To Provenge or not?

[tallguy2]

I am confused.

My urologist recommends Provenge given my low cancer burden and that I am asymptomatic after RP, Taxane chemo, and two rounds of EBRT, all with Eligard every 3 months. Current PSA is 0.6 with a doubling time of 3 months. I am now castrate resistant.

My research MO says forget Provenge, it’s efficacy is questionable. Consider a clinical trial involving abiraterone plus “X.” But this means waiting until PSA hits 2.0 for most clinical trials.

Why should I wait until PSA is >2.0? We know I am now castrate resistant. And why not Provenge? It has been shown to prolong life >1 year for men with PSA<20.

Maybe I could have an even better result with a PSA <1.0.

[tango65]

Provenge could offer a survival advantage.

provengehcp.com/extendsurvi...

Some MO think that is better to get Provenge earlier in the disease process.

I will not wait until a PSA of 2. I will get Provenge now and try to get a Ga 68 PSMA PET/CT when the PSA is close to 1 . If there are few metastases I'll try to get them treated directly with SBRT and see what happens.

[tallguy2 in reply to tango65]

Thank you that’s my feeling too after doing some more reading. I like the fact the Provenge will not likely rule out my participation in a clinical trial with Zytiga plus “X.”

[tango65 in reply to tallguy2]

Best of luck on this journey.

[Magnus1964]

Do you have soft tissue Mets? That is what Provenge is meant to be used on. Are your scans showing anything?

I had Provenge for nodules in my lungs, Provenge worked well.

[tallguy2 in reply to Magnus1964]

After chemo and radiation my scan showed reduced size of a few lymph nodes. So yes, a few soft tissue met. Alkaline Phosphatase is very low, near 40, so bones seem clear.

[monte1111 in reply to Magnus1964]

I did not know that. Maybe helps prevent soft tissue mets? Seems to help some. On my to do list. Thanks for info.

[AlanMeyer]

My knowledge of all this is pretty low, but I have read claims that Provenge is more effective when the cancer burden is low. If that is true, then I would think that your view that it's better to try it earlier rather than later is right.

I found an article that discusses the interactions of Provenge and Zytiga (abiraterone) + prednisone. It turns out that prednisone will interfere with Provenge. So the two drugs can't be taken together, and a patient may have to wait 3 months after stopping prednisone before taking Provenge. However, the article suggests that Provenge can be taken first and may actually help the Zytiga work later. See:

archive.constantcontact.com...

This all leads me to think that your idea of taking Provenge now is a good one - but keep in mind that my knowledge of all this is pretty low and I could be totally wrong.

Best of luck.

Alan

[tallguy2 in reply to AlanMeyer]

Thanks very much, Alan. This is indeed the plan as of today and accounting for everyone ‘s input: do Provenge now then wait the 3 months and try and help myself and other men by enrolling in a clinical trial involving abiraterone.