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Advanced Prostate Cancer
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mCRPC, running out of options and scared !

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)

21 Replies
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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

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

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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.

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I’ll discuss this too. Helpful points.

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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!

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

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No soft tissue mets. Bones and lymph nodes.

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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.

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I will explore the above further. Thank you.

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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

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

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Sorry to hear about mom.. Take care

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

palliumindia.org/resources/...

Good Luck!

Charles

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That’s great information. Thanks so much.

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High Dose Testosterone Cyprionate, 400 mgs Injection--as per the BAT Protocol, may have some positive effects. Where Dad will feel stronger for the first 2 weeks with the high T, and may allow re-sensitivity to Zytiga, or Xtandi. If there is a drop of PSA the Injections would continue every 30 days. It is dangerous, for 2% of those that do this in late stage Pca.

Better you check out the BAT Protocol. I am not prescribing--just providing info.

Nalakrats

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

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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

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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.

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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.

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

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You will .. peace

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