CRPC with Complications.. Do not know... - Advanced Prostate...

Advanced Prostate Cancer
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CRPC with Complications.. Do not know what to do now ?

Cladius
Cladius

My dad was diagnosed with PC in June 2015 with bone mets. Had tried Docetaxel, Zytiga, Xtandi and Radium and Lupron , Nothing worked and he got only side effects from those.

He did better after he stopped Xtandi (last Chemotherapeutic agent he had) and stayed on Lupron with his PSA went down from over 400 to less than 1.

Had right ileiopsoas muscles mass, presumed to be metastasis and had focused radiotherapy, did not help that much but at least did not get bigger then.

Had Laminectomy in Aug 2017 for radiculopathic pain because of the spine Mets and did well with no more pain then until last summer started to have another radiculopathic pain and weakness and they decided to do another laminectomy with canal decompression in Nov 2018. Before that in Oct 2018, had hematuria which he had few times before and they were doing fulgration of the local invasion of the tumour to the bladder and he was going well but this time they found that the tumour if extensively invading the tumour and couldn't remove that much and it was obstructing the left uretric opening and they hardly could insert a stent in the left ureter.

On Nov 2018, admitted for the spine surgery but one day after surgery, he had acute kidney failure and found to have bilateral hydronephsis and they did cystoscopy and found the tumour almost obstructing the left ureter and partially right ureter, did right uretric stent and decided to do nephrostomy to the left kidney as the left stent is useless.

Also because of the pain he had before the spine surgery and while waiting for surgery and because of poor pain management from his family physician, he was bed bound and started to have swollen right leg.

They discovered that he is having right leg DVT and started to Heparin but he started to bleed (Hematuria) through the foley catheter he has been inserted. He stayed like that for over a week with difficult balance between the DVT and the Hematuria until they decided to stop the Heparin and insert IVC filter to protect the lung from propagation of clots into his lung. He had gone into sepsis twice during that time, with electrolytes changes and A Fib and admitted to ICU twice.

Then stablized, he did well over the last 2-3 weeks and going into rehab as he had swelling in his lower part of his body ( secondary to IV fluid, Steroids, Vasopressors and IVC filter ) . Did not do that much with the swelling with close observation of the kidney funtions, then they found the right kidney is still swollen and they replaced the right uretric stent but it's actually the tumour is progressing too fast to that it is pressing onto the lower left ureter. Yesterday they decided to do right nephrostomy.

I am not sure what else will happen, his oncologist has no more plan for him with his current condition , lost weight, anemic, impaired kidney function and poor general condition.

I am still hoping that he can recover from all the above to certain level that I can take him to join Endocyte trial for Lu 177 PSMA which they just opened in his state but it is a small hope.

He is very depressed, and hopeless and do not know what to do for him and what to say to him to give him some hope. He is waiting for death as he says.. He is been in hospital since Nov 8th .

I am so stressed and sad as well, thinking of every possible way that can give us some hope and I am afraid that he won't make it and unfortunately no Chemotherapy can fits for him anymore ( he was not on Cabazitaxel ) .

Do you have any suggestions ? Any herbal medicine ? any hope with his current condition ? I am praying day and night to find a hope.

Thanks for your replies in advance .

8 Replies
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Clinical trials want good organ function, so I'm afraid he won't qualify. I would avoid herbal "remedies" because they give the liver and kidneys one more thing to detoxify. Hospice care is a godsend - they can keep him comfortable.

Cladius
Cladius
in reply to Tall_Allen

Thanks TA. You are right but I'm still hopeful. If his kidney function improve after the nephrectomy, his liver is still normal, no more infections, diuretics will work better to reduce legs swelling, last doppler showed no more dvt expansion.. so hope he will qualify for that trial.

Also I'm requesting his oncologist to arrange germline genetic testing for him to find out if he has BRCA gene mutations to see if he can benefit from PARP inhibitors but his oncologist wants him to get better and discharged home and has the test done as an outpatient!

Tall Allan, I was waiting for you in particular to help me with some other hope .. I'm still hopeful and trying to get him something that can help him to recover with some anti cancer effects ( such as herbal rx.) until he can get more specific anti cancer rx.

Help me please with other suggestions. I can not imagine that I'm loosing my dad without doing anything. His other organs (liver, lungs,etc ) are clear .

Please help

Tall_Allen
Tall_Allen
in reply to Cladius

I've been through this with both of my parents, so I do know what you're going through. With my mother, she felt like she was letting her children down by not taking every therapy. A therapist helped us understand the burden we were placing on her. At some point, she refused all but palliative care. In the end, it's his decision to make.

I've heard PARP inhibitors can be rough. Color Genome Dx makes a germline test that can be done at home with saliva, and it only costs $200. If he tests positive, there is a list of PARP inhibitor clinical trials here:

pcnrv.blogspot.com/2018/02/...

Cladius
Cladius
in reply to Tall_Allen

Thank you so much.

j-o-h-n
j-o-h-n
in reply to Cladius

How old is your Dad and where are you located and where is he being treated? BTW are you in the medical field?

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/08/2018 6:28 PM EST

Cladius
Cladius
in reply to j-o-h-n

He is in US. He is Beaumont Hospital now.

j-o-h-n
j-o-h-n
in reply to Cladius

Thank you... Remember, God is on your side...

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/08/2018 6:42 PM EST

j-o-h-n
j-o-h-n
in reply to Tall_Allen

You're God sent....

Good Luck, Good Health and Good Humor.

j-o-h-n Tuesday 01/08/2018 6:26 PM EST

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