Need help.
My friend has had chemo and Zytiga. DX Oct 2018 with bone mets.
Had radiation and started Zytiga in May of 19. His PSA is rising and his medical oncologist suggested changing over to darolutamide instead of trying to recharge zytiga by changing the Predizone to another drug.
Any thoughts on Darolutamide? Work for Castrate Resistant?
Help and thoughts please.
Darolutamide (Nubeqa) is only approved for non-metastatic CRPC, but some MOs seem able to somehow get it for their patients outside of clinical trials - I don't know how. It hasn't been proven to extend survival the way Zytiga and Xtandi have, but it might.
"some MOs seem able to somehow get it for their patients outside of clinical trials - I don't know how"Ta
Long-term
Would it be possible for you to get this patient to ask his Doc how his Doc is able to access this medication.
Then report back to us what you learn?
Chemo and Lupron immediately in oct 18
Zytiga in may of 19
Became undetectable in June 19
Radiation IMRT completed by July of 19
Remained undetectable thru nov <.02
Jan 3rd PSA jumped from <.02 to .32
Another test a week laster .39
Fast double time
If I were in this situation, I would be looking at going back to chemotherapy instead of another androgen based treatment. The reason is mainly because of the relatively short effective time of ADT plus Zytiga and because of the cross-resistence between anti-androgen treatments. He may have a better chance of them working and working longer after chemotherapy.
I would also be having molecular testing done to see if there is a treatable mutation such as BRCA2.
I would do chemotherapy first, then try an androgen blocker after chemo such as Enzalutamide or Darolutamide if he can get it.
These are things he can discuss with his doctor.
Thx Gregg,
He has an appointment on Friday with his Med Onc. and they are now discussing provenge.
I know my friend isnt keen on having Chemo for the second time in just 14 months.
It didnt last long the first go around so why would this time be any different.
first one was docitaxel. second round would probably be cabiztaxel. Chemo is Chemo........ Terrible options!!!
So sad and frustrating
56 years young, with kids and a terrible place to be.
I cry for him and his family.
No doc has a clue. its all a crap shoot
frustrating and scary
Not sure this has been mentioned, but he shouldn't change treatments at all unless there is progression as indicated by imaging. He already knows he can switch steroids from Prednisone to Dexamethasone (see SWITCH trial results) Doing that could also buy more time.
In any case, PSA rise alone is not adequate reasoning for changing treatments.
understood and thx.
From what I've read, Darolutamide can still work with some AR mutations, and thus might work where Zytiga and Xtandi have failed. I would be interested in trying it if I were in your friend's position. If he does try it, please let us know how it worked.
Good point on the AR mutations. If you read the Wikipedia page on Darolutamide it says that in testing, it worked with all known AR mutations. I know Wikipedia is not always accurate and I don't know if this has actually been proven in trials.
His doctor is offering it so that's great for him. If he tries it, it wouldn't take long to find out if it works.
ok i will.
He has an appointment on Friday and i'll let you know what direction they decide to go in...
At a PSA value of .39 I would not start with Chemo again. Maybe at a PSA value of 5.0 or 10.0 ng/ml.
Based on the doubling time he ll be at 5 in a few months unless he can change drugs and slow the velocity
I would not calculate the PSADT based on the jump to 0.32. A week later for the 0.37 value is not possible, that would be the 10th of January. So this was probably a PSA test to confirm the 0.32 and this resulted with 0.37. Difference due to different lab? I would wait for two weeks and then do another test and then calculate the PSADT. I guess it will not be that short as you think now. Do not panic based on one PSA test.
PSA was <.02 in late Oct.
Jan 4 its at .32 then .37 within a week later.
The jump from <.02 to .3 is the big increase which happened within two months.
Agree?
You wrote:
"Remained undetectable thru nov <.02
Jan 3rd PSA jumped from <.02 to .32
Another test a week laster .39 "
My argument is that we have the 8th of January now and if the 0.32 was measured on the 3rd or 4th of January this are just four or five days ago - this is no week.
Also you do not calculate PSADT based on values as lower than 0.02. I would start with the 0.32 and get another value in two or four weeks. A PSA value of 0.32 alone is no threat.
I agree with GP24. My PSA is tested monthly. I hit my nadir in June at 0.17. It then started climbing and I worried I was becoming resistant. 0.21, 0.31, 0.38. Then it dropped back down to 0.31 and has been at that level for a few months. My oncologist said not to worry as long as it was staying below 1.0.
I would be asking for scans if the doubling time continues to accelerate. You may have to fight insurance for your first PET/Axumin or CT before the PSA hits 2.0.
First of all, thank you Longterm for being such a good friend and incredible support for my brother. Secondly, this forum, rich in knowledge with incredibly intelligent people, has been invaluable. We are blessed to have found it. I will be going tomorrow with my brother and sister-in-law to Dana-Farber once again. So many questions and never sure which road to take. Our number one priority is Gene mapping. We are going to insist upon it. Number two, we will discuss Dilutamide. I’m not sure why the doctor recommended it. It is not normally used for metastatic prostate cancer. There is a clinical trial on going that will have results in 2022. Other than that, I have no idea how he will get it or if insurance will approve it or how it will be any different from Zytiga which is also an androgen receptor blocker. I worry he may be getting off Zytiga too soon as noted above in one of the comments. Either I or Longterm will report back on the outcome of tomorrow’s visit. Thank you to all who commented. Patty
Praying and crying for him!!! It’s so painful and sad that we both have to deal with this disease at 56 years of age
It’s a Terrible place to be!!!
Hoping he has a long runway that he can keep coasting down !!!
What was outcome of doctors visit?
Decided to start Provenge. Bob already went for his first infusion. We have next week off and then will repeat the procedure the following week. Handle the first infusion very well right back to work the next day. The doctor wants to start Darolutamide when he’s done with Provenge. He seems to think he can get it. We’re taking one step at a time. When he finishes with Provenge I will post back to let you know about the Darolutamide
I pray for both of you. Glad you have each other for support!
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