Looking for support and direction from the community. My husband had his 4th and 5th docetaxil treatments which resulted in an increased PSA. Began at 16 and trended down to 8. Tx 4 his PSA increased to 9.41 and yesterday 11.2. Disappointing and frightened we are running out of options. Spoke with Dr. Oh who suggested adding Carboplatin I asked about LU-177. Do not want to proceed with anything that could knock Vince out of the box while considering LU-177. I know he needs to meet criteria for LU but if given choice, what are the experiences you have had? Good or bad. Dr’s recommendation was the Carboplatin. When I asked about LU-177 he said he would look into both for us. I was a bit surprised it was not brought up by dr as an option.
Increased PSA again: Looking for... - Advanced Prostate...
Increased PSA again
Chemo is usually done before Lu-177-PSMA. Scott Tagawa at Weill Cornell has a trial running that only includes patients who have completed chemo first. There are usually 6 rounds of chemo, so why not add carboplatin for the 6th round and see how he does? If he does well with it, he might respond to a PARP inhibitor too.
Before he gets the Lu-177-PSMA, given his liver involvement and his fairly low PSA, I think it's important that he get both a PSMA and an FDG PET scan. There are also some new clinical trials mentioned at the end of this article that he may qualify for. The Harpoon Study is in NY at Columbia Presbyterian.
pcnrv.blogspot.com/2019/12/...
If he has had a biopsy of tumor tissue and found to be low for expressing both PSA and androgen receptor, he may qualify for this trial at UW Seattle:
clinicaltrials.gov/ct2/show...
Hello Tall Allen I received copy of Vince's biopsy. Sema 4 did the testing. ERG gene SLC45A3ERG Fusion only found in 0.02 % of metastatic prostate cancer patients. How unfortunate. The most loving, giving, thoughtful 63 year old man. A rare case of this cancer. He feels good so I'm guessing it has not spread too far yet. Other than fatigue, he goes to work daily and does not think about his cancer. He is having more scans done Friday
Any suggestions? i know its a long shot....Thank you
I gave you my suggestions above. You did not tell me what his biopsy showed, only what the genomics were. What was the histological analysis? The IHC?
I’m sorry I do not know what IHC means. So much to take in. We did put a call in to dr oh for a PSMA scan. They will be adding Carboplatin on Tx number 6. I will be calling tomorrow on his biopsy and ask for explanation on the findings
thank you Carol
Dr Oh can't get you a PSMA scan.
Can you help me understand your comment please. Last I spoke with him he said he would look into the PSMA scan and the possibility of an LU 177 trial going on in the radiation dept at Mt Sinai where Vince receives treatment.
When did you last speak to him? I was not aware that Mt Sinai still had a PSMA PET scan trial or a Lu-177-PSMA trial that is open to recruitment - they both ended. Weill Cornell has an open trial.
We were told this past week by Dr Oh that radiology is running the LU 177 trial. Opened in December.
Talk Allen I am looking at his SEMA4 report and wondering if you would help me navigate it so I can answer your question on IHC?
No, it is not a genomic analysis. Call and ask for the path report and the IHC.
Just requested report. I’ll be back in touch with you. Thank you for your time
These are small changes in PSA and PSA alone shouldn't be used to determine progression. The chemotherapy could still be working.
Has he had imaging done to see if there is radiographic progression?
Another thing he could do is a biospy and molecular testing to see if he has any treatable mutations. This might also help to determine if adding Carboplatin would be beneficial.
Thank you Greg! He is going to have a bone and cat scan next Friday. We also asked about LU 177 Doc said he needs the PSMA scan and is looking into it for us. He did gene testing. Is that different from molecular testing? Thank you!!!!!!
If the genetic testing he did is germline (hereditary), then he should also get genetic testing that looks for somatic mutations specific to his cancer.
For example, he could have an inherited BRCA2 mutation. But if he didn't, a BRCA2 mutation might also develop in the cancer later. If that was the case, he could be treated with a PARP inhibitor.
Something to discuss with his doctor.
Hi Cloc
My husband completed 7 rounds of chemo recently, the last 3 were Docetaxel with Carboplatin. He too had a modest psa increase on chemo, that increasing trend stopped and then slightly reversed with the addition of carboplatin.
It makes sense to add carboplatin And see how he responds to that. As Tall_Allen said, if carboplatin works, then a parp inhibitor may also be an option.
If you have information about what specific genetic mutations he has, it might be helpful to post that here. There are targeted drugs that can work well with certain mutations.
Best to both of you
Thank you for your response. It gives me some hope What is a PARP inhibitor? I just requested his genetic testing report from the dr. Want to put my eyes on it so i can input some info here. Than k you again and good health and prayers for both you and your husband Carol
Hi Cloc
A parp Inhibitor is a targeted drug that prevents the repair of DNA causing tumor cells to die. Drugs working in this way, can be very effective in people with repair defects such as BRCA. Our oncologist put the response rate for people harboring repair defects at 80% or more. They are great drugs for people with the right genetics.
Find your husband’s results and post them. Collectively there exists so much knowledge here!
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