mCRPC, running out of options and scared !

[sujkap]

My dad 88, is mCRPC status since September 2018. He was on Firmagon for 15 months before that. Was started on Xtandi in October 2018. Latest PSMA pet scans show progression of PCa. PSA is 1740, shot up from 155 in September. Not a candidate for aggressive chemotherapy. Zytiga not considered due to poor response to Xtandi. Started on oral Fosfestrol and Inj. Xgeva, firmagon to continue. No pain, but weight loss and poor appetite.

We have limited treatment options now.

1. Getting blood test to check for Brca1 Brca 2 gene mutation. Not the Biopsy route as Pca is in bones and lymph nodes and difficult to obtain sample.

2. Lu 177, though I have no idea of the side effects and if at his age it will be tolerated.

What else can be considered ? Looking for quality of life and palliative options. (New Delhi, India)

[Hidden]

Radium 223 (Xofigo) might be an option for him, though it only goes after the metastases in bone. If he has extensiive metastases there, I might be a good treatment for him. Something to discuss with his doctor

[sujkap in reply to Hidden]

Yes extensive bone mets are present. Thank you for the information.

[Hidden in reply to sujkap]

One other thing: when he is tested for genetic mutations he can possibly be treated with a PARP inhibitor of he has the ATM mutation in addition to BRCA1 or BRCA2.

[sujkap in reply to Hidden]

I’ll discuss this too. Helpful points.

[Stegosaurus37 in reply to sujkap]

I have the ATM mutation and am currently on rucaparib in the TRITON II study. I've also run out of other options (lupron and enzalutamide resistant). I have bone mets but no soft tissue. I'm tolerating the rucaparib well. Best of luck, old sport - stay in there!

[Hurling24 in reply to Stegosaurus37]

Hi I am also on that trial I have ATM but looks like i will be off it next week as psa rising and scan show possible progression, my study of this trial is there is little or no success for atm but good response for brac 1

[Stegosaurus37 in reply to Hurling24]

I'm off it now too. Same thing, PSA up and increased bone mets. And now I find out that they knew LAST YEAR that it had no effect on the ATM mutation!!! So I'm starting the VISION (Lu-177) trial and hope I get randomized for the study drug.

Attitude is everything - you're never defeated until you quit.

[Hurling24 in reply to Stegosaurus37]

exactly. I am also thinking about the lu177

[YostConner in reply to Hidden]

I agree. I was going to ask whether he has any soft tissue mets.

[sujkap in reply to YostConner]

No soft tissue mets. Bones and lymph nodes.

[GP24]

Xofigo has a lot of side effects and if he is unfit for Chemo is probably also unfit for Xofigo. I would recommend Lu177 which has very mild side effects only. It will provide a great benefit in the current situation.

[sujkap in reply to GP24]

I will explore the above further. Thank you.

[softwaremom00]

My husbands second treatment was Strontium. I think it used to be popular and was replaced by... something else. His doctor gave him Strontium followed by a low dose chemo of Mitazantrone. It sensitized his cancer cells to the strontium.. well that is what we think. Since it was low dose.. it was very tolerable. The Strontium was also very tolerable and just a one time dose. Something to discuss with your doctor.

Husbands first treatment was a tough chemo that would be too much for most 88 year olds.

Hugs and prayers for both of you. Hug your dad, and enjoy him. I sure do miss my dad!

Softwaremom

[sujkap in reply to softwaremom00]

I feel better with all this information to explore. Thank you. Lost my mum 3 months ago, haven’t recovered from that blow yet.

[Hidden in reply to sujkap]

Sorry to hear about mom.. Take care

[ctarleton]

This is one link that has a list of Palliative Care organizations in New Delhi for further exploration.

palliumindia.org/resources/...

Good Luck!

Charles

[sujkap in reply to ctarleton]

That’s great information. Thanks so much.

[sujkap]

Right, that’s an approach I will discuss with the doctor.

[Jackpine]

I would at least talk to your OC about LU177. Side effects if you have a large amount of bone Mets can be extreme tiredness and increased bone pain but it only last a few days then you feel good again. In my case I went from innumerable bone Mets prior to my first injection to almost clear scans after 4 injections.

If your father is weak this might not be a treatment for him, but at least worth a conversation. He would need to be part of a trial or go to Germany or Australia for treatment as it is not yet approved in the US

[sujkap in reply to Jackpine]

Yes, gathering all the information we can so that we make an informed decision. Will have to consider the side effects along with his present state.

[Hidden]

I am sorry that you are seeing dad suffer so. Don’t have answers so I send you and dad love.. Good that he has you . He is not alone.. great job caring.

[sujkap in reply to Hidden]

Thank you for your kind words. Praying we have the strength to take the decisions which will be right for him.

[Hidden in reply to sujkap]

You will .. peace

[sujkap]

Update - Dad had a terrible terrible response to Fosfestrol (Honvan) within 2 weeks of starting the drug. Life threatening Pulmonary oedema complicated by anemia and went through a rough patch. He's better now after discontinuing the drug. Will continue monthly Firmagon and 3 monthly Xgeva. That's it, we are done with trying out anything else !