Hi guys,
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. 
New to site- need advice 
advice needed for treatment after chemo with rising PSA 
Stage IV Treatment Advice Please 
what next? Really need your advice. 
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:
clinicaltrials.gov/ct2/resu...
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.
My Father has switched to dexamethasone immediately after the PSA risen whilst on Zytiga / Prednisone.
I believe I read that Niclosamide failed in that study? Unless that was another drug they tried.
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.
ncbi.nlm.nih.gov/pubmed/285...
ascopubs.org/doi/abs/10.120...
health.ucdavis.edu/synthesi...