 Docataxel chemo PSA - 128 today.

Size of lymph nodes detected in Psma has increased.

Was told treatment options :

1. Enzulatumide

2. Zytiga (rechallenging)

3. Cabazitaxel

4. Keytruda

5. Lu 177

Doctor's opinion is to go with Enzulatumide since :

- Cabazitaxel will cause too much toxicity

- Keytruda and Lu 177 are very costly

- Xofigo isn't available in India

Please provide your valuable opinion

[Hidden]

If I were in that situation, I'd rechallenge Zytiga first, then Enzalutamide. After those, I'd consider going to Cabazitaxel.

[malihaamjed in reply to Hidden]

Thanks gregg57

[Tall_Allen]

I think that's good advice. Enzalutamide may work longer than otherwise expected after the chemo, but it probably won't work for more than a few months. Keytruda has no proven benefit unless he has a rare genomic mutation. Lu-177-PSMA is a good choice imho, but it is expensive.

[malihaamjed in reply to Tall_Allen]

Thanks Tall_Allen

[tango65]

I believe the best sequence of these treatments is unclear. They could try enzalutamide or rechallenge with abiratoraterone . Sometimes these drugs could work again or better after treatment with chemo. If both fail, cabazitaxel could be an option. You could also try Lu 177 PSMA treatment. I had this treatment in 2016 for lymph node metastases in the pelvis and abdomen and it was effective.

I wonder if one or more of the metastases could be biopsied to determine if there are mutations which could have specific treatments. If direct biopsy is not possible, they could try a liquid biopsy to determine if the androgen receptor AR V7 is present which could indicate poor response to enzalutamide and/or abiraterone.

nanthealth.com/liquid-gps/

[malihaamjed in reply to tango65]

Thanks tango65 . Yes the doctor suggested a needle biopsy of a fluid sac but we refused of the fear of it causing more harm

[Shooter1]

Went with chemo and after #5 added xtandi acct rising PSA. Did my 9 cycles and combined chemo/lupron/xtandi side effects were really bad. Pushed PSA to 0.130 and now stable. Xtandi should be good option for you, if 160 mg to strong (toxic side effects) cut dose to 120 mg or less. I'm now at 90 mg---three days 2 pills one day 3 pills. Holding every thing in check and recovering from long term side effects. .

[malihaamjed in reply to Shooter1]

Thanks Shooter1, wishing you speedy recovery

[Hazard]

It's all a crap shoot, people can tell you what worked for them but it may not work for you. I just finished 9 cycles of chemo in June PSA was going down for first 6 cycles then started going up again after last 3 cycles. So MO canceled Cycle 10 and put me on Enzalutamide. Enza made no difference at all PSA continues to double roughly 1 month intervals. Next stop - MO is doing DNA tests to see if I will benefit from PARP inhibitor.

Sorry dont mean to be pessimistic. But no one can really tell you what to do next. You have a number.ber of options, they may all work, some may work, none of them may work. You just to keep fighting and find something that works for you.

[malihaamjed in reply to Hazard]

After all the decision in healing power lies with the Almighty. Hoping you benefit from whatever treatment is ahead

[podsart]

Do you have info on the T needed at 2000?

[Grumpyswife]

Taking a capsule like Xtandi would be a lot simpler to try. Dose can be adjusted as needed and in the meantime you can plan what’s next.

[malihaamjed in reply to Grumpyswife]

Thanks mjbach , yes decided to do the same

[j-o-h-n]

to malihaamjed,

Do a search on (click on their icons) pinks124 and drsidhar53 from their posts yesterday 10/15/2018. Both of these gentlemen are in India and you might find their posts and the replies informative.

Good Luck and Good Health.

j-o-h-n Tuesday 10/16/2018 9:00 AM EDT

[malihaamjed in reply to j-o-h-n]

Thanks j-o-h-n, I did check both of them's post

[podsart]

Thanks:just sent him a note

[malihaamjed]

Thanks Nalakrats, will discuss this with the MO

[Hidden]

Where are you located that you are offered Lu-177 as an option?

[malihaamjed in reply to Hidden]

Not directly offered as an option.. I actually brought that up myself researching from this site .

Located in India