While on Xtandi monotherapy after some 12 months PSA began to rise. Pet Ct and MRI showed multiple Metsin bones and lymph nodes. Submitted to 6 sessions of Taxotere, still on Xtandi, when PSA had crept up to 18 from a nadir on Xtandi of 12,,,started at 374, Gleason of 9. No local therapy of any kind. diagnosed 2005, PSA of 5.5.
PSA after end of Taxotere was nadir of 3,,,still on Xtandi mono.
PSA subsequently began rising monthly from 3 to 6 to 9 etc.
submitted to 1/2 monthly dose of lupron. T dropped to 16, now at 10 after 4 injections. PSA still rising, dropped Xtandi PSA now at 55.
Have considered Zytega, but having failed Xtandi and now Lupron, assume perhaps of no value.
Have results of AR-V7 test, which surprisingly was negative,,,,positive of course is bad.
I am in the running for an upcoming LU 177/Pmsa/Keytruda trial. Meanwhile still on failed Lupron with T of 10.
With this preamble my question(s) is/are.
Is there any benefit or reason to continue obviously failed Lupron(failed from very first injection). Or am I just to suffer unproductive deleterious side effects for zero benefit? This is primarily my most urgent question,,,what additional risk is incurred ceasing Lupron? Of course my primary MO looks to the sky and says why me God? Posted literature on this question is scant
Any thoughts or opinions on Zytiga regardless of failed Xtandi, understanding my recent negative AR-V7 finding.
Any thoughts on successor antagonist drugs(Daro or Apal) to Xtandi? Understanding Daro not quite approved yet.
Had a very small short term benefit in PSA from Taxotere, but scans did improve moderately well. However after final infusion, there was no rest for the weary as PSA began it relentless climbing immediately.
Considering Cabazitaxal, but suspect may see basically the same result. And of course would be an exclusion for LU 177 trial,,,,as I suspect Zytiga would.
A real Hobson’s choice of unpleasant options. However my very long term game plan 14 years ago to deal with this disease did assume that one day if I lived long enough I would experience this predicament. Given male members of my family all expiring at 76 or less, felt this was a sound assumption. Currently almost 79 with all systems go except for this confounding disease.
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The way it was explained to me is PCa is heterogeneous not homogeneous. Some of your cancer cells may still be responding to ADT therapy. If you get off Lupron none of your cancer cells are being held in check. My oncologist told me to think of ADT as a train. You can add things to the train and you might remove some drugs from the train but if you have metastatic cancer you don’t get off the train. Staying on Xtandi might also enhance the visibility of the PSMA protein to Lutetium. Good luck!
As castration resistance sets in, the androgen receptor (AR) becomes exquisitely sensitive to even the smallest amount of testosterone. It is therefore more important than ever that you suppress all testosterone.
AR-V7 is just one of several ways that the AR becomes resistant to Zytiga/Xtandi.
The VISION trial allows two taxane regimens and two advanced hormonals.
Of the hormonal gents, you can get Xtandi or estrogen patches. You can also get Xofigo and Provenge.
Thank you to the both of you on your comments to remain on Lupron. I was hoping for otherwise but common sense prevails and I will abide by your recommendations. This Lupron business has been a hellish QOL killer. Very lucky to have missed the first 12 years of it,,,not that it would have remained effective for that long anyhow.
Interesting how it failed for me from the very first injection,,,although did have some 14 months of effective Xtandi before it failed. Seems the Xtandi burned up the reservoir of any hoped for positive therapy that I was counting on to carry me on, once my luck ran out prior to going stage 4.
The best laid plans of mice and men.
I have never subscribed to a firm belief in Proscar or Avodart so have always avoided though have known many friends have been on either for many years. Am quite aware of the polar opposite views within the professional medical community among experts on either side. UCSF/john’s Hopkins verses Scholz or Myers as examples.
Question is with my extremely low T level of about 9 granted from my monthly 1/2 dose Lupron injection, would there be any benefit at all to either of these drugs in wiping out any tendency for DHT to contribute to my rising Psa?
Another thought instead of failing Lupron, to perhaps try Casodex to nail those buggers that Lupron is possibly keeping at bay. Or is it a given if failing Xtandi and Lupron, there is little to hope from Casodex? Just thinking out loud.
I am being very wary to elect any therapy that might jeopardize or exclude me from possible upcoming LU 177 trial. This could rule out estrogen patches which has been on my short list.
Getting back to DHT drugs, proscar/Avodart, would these be of little value as this horse has already left the barn,,,somewhat as electing to adhere to a healthy diet only once you have been diagnosed with advanced disease.
If Xtandi failed, Casodex, which is a much weaker anti-androgen, isn't likely to do much. I agree with you about the 5aris - they are a drop in the bucket compared to the other hormonal therapies you've taken. They prevent external testosterone from getting converted to the more powerful androgen, DHT, but your external testostosterone is minuscule anyway. It does nothing to keep the cancer from making its own androgens internally (like Zytiga does). But if Zytiga can no longer do that, the cancer probably would see little effect from a 5ari.
Have not yet tried Zytiga. As noted failed Xtandi after about 14 months.
Following popular consensus I then assumed would fail Zytiga so have not tried. Also had never been on Lupron until recently and it of course is a pre-requisite for Zytiga.
This dilemma that suggests if you fail either Xtandi or Zytiga you will likely fail the other, was my motivation for the AR-V7 test to find if I would undoubtedly fail Zytiga. However as test was negative, there remains a chance that Zytiga might work.
As I am now on Lupron(failed immediately as previously noted) I could now try Zytiga. However this would require several months to prove if it was helpful. Which would run right into and thru my hoped for Lu177/PMSA/KEYTRUDA trial,,,scheduled to commence in May if selected. I just today had a CT scan as Dr. leading the trial was concerned that my January CT results concerned him that my cancer infested lymph nodes needed to be larger???? Bone Mets are obvious but trial is for both skeletal and soft tissues,,,what’s the word,,,starts with a V I think. B
As I recall Zytiga is an exclusionary drug for trial. I am going to double check this.
Thank you for your comments on 5aris, confirmed my suspicion.
If you are in a position to pay for treatment, I just returned from Homburg Germany where I received PMSA lutetium/actinium therapy for metastatic Prostate cancer. It is not a cure but he has great success with remission, and is the new standard of care for ADT resistant prostate cancer in Germany. Dr Ezziddin is one of the pioneers, and one of the two to use tandem therapy that I know of, the clinic is excellent, the staff competent. The mostly speak English.
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