Dora phase 3 study when zytiga is working

Is Dora phase 3 the best treatment for him?

Here is the history and questions:

83 years old , Gleason 8 , extensive Mets to bones and lymph nodes

Diagnosed in October 2018 with PSA of 947

Initial treatment of firmagon first month then lupron and xygeva every 3 months.

PSA from 947 to 20 from October 2018 to February 2019 with lupron alone. Zytiga and prednisone was added on February 13, 2019. With the addition of zytiga , PSA slowly decreasing to PSA 11 in May but on June 5, 2019 , PSA increased to. PSA 14.

Today he had visit with Dr Vogelzang . His PSA is 6.69 so zytiga is working.

Dr. Vogelzang said he will need Chemotherapy even with zytiga working. He wants his PSA to zero .

The Dora phase 3 is randomized , either radium 223 with Docetaxel or Docetaxel alone for 30 weeks .

They will need to stop his zytiga before the Dora study .

1. Will zytiga still be very effective after the Dora study ( chemo or chemo with radium223)? His MO said yes but would like reassurance.

2. Should he just take the option of just the Docetaxel ( no Dora study) since Vogelzang said he should have Chemotherapy ?

3. Continue with zytiga since it brought PSA from 20 to 6.69 from February 13 th to June 21st?

4. When does zytiga need to be stopped before the Dora study? Is this safe as he won’t have zytiga for ? Number of days before Dora?

Dr Vogelzang knows he wants the most beneficial treatment with longevity. MO said there are still half dozen treatments after Chemotherapy

He trusts the MO . I trust him too. I have read excellent reviews on his new MO Vogelzang but it’s always good to have input from those who are in the same boat as him.

I just like to have reassurance.

Thanks so much everyone

P. S . He bruises easily and now taking antibiotics for a toe infection . His May 2018 blood test was pretty normal

[Tall_Allen]

Vogelzang would certainly be on my top 10 list of MOs in the US.

I can't see why he would not participate. Either way, he gets docetaxel, and he gets a chance of getting Xofigo earlier than he normally would. He can either pick Zytiga back up later (when it might be more effective) or switch to Xtandi. The study rules dictate how long the Zytiga-free period is.

[Hidden in reply to Tall_Allen]

Tall_Allen. Thanks a million. I was hoping you would answer . Thank you for the reassurance. You made my day . 😀😀

[tango65]

Both treatments may be associated with significant negative side effects. I wonder if it is indicated to submit a 83 year old to both treatments simultaneously for an unknown potential benefit.

rxlist.com/taxotere-drug.htm

rxlist.com/xofigo-drug.htm