NEED THE COMMUNITY INPUT

I recently shared my husbands rise in PSA. It had gone from 4 to 7.99. Dr had him do a bone scan and CT scan of abdomen, chest and pelvis. Today was our appt and there is some progression. Erleada never worked for him. Prior, he was on Xtandi which lasted a short 9 months. His choices: 1) Chemotherapy (Docetaxil or cabazataxil) 2)Provenge 3)radium-223 (treats bone only and he may have some lymphnode involvement) THESE FIRST 3 OPTIONS ARE FDA APPROVED 4) clinical trial at Mt Sinai of immunotherapy tx (NKTR213 and Nivolumad) I think I need to hear others experiences in regard to treatment experiences with outcomes. Thank you in advance! These decisions are soooo hard.

[Tall_Allen]

I think Chemo+Provenge or Xofigo+Provenge is a good combo. A cycle of 6 chemos takes 15 weeks, while a cycle of 6 Xofigo injections takes 30 weeks, so if he does the chemo first, he can start both therapies in less time. Does either of those preclude the clinical trial? if not, he can always do the trial afterwards.

[Hidden in reply to Tall_Allen]

Hello. Yes if he goes with chemo it does preclude him from the clinical trial. Dr Oh suggested the trial bc of his age and good health. He describes small windows of opportunity. I’m not feeling it but my husband is.

When you suggested the chemo and provenge you are saying chemo THEN provenge correct?

Are you also suggesting the radium and Provenge bc of the minimal lymphnode involvement?

Thank you for your input!

[Tall_Allen in reply to Hidden]

I am suggesting chemo or xofigo at the same time as Provenge - I think they work synergistically.

[Hidden in reply to Tall_Allen]

I was told they work sequentially? Do you know of patients who receive synergistically? I suppose Im not sure if it matters.....maybe we do one and begin second immediately? Tall Allen thank you for your input! Not getting responses from the community as of yet.

[NPfisherman]

I think Tall Allen's advice is good... Tall Allen was advising Xofigo and Provenge at the same time, since that is what is allowed prior to the trial, then get in the trial after that....Tall Allen was advising Xofigo and Provenge at the same time.... Provenge is well tolerated and I can find no reasons not to do them together--not been studied much... Also, the Xofigo and Provenge may be like priming the pump prior to doing NKTR 214 and Opdivo. if you get my meaning...

NKTR 214 is a Natural Killer T cell stimulator being given with Opdivo--in Phase 3 for RCC and other cancers--see below:

nektar.com/pipeline/rd-pipe...

Xofigo and Provenge may turn on the immune system (prime the pump) by killing cancer cells and buoying up the immune system (Provenge) and then NKTR 214 and Opdivo may keep the pump running and for some time...

Best of luck...

Don Pescado

[Hidden in reply to NPfisherman]

Hi How do you know that the Xofigo and Provenge are permitted before trial?

[NPfisherman in reply to Hidden]

You said the chemo wasn't, but mentioned nothing about Provenge and Xofigo, thus deduction--

[Hidden in reply to NPfisherman]

I did not ask that question to the doctor yet but will do so today. Thank you for the input

[NPfisherman in reply to Hidden]

You're welcome...

[Hidden]

By Doctor, I don’t know who or skill level level..... But, the question I asked to my two Radiation Oncologists and a fair question to a Medical Oncologist: “ Doc, If you were in my shoes, diagnosed with metastatic prostate cancer, what would you do?”

I asked this question in 2004. Both responses, although separated by 200 miles were the same. I’d find the best medical oncologist available; not one who treats all cancers. Someone who is the top of their game in new treatments.

The follow up question: Do you know one?

I was most fortunate in that the second RO knew one and I ended up with a person at a major medical school teaching new Doctors and doing research.

It’s not a perfect world, but aim for the best. My treatment was not standard and involved alternating weeks of Taxotere and Adrimyacin in three six week cycles with a break of two weeks in between; plus, alternating Ketokonazole and Estrumine orals with the chemo. Today, there are new and improved methods.

Use the treatment that your Doctor would personally use if he were in your shoes...... may your husband have many undetectables.

Gourd Dancer

[j-o-h-n]

Can you easily get a second opinion?

e.g. Doc ,if you were in my husbands shoes what would you do?

Good Luck, Good Health and Good Humor.

j-o-h-n Thursday 08/08/2019 5:41 PM DST

[Karmaji in reply to j-o-h-n]

I would walk alone

[j-o-h-n in reply to Karmaji]

Stupid me, I should have said running shoes...

Good Luck, Good Health and Good Humor

j-o-h-n Tuesday 09/03/2019 10:49 AM DST - Pinnes

[Mauvemood]

My husband tried the Nivolumad and Xtandi cocktail. We just got approved for the other drug but my husband's liver enzymes are way out of wack so they are holding the Nivolumad and giving him high doses of steroids to see if anything improves. We will see what happens next. Prayer for you and your husband that you find the right combination.

[Hidden in reply to Mauvemood]

Thank you for your response. My husband got 9 months out of Xtandi. Now we will try Nivo and NKTR-214 combo Best wishes to you too.