Disease progressed: After 9 Docataxel... - Advanced Prostate...

Advanced Prostate Cancer

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Disease progressed

malihaamjed profile image

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

21 Replies

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

malihaamjed profile image
malihaamjed in reply to gregg57

Thanks gregg57

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.

Thanks Tall_Allen

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 profile image
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

Usually you cannot rechallenge Zytiga, until you have done a course of Chemo--one other way I know of but not sanctioned any where but has been done by visionalists--is to challenge your Pca with High Dose T--or follow the protocol of Demeade at John Hopkins in Maryland, or Liebowitz, at Compassionate Oncology in LA. I understand you have to get your T to over 2,000 to put a hit on the AR-V7 gene splice.

Or you can Post about the use of High Dose T on this site--there are men that use it. I have a Geneticist as part of my team--and she claims you can do a rechallenge of Zytiga and Extandi after treating with High T. It is not a 100%--nothing is with PCA---just reporting, not recommending anything--and I am not a doctor of medicine.

Nalakrats

podsart profile image
podsart in reply to Nalakrats

Do you have info on the T needed at 2000?

Nalakrats profile image
Nalakrats in reply to podsart

Send pjoshea13 a note he would have for sure.

Nalakrats

podsart profile image
podsart in reply to Nalakrats

Thanks:just sent him a note

Thanks Nalakrats, will discuss this with the MO

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 profile image
malihaamjed in reply to Shooter1

Thanks Shooter1, wishing you speedy recovery

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 profile image
malihaamjed in reply to Hazard

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

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.

Thanks mjbach , yes decided to do the same

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 profile image
malihaamjed in reply to j-o-h-n

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

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

malihaamjed profile image
malihaamjed in reply to

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

Located in India

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