Second opinion at Cleveland Clinic... different treatment plan

[Lynsi13]

So, after my dad's increases in PSA over three month periods (.07, .13, .23) his oncologist suggested we start with Xtandi and sent us to see an oncologist at the Cleveland main campus regarding Provenge. Well, insurance decided that they weren't going to cover Xtandi and said it's Zytiga for you! So, we headed in that direction.

In the meantime, we went to see the Cleveland clinic oncologist (specializes in urological cancers) and we were surprised to hear that she doesn't agree that we need to move onto a new therapy at this point but rather should get updated scans (he hasn't had any since 2015) and then we should decide on a new therapy. She didn't seem overly excited about my dad's PSA increases at all.

She said if his scans don't show any disease progression than he'll be a perfect fit for Provenge and that afterwards we'll not move on to Zytiga or Xtandi but rather will stick with Lupron as she isn't convinced that he's failed it.

I was a bit surprised to hear that the upward movement didn't lead her to suggest another therapy, but I am pleased that she's set up new scans as it's been too long. He goes in on Thursday for the scans and we head back on Tuesday to Cleveland to see what our next steps are.

Thoughts?

(And to recap my dad's history, diagnosed in June 2015 PSA 257 mets to local pelvic lymph node. Had chemo and has remained on Lupron + Casodex until the end of September when he dropped the Casodex. He feels great and his labs look wonderful. Dad's 78 years young. =) )

[Tall_Allen]

Good idea to get confirmation from a scan. Take it from there.

[Lynsi13 in reply to Tall_Allen]

That's what I'm thinking.. I'm crossing my fingers that we're not in for any surprises! Also, I found it really interesting that the Cleveland Clinic oncologist seemed really shocked that we were going to move forward with BOTH Zytiga and Provenge. I didn't realize that you didn't do the two in tandem.. is that not common?

[Tall_Allen in reply to Lynsi13]

I think Provenge pairs better with chemo or radiation

[Lynsi13 in reply to Tall_Allen]

Gotcha.. well I'm really hoping that chemo isn't in the picture again. My dad really struggled with it. Just to mention it makes him cringe! Thanks for clarifying!

[Shanti1]

It sounds like your dad still has his prostate. Did he receive any radiation treatment to the tumor in the prostate gland? These factors can influence the PSA rise that a doctor considers concerning because the prostate gland itself continues to make PSA.

[Lynsi13 in reply to Shanti1]

Yes, he still has the prostate gland and we've seen his PSA bounce around at the bottom for some time.. but this was the second upward movement and seemed to be enough for his regular oncologist to think that he was becoming resistant to the Lupron.

[Magnus1964]

Having scans now is a good idea. The outcome will determine the next steps. Possible radiation and ADT treatment.

[Lynsi13 in reply to Magnus1964]

Yes, I'm glad that we're getting scans.. nervous, but glad! And he's already been on hormone therapy for over four years, so it would be second line hormone therapies or possibly radiation, too!

[j-o-h-n in reply to Lynsi13]

I hate scans too... and as I've said before, "I've had so many scans that I now speak Scandinavian".....

Good Luck, Good Health and Good Humor.

j-o-h-n Wednesday 10/09/2019 7:03 PM DST