After completing 6 cycles of docetaxel, the PSMA scan results are:
- Residual 68Ga-PSMA expressing lesion in the right acetabulum and right ischium (max SUV 8.7) and D11 vertebrae.
- PSMA not expressing multiple skeletal lesions in vertebrae.
- No other evidence of 68-Ga PSMA disease present in the whole-body scan.
- In comparison to the previous scan dated 18 Nov 2019 (after 3rd chemo), there is a decrease in PSMA expression of multiple sclerotic lesions.
Dad is still Hormone-sensitive and has little to no bone pain and is doing better than ever, thanks to chemo.
After 6 cycles of chemo + ADT :
PSA: 0.04 [From 149]
ALP: 81 [From 887]
- Told that's a good response to chemo and only 3 places still haven't reduced yet.
- He wants to start Casodex 50 mg (Bicalutamide) once a day, and if there is a rise in PSA/descrease of blood levels/pain he will then consider shifting to Zytiga.
Mo's initial plan was to start Zytiga immediately, but now due to good response to chemo and a very low PSA, he wants to wait.
He tells me based on some recent results he studied, adding Zytiga immediately did not give a lot of extra benefit. He told me to consider Casodex as a weaker form of Zytiga and wants to use this before moving to Zytiga.
I'm concerned why he changed his mind about Zytiga at the last minute after the scan results?
Is Casodex + ADT good to retain the benefits of chemo for long?
Should we add Zytiga only after Casodex as per MO?