Advice on next best step?

[Kcski]

Hi strong guys and strong girls supporting,

My Dad has advanced PC.

He was diagnosed at age 72, has a Gleason of 9, and had regional mets in pubic lymph nodes. He currently has no bone mets. His initial PSA was 10,000ish.

Upon diagnosis he immediately had one shot of ADT (Firmagon) and switched to ADT (Eligaurd).

He also did 6 rounds of Taxatore.

The results were very good, with lymph mets shrinking by half plus, and freeing the potential blockage by his kidneys and bladder. His PSA is now in the neighborhood of 10.

Before receiving scan results of how Eligaurd and Taxatore were working, his doctor mentioned Zytiga.

After results came in favorably, his doctor offered more Taxatore, ADT alone, or Zytiga.

When we asked his doctor what he thought was the best course of action, he recommended ADT (Eligaurd) alone. He said wait and see how his body responds.

His PSA will be monitored monthly-ish. If there is a rise we can act accordingly.

How does the forum feel about this approach?

Also does one rise in PSA constitute hormonal resistance?

Many thanks and love,

Karyn

[Tall_Allen]

Fantastic response to Taxotere! Think of castration resistance as a spectrum, instead of an all-or-nothing. But if his scans do not show an increase in mets, he may still qualify for the drugs approved for metastatic hormone-responsive PC. I do not see the point of waiting for Zytiga or Erleada (which just got approved for metastatic hormone-responsive PC). When they stop working, you can rechallenge with Taxotere or Jevtana, maybe with Provenge. After that, he can rechallenge with a hormonal agent. If any of those lymph nodes are still large enough to biopsy, there are a (very) few genomic-based medicines. Clinical trials are an option too.

[Fairwind]

Before there was Zytiga, there was Casodex. As long as the Elegard (Lupron) is working, I would stick with that...When his PSA starts to climb (that could be one year or ten years, every case is different..) try the Casodex and see how that works. When that fails, move on to Zytiga or Xtandi..After that, there's another taxol related chemo, Cabazitaxel, which worked pretty good for me with fewer side-effects than the Dosetaxel.. There are lots of tools to work with out there approved and ready to go..Plus a bunch more waiting approval for general use. So with any luck at all your Dad will be with you for a long time.. Is he being treated by a Urologist or a Medical Oncologist ? The Oncologist should be the lead doctor..

[Victorq1 in reply to Fairwind]

I was dancing and was a happy man

for about 10 years after diagnosis

until I got pain

in the leg PSA shot to 122

and Bone scan was showing metastasis in the leg bone and hip and other organs

do not want to scare you..

I wonder with what joke j-o-h-n will come now..he,he,,

major improvement with one only salvage external radiation

Zytiga and Prednisone.

I am starting to dance again

but

very slowly

Good luck to you

and all.

[LearnAll]

PSA down from 10000 to 10...means current regimen is doing its job beautifully.

Adding Zytiga to Lupron will consolidate these gains and hopefully...bring PSA to undetectable level Good luck..

[Magnus1964]

Eligard is working, stick with it. If and when it fails your dad can move on to casodex, then zytiga, xtandi and other ADT drugs.

[j-o-h-n]

Hello Karynish.... 10,000ish to 10ish ish greatish...

Good Luck, Good Health and Good Humor.

j-o-h-n Friday 10/11/2019 6:59 PM DST

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

Lol - thanks!