Docateaxel or Actinium?

[boseley]

Decision time!! Any advice and experiences would be appreciated.

Diagnosed 2014 with PSA 15. Gleason 8 (9?) . ADT worked for a number of years but PSA climbed in late 2016 so had 62 Grays in 20 fractions late 2016. PSA continued to rise so had 2 months of Casodex which did not work with PSA climbing to 62.9. Zytiga/Prednisone started early Dec 2017 which dropped the PSA to 4.6 by July 2018. PSA took off again at this time and was then offered Docatexel as standard of care.

I chose to try Lu177 while I was still chemo naïve. After two cycles of Lu177, PSA had climbed to 157 in Jan 2019. Am getting some pain in my right hip and pelvis currently controlled by Panadol with occasional Codeine or Ibuprofen . PET scan showed advancing disease in hip and spine.

So the decision is:- Do I do Docataxel (plus local radiation and maybe Zometa) or should I try for Actinium 225

The questions are :- Does Chemo control pain, does it extend life (was told by my MO only 3months life extension), what side effects can be expected and are they worth it?

Actinium is relatively untested and unproven but my wife and I have seen some good reports. Can anyone point to some trial results as to how many patients have been treated with it, has there been a demonstrated pain control, and life extension to confirm that it may be worth a shot ?

Any advise would be appreciated

Howard

[Tall_Allen]

At this point, as far as anyone knows, all therapies provide a median of 3 or 4 extra months. But a "median" means half do worse and half do better, and some may do a lot better.

There is definite proof that chemo extends life, and it also relieves pain and improves quality of life.

There is also definite proof that Xofigo extends life and relieves bone met pain.

There is no actual proof yet that Ac-225-PSMA-617 extends life, although it seems to. So far, there have been no randomized trials that could prove that definitively. But it looks good so far - here's what I've got:

pcnrv.blogspot.com/2018/01/...

pcnrv.blogspot.com/2016/12/...

Of course, any PSMA-based therapy depends on the metastases expressing PSMA (on a Ga-68-PSMA-11 PET scan). So you would have to test for that first.

[strummer]

My husband is recently diagnosed and on Docetaxel, firmagon and zometa. He’s tolerating it well. Had 4 doses each so far. his bone pain is gone and numbers are down.

To counteract bone pain from chemo and zpneya he takes Claritin and Zyrtec week of treatment. He is a bit under weather days 3-4 but no major side effects. Worth a try IMO good luck

[boseley in reply to strummer]

Hi, I am interested in how Claratyne and Zyrtec help with bone pain. They are over the counter antihistamines, to help with hayfever etc. Also could you tell me what zpneya is.

Thanks

[strummer in reply to boseley]

zpena is my poor spelling ha! I meant zometa.

they aren't sure why the Claritin and Zyrtec help but it seems to do so.-thinking the treatment releases histamines. he also takes melatonin week of treatment. per doc.

zometa helps to beef up the bones and may help with pain. his combo has reduced his bone pain to nearly zero. most days doesn't even take a Tylenol.

he has multiple mets. so hoping next scan shows reduction. has 2 more chemos left and has tolerated them well. some fatigue is about all.

good luck with your decision.

[boseley in reply to strummer]

Thank you for your prompt reply . It is very encouraging and will help my wife and I make a decision this Friday. My wife is being incredibly supportive so I am blessed am I not I!! Thank you.