Diagnosed 2009. RRP in Nov 2009. SRT in Feb 2013. ADT off and on since 2015. Now with mCRPC. On Eligard. Testosterone is <3. Xtandi and zytiga have failed. Had chemo with docetaxil and carboplatin this summer, 6 cycles. PSA went from 18 to 6.8. Last chemo was October. PSA now 20 with evidence of progression in lymph nodes and bones. Lungs and liver clear. Need to decide next treatment. Would appreciate any advice. Thank you.
Rex
Jevtana, Xofigo and Provenge are available now.
Since you've had a PSMA scan, I suggest you have an FDG scan too. If low FDG or concordant, a PSMA-targeted therapy may be useful. In the US, only Scott Tagawa at Weill Cornell is offering Lu-177-PSMA for now. There are also a couple of PSMA T-cell targeted therapies in Phase 1 trials.
Ta
What is a pmsa t-cell targeted therapy.
Do t-Cells have any psma to target?
Or do the psma ligands have something that attracts the t-Cells? If so, what are they using to attract the t-Cells?
A T-cell-recruiting antibody attached to a PSMA ligand. You can find links here (bullet points towards the end):
pcnrv.blogspot.com/2019/12/...
That sounds really interesting if it works.
Ta, is there any reason not to consider Bipolar Androgen Treatment at this juncture?
Alone, or in conjunction with psma based treatment?
Or perhaps while in the process of arranging psma based therapy?
Rexwaterbury was treated at JH, so he may know Denmeade. It is an option that I don't think anyone should do outside of a clinical trial. PSA increased in 43% of patients, and more than doubled from baseline in 17%. Serious side effects in a very small trial (n=30) have included pulmonary embolism, heart attack, urinary obstruction, gallstones and fatal sepsis. It may resensitize some of the cancer to hormone therapy. Will that lengthening of the time for enzalutamide sensitivity translate into increased survival? There is no evidence so far. Not a therapy to approach lightly.
Here's an article about it:
pcnrv.blogspot.com/2016/09/...
It's worth noting that the newer hormone therapies - Erleada and Nubiqa - also prevent androgen receptor amplification, which is thought to be the primary mecanism for BAT when it works.
Rex
Tall Allen has a recent post here that details the different treatment staging issues. It in turn has a link to his personal blog with even more detail.
I would encourage you to look up and read both.
They will equip you with enough information to to seek out some second opinions and have an intelligent and informed discussion with the docs.
Any Docs you find that are not at least as informed and current as Ta, maybe you need to pass on them.
Perhaps time for second-line chemo (Jevtana). You are where I expect to be some day. I am progressing and waiting for a higher PSA to begin abiraterone plus a study drug. After that current thinking is Jevtana. Thanks for posting.
If he has a Ga 68 PSMA or DCFPYl PET/CT showing metastases he could qualify for Lu 177 PSMA treatment:
These are the places recruiting patients for Lu1 77 PSMA therapy:
clinicaltrials.gov/ct2/resu...
If you can afford and he is interested and able, you could consider to travel to Europe or Australia for lu 177 PSMA treatment.
I have a Psma pet at UCLA in 2 weeks. I was Psma avid one year ago so hopefully that remains the case. Is an FDG pet required for all of us that are considering Lu 177?
No.
USE THE CROME BROWSER and go to: mycancerstory.rocks and read Joe Tippens' Blog (Fenbendazole protocol). Read it all the way through. If you are intrigued, join the Facebook group it references to see what is happening everyday to people with cancer using it. The protocol does not conflict with any other treatments. Decide for yourself if it is something you would like to try. Decide for yourself if it is something you will tell your doctor about. Best wishes on whatever you do going forward.
Off topic, but around here (mid-atlantic), fenben is unavailable in any pet store, and there is a multi-week wait online.
Panacur C Canine dog dewormer is available on Amazon with a couple of days delivery time. If you are going to do it long term, you can shop around to find best price after getting enough to get started. For full protocol, read Joe Tippens blog to get dosages and other things he takes it with.
What does your Doctor(s) advise???
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/19/2019 6:05 PM EST
Dr Drake recommended Lu177 in Bad Berka, sooner when disease volume is still relatively low, rather than waiting, in hopes of a longer remission. He also discussed with me the clinical trials involving regeneron and CAR-T, but favored the Psma targeted radioisotopes.
I did the same at TUM. Just finished the second cycle last month. They hardly see mid/low volume early disease patients, so they don't have solid statistics backing their claim. But they also feel it's better to push it forward. CAR-T therapies right now is PSMA based (as far as I know), so seems to me lu-177 would do the job, with a lot of collective experience and data behind it.
One of my concerns is if I have lu 177 first and wipe out all my Psma Prostate cancer , then there will be no Psma for Car T therapies to work, as they are Psma based.
it doesnt make any difference what kills the PSMA expressive cells. If you have a limited number of them, the end result is the same.
There are working on new targets for both CAR-T and radionuclides away from PSMA. Early stages, but clinical trials will be out soon hopefully.
Hmmmm... If he had to choose for HIMSELF what would he choose?
Good Luck, Good Health and Good Humor.
j-o-h-n Thursday 12/19/2019 6:22 PM EST
Keytruda failed on trial, now chemo
Zytiga failure after 4 years what now 
What next after chemo, neuroendocrine cancer
What scans have you had after chemo? 
Xtandi after Zytega and then chemo
