Update on Dad and Cleveland Clinic-Xofigo, then Docetaxel- Any Advice?

[missh2]

Hello all,

My Dad, a spunky 83, is in this fight and is my hero. Today, he consulted for a 2nd opinion with Dr. Gilligan at the Cleveland Clinic. I am looking for any advice that anyone can offer who may have walked a similar path and how I can help support him in this next round. Here is where he has been and where he is going:

DX 11/2017 Gleason 9 stage 4 and bone mets

Began lupron, zometa and zytiga

Got almost a year on Zytiga and then onto Xtandi

Things looking good until PSA began rising in June 2019

PSA numbers:

1/8/18 6.590

4/27/18- 2.108

7/27/18- 1.534

8/24/18- 2.88

10/23/18- 9.54

11/6/18- 17.95

12/12/18- 43.915

3/5/19- 3.372

6/19/19- 7.196

9/11/19- 16.049

Had a new bone scan 9/19 which showed progression

Had a CT scan 10/19 which showed an aortic aneurysm, spot on the lung that the onc says they will watch

From the Ct Scan report:

Lungs: No consolidation or atelectasis. Mild emphysematous changes

are present with multiple small blebs in both lungs. There is an 11 mm

right lower lobe nodule

Mediastinum/Hila: There is enlarged right hilar lymph node measuring

13 mm in short axis diameter. There is a large right lower

paratracheal lymph node measuring 10 mm in short axis diameter.

Osseous structures: Sclerotic lesions are present in multiple

bilateral ribs, bilateral scapula, sternum, and multiple thoracic

vertebrae. These are consistent with osseous metastatic disease.

Degenerative changes are present in the spine.

IMPRESSION:

1. Osseous metastatic disease.

2. No evidence of a soft tissue mass or lymphadenopathy within the

abdomen or pelvis.

3. Abdominal aortic aneurysm measuring up to 3.3 cm. Focal left common

iliac artery dissection, likely chronic.

4. Colonic diverticulosis.

So, Dr. Gilligan is starting him on Xofigo every 4 weeks for I think, he said, three cycles and then Docetaxel every three weeks for I'm not sure how many cycles.

Anyone who has had a similar protocol that can offer any advice on how to help him through this next chapter? I am still ALMOST divorced, and he is still planning to be here in Florida for a good part of the winter being Grandpa when he is not being treated in Ohio. And if you read all that, God bless you! I print everything you all write in response to my posts and share it with him. He is amazed that this community exists, and he is grateful for all the support (and so am I!) Keep fighting!

Lora

[tango65]

You could discuss doing a study of the genome of the cancer by direct biopsy if it is possible of by liquid biopsy. The cancer may have mutations which could make it susceptible to drugs such as keytruda or olaparib. The biopsy could also give an idea if the cancer is becoming small cell or neuroendocrine. This could have some implication for the chemo treatment. If the cancer were neuroendocrine, a taxane and a platin compound could be used for the chemo

You could also discuss doing Provenge (the cancer vaccine) before doing Xofigo. He qualifies since he is castration resistant.

You could also consider treatment abroad with Lu 177 PSMA and or Ac 225 PSMA.

[pcfred]

Lora, keep up the fight, having grandpa around is more precious than you can imagine. Chemo can help him stay around longer (it works wonders for some people) but the side effects for a week or so after infusion will kick his butt, I guarantee he won't tell you everything he's going through and at some point it will mess with his will and spirit. But in-between he will be the grandpa you know. If he get's to the point he doesn't want another chemo treatment keep encouraging him to push on and keep up the fight. BUT, understand there could come a time when he says "no more" and you'll have to support his decision. We are all in God's hands in the end.

[monte1111]

Perhaps doing provenge with the xofigo? I was 67 and had little issues with chemo. They can reduce dose and do it more frequently I believe if he has issues. Wondering why not chemo then doing xofigo. Of course the good doctor knows way more than me!!!! Best of wishes.