Any list of progression of treatment used for advanced PC stage 4

My very very best friend ( 82 years young) was diagnosed with AD PC with many bone Mets and lymph nodes with PSA of 947 before initial treatment .

He is on Lupton and Xygeva

Just wondering if there is some standard procedure what the next drug would be if he becomes resistant to this treatment done the line.

What is 2nd treatment ? 3rd, 4th etc

At initial consultation MO was very positive and stated hormonal treatment would be first line of treatment for several years follow by another one then another one. He never specified what the other ones are.

Thanks in advance .

You are all like my extended family

[Hidden]

Thanks . He is relaxed . It’s me that’s not . Today he has an appointment with the dermatologist about a sudden invasion of rash on his body and legs . This is after the lupron and xygeva treatment. Hope it’s nothing serious.

[AlanMeyer]

The use of Lupron (for prostate cancer) + Xgeva (for bone metastases) is a good start but increasingly, the experts are recommending either chemotherapy with docetaxel or advanced hormone therapy with Zytiga, combined with the Lupron, to attack the cancer. Allen Edel ("Tall_Allen"), a very knowledgeable member of our group, has a blog posting that explains the clinical trials that established this as a new standard of care. See: pcnrv.blogspot.com/search/l... I think this may be worth showing to your friend to bring to his oncologist. The idea is that combined therapies produce a longer overall survival than sequential therapies. Really hitting the cancer hard holds it down better and longer than hitting it not so hard with one treatment, then hitting it not so hard with a second treatment after the first one fails.

Some well established therapies that are typically used for second or third line treatment are Zytiga (if it wasn't already used), docetaxel chemotherapy (if it wasn't already used), and Xtandi. Some newer treatments that are just recently approved, or are in the process of being approved, are Erleada and PSMA or other ligand linked Lu-177 or Actinium-225.

Another treatment that can extend life if bone metastases are the biggest threat is Xofigo (radium-223). It won't treat cancer in soft tissue (e.g., lungs, liver, kidney, etc.,) but can make a significant difference in bones. Another new kind of treatment - some examples of which are already approved for prostate cancer and some are in trials, is immunotherapy, trying to get the patient's own immune system to attack the cancer. In the old days that couldn't be done because cancer cells are our own cells and our immune system won't normally attack our own cells. But a lot has been learned about the immune system and more is being discovered every year and methods have been found to try to get it to attack the cancer.

None of these treatments are a cure. All of them work for some men and not for others. Most of them have unwanted side effects. However the average length of time that a man can survive with PCa keeps increasing. There is a chance that your friend can live for quite a few years and die of something else without ever experiencing the pain and debility of advanced PCa.

I wish him the best of luck.

Alan