What to do next for treatment

[sjpoli46]

I have prostate cancer which started over 3 years ago, I did chemo and lupron which seemed to work great for couple of years then PSA started going up like to 122. I must mention that I have the BRCA 2 gene which makes my cancer somewhat aggressive. My onc put me on Xtandi which worked for 7-8 mos but now PSA after going back down to 6.5 it slowly rose to over 22. The two main options he is talking about include a PARP inhibitor the first one is a UCLA trial in conjunction with immunotherapy (Katruda). The other is just the PARP inhibitor. He mentioned also Radium 223 which he wasn't a big fan of (doesn't follow PSA or CT scans for that matter) and Provenge which he said was more for slow growing cancer. I am 73 now just looking for answers.

[henukit]

With BRCA2 PARP inhibitors is a viable option. They are available as breakthrough designation for now and may be approved for PCa in a few months. If you have ability to go into combination trial like you mentioned it's a great option as well. Keytruda alone showed some activity in PCa but in combination with Provenge and considering BRCA mutation it may work even better.

[tango65]

The PARP inhibitor will offer a survival advantage over other treatments.

urotoday.com/conference-hig...

Keytruda has undesirable side effects and I believe it is not very effective unless your cancer has mismatch repair deficiency and high microsatellite instability mutations.

rxlist.com/keytruda-drug.htm

You could discuss doing Provenge at the same time or before doing the PARP inhibitor.

[sjpoli46]

I'm not sure what you mean by that. I will be seeing my onc over here in Maui tomorrow sharing the results I just posted and what my onc from UCLA Health suggested I do and will of course get his opinion as well.

[tango65 in reply to sjpoli46]

Since you have BRCA, the data show Olaparib will be effective in most of the patients

[Tall_Allen]

I think the clinical trial with the PARP inhibitor and Keytruda is an excellent choice. I think that Xofigo + Provenge is a great choice too if you have bone metastases.

[sjpoli46]

I'm kind of new to this forum and would like to know more of who you are and if you have first hand experience with either of your suggestions. Thanks Steve

[vandy69 in reply to sjpoli46]

Hi Steve,

I have been in this battle for 7 1/2 years, with every drug, proton beam radiation, and currently 17 chemo infusions of Docetaxel and Carboplatin. My cancer is in lymph nodes and liver.

After a Guardant360 liquid biopsy, it was determined that I had an ATM defect which qualified me for the PARP inhibitor Lynparza. Lynparza worked for about 9 months for me with few side effects.

Best Wishes. Never Give In.

Mark, Atlanta

[sjpoli46]

Wow, I am sorry that you had to go thru so much, I only had the minimum 6 rounds of the Docetaxel and that was enough for me! My cancer never went to nodes only to bone, mostly pelvic region which is why my onc over here in Maui wants me to go on Xofigo. Good luck to you and I will put you on my prayer list.

God Bless,

Steve