Looking for some advice and experiences that may help. My Father was diagnosed with prostate cancer in march 2014 with a PSA of 433.
First round of ADT got his PSA down to 0.23. He has since done three rounds of intermittent hormone therapy since, and he is currently on Zytiga and Firmagon after Casodex previously failed last year. However for the first time his PSA has gone up whilst on Zytiga. From 20 to 32. A CT Scan today has revealed several mets on the spine, ribs and manubrium which are described as mild endplate depressions but with no significant vertebral collapse.
We are scheduled to see Dr Nick Plowman on Harley Street (He was strongly recommended by Dr Khoo at the Royal Marsden) My Father has never had radiation, chemo, xandti, enzalutamide, denosumab etc.
What other treatments are viable at this stage? We are looking to do a PMSA scan with a view to Lutetium 177 as well.
Has anybody used radiation for several bone mets?
Has anybody had any experience with Chemo or BAT resensitising Zytiga ?
Any other advise would be greatly received.
My Father has no pain also.
Huge thank you to anybody who replies.
Written by
taylor123
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They could try to change prednisone to dexamethasone and/or add indomethacin and see if zytiga keeps working. With bone metastases and a PSA of 32 they could do a liquid biopsy and study the genome of the circulating tumor cells (CTC) and/ or free cell DNA, to see if the cancer has mutations which could be treated with specific drugs.
There are clinical trials in the USA which could re-sensitize the cancer to zytiga or enzalutamide using niclosamide:
It could be convenient to get a Ga 68 PSMA PET/CT and if the cancer express PSMA to consider Lu 177 PSMA treatment or Ac 225 PSMA treatment if there is diffuse bone marrow infiltration by the cancer.
Lu 177 PSMA and/or chemo could resensitize the cancer to zytiga or enzalutamide.
The clinical trials use a special form of Niclosamide (PDMX1001/niclosamide) which is absorved by the gut and can reach anti tumor concentrations in blood.
Have you had any Genetic Counseling to confirm whether it would be useful to do Genetic Testing looking for certain mutant genes? Would require ancestral blood line cancer. If you have such genes then some different therapy is available to most.
You didn’t say how old you father was, I was 66 when diagnosed, went through 6 rounds of taxotere chemo, with casadexe and lupron, been on Xtandi since then with lupron and Xgeva shots monthly. 35 months and counting. 🙏🙏🙏
I'm 72, had Gleason 9, inoperable at 62, Psa low for large amount of Pca. I had ADT, then Casodex and Zytiga added, did not work for long, then 5 x Docetaxel, Psa just went up, so 4 x Lu177 shots got Psa from 25 before to 1.6 about 1 month later, maybe its still going down, but no more bone pains, scans show bones healing, so not bad so far, from Lu177 treatments in Sydney.
Using beam radiation hardly worked for me initially at 9 years ago and may have damaged cartilage in hips, so I have a bad hip now and may need a new joint of an arthroscopy to clear out damaged tissue to reduce pain. Docs said they'll do one or other, and maybe I can cycle again. I have cycled 140,000km since 2006 - its very good for a man but I live in Canberra with the best cycling amenities in maybe the world.
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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RO said 6-12 months
What’s next? Hearing different approaches from different people. 
Update on my Dad
Advice needed please.
PSMA scan results 
