What treatment next??

[Tiger22Warrior]

Diagnosed July 2018 at 50 yo with Stage 4 PC with as the radiologist stated “too many lesions to count” in skeletal system. Lesions present in ribs, shoulders, skull, pelvis, hips, and left foot. Gleason 6+. 14 vertebrae with cancer! Started with monthly Firmagon shots, every 4 months Xgeva, and 6 treatments of Taxotere . Supplement with Calcium and D-3. I just finished 15 radiation treatments on L3 for back pain and most affected back area. Initial PSA 90, after treatments down to .3 in March. Has risen to .6 now, Urologist recommending starting Erleada due to age and mets. Any thoughts??

[Magnus1964]

With that many bone mets zofigo may be a good plan. There are lots of ADT drugs casodex, xtandi, zytiga, Lupron, etc.

[Hidden]

Erleada is a good choice. There are several second-line ADT drugs that would work: Erleada, Zytiga, and Xtandi.

Hope things go well, let us know how it goes.

[DarkEnergy]

Hi Tiger,

This is a great place to exchange experiences and ideas. Although, I've learned a lot from my 09/11/2018 diagnosis - PSA 1000+, extensive metastasis from vertebrae to pelvic area. Our PCa is like a fingerprint, biologically uniquely specific, the common ground is testosterone fueled circulating tumor cells (CTC) that left the prostate.

So, your care is spot on (pun intended), attacked PCa with complete set of arsenal - PSA 90 to 0.3, awesome!

The question, IMHO, your CTC is hormone sensitive, keep it starving with Firmagon and add ADT treatments, like Zytiga.

Xofigo (xofigo-us.com/patient/how-x... was mentioned, which does target your condition. But, it has an adverse effect condition with Zytiga.

Suggest to engage with an PCa Oncologist, preferable with an academic research oriented practitioner with real patient experiences.

I'm being treated by Dana-Faber - Boston, MA, my current PSA <0.02...

[Tall_Allen]

The issue is insurance. Is the small PSA rise from 0.3 to 0.6 enough to allow a diagnosis of castration resistance? If not, your options are Erleada or Zytiga. If so, you have a broader range of options: Xofigo, Provenge, Xtandi or Zytiga. If so, Provenge+Xofigo next will allow you to get to more therapies faster.

Consider adding Celebrex to Xgeva. When added to Zometa, it increased survival by 22%. It may help with the pain too.

Have you had any of the bone mets biopsied?

[Tiger22Warrior in reply to Tall_Allen]

Thanks for all the wonderful advice!! No bone biopsy!! At least, I have several options!!!

[JP63 in reply to Tall_Allen]

Hi Allen

Do you have a reference for the Celebrex increased survival with zometa? I am on zometa for bone strength and Celebrex for anti inflammatory because of hip pain. It would appear that I may accidentally increasing survival 👍😀

[abmicro in reply to JP63]

I heard same thing. If you have a pain med choice, I would choose Celebrex. Old studies. Cant find them anymore. Dr Charles E Myers was a fan of Celebrex but he said the daily dose needs to closer to 400 mg to get the anti cancer "survival" benefit. 200 mg morning, 200 mg night, assuming you have a lot of pain. Check dosages with your Dr. I am not a Dr. This is only what he told me.

Celebrex has some bad cardio side effects documented with it so be careful. Medicare wont pay Celebrex unless you say to medicare that you are on a blood thinner therefore you cant take Ibuprofen because of dangerous bleeding risk that can happen with Ibuprofen.

[Tall_Allen in reply to abmicro]

The risk of cardiac side effects are no worse than any other NSAID like ibuprofen or naproxen. The big benefit is that it doesn't have the same GI effects, so it can be taken long-term more safely.

[Tall_Allen in reply to JP63]

ascopubs.org/doi/10.1200/JC...

[DrWrite]

Looks like Erleda is meant for "NONMETASTATIC castration-resistant prostate cancer." So not familiar with it. Is it correct to say your case is nonmetastatic castration-resistant prostate cancer?

[Tall_Allen in reply to DrWrite]

Erleada is also approved for metastatic hormone sensitive PC.

[DrWrite]

Thoughts? Of course. All the time

I feel like I have been through it all, but I come here and always find something new.

Hang in there; ask questions; do your research.

[tom67inMA]

I feel compelled to respond as I was also diagnosed at age 50 in October 2018, but probably should have been diagnosed in July 2018. Typical procrastination My diagnosis also came with a side of bladder cancer.

My treatment details are in my profile, but they have been very similar to yours with the exception that my MO put me on Abiraterone shortly after completing Docetaxel without waiting to see where my PSA ended up.

I'm also on Xgeva, Celebrex, Atorvastatin, and Bupropion, all with some evidence implying anti-cancer activity or other benefit. Bupropion is especially good for fighting fatigue. Also eating more broccoli and more fruits, and replaced about half my milk consumption with soy milk. That said, the Lupron, Docetaxel, and Abiraterone far and away had the most obvious benefits.

[j-o-h-n]

No advice but "kill the MF beast"....

You may want to copy and paste your history from above to your home page under your name for future reference by other members.

Good Luck, Good Health and Good Humor.

j-o-h-n Monday 11/25/2019 8:41 PM EST

[Hidden]

Tiger, first question, are you in the States? I ask because options vary. If you are in the States: Typically Urologists are ill equipped to treat metastatic prostate cancer. See a medical oncologist that specializes in Genitourlogic cancers; not any other cancer as the field is too broad to be aware of advances. While cancer is cancer, run amuck cells that have mutated, each cancer has its own unique characteristics.

In the field of prostate medical oncology there are generally two distinct types. First the community medical oncologist; second, those in academia and research.

Community oncologists are bound to treat with normal and in progression protocols. There is zero flexibility. Those in research have greater flexibility in finding new protocols through research and clinical trials. You will find these people at major medical schools. They are the people who also carry the title of Professor and teach new doctors their craft.

This is the path which I took in 2004 when diagnosed with metastatic prostate cancer. Not everyone in the trial which I undertook where successful in killing the little bastards. However, I was one of nine in the initial 56 cohort with a complete response. So I am prejudiced toward this path. As near as I can tell, those who treated metastatic PCa fared better when treated early before cancer had an opportunity to grow and become too invasive weakening the body.

Essentially the treatment which I received over a six month period is now the standard for metastatic breast cancer. As explained to me there is a relationship between the two hormone-based cancers.

I know well as it’s a long road to travel. A lot of the guys in this group know far better as to the latest advances in cancer with an eye toward life longevity than I do. I went for the cure.

I wish you well in your journey.

Gourd Dancer