PSA Up During Docetaxel, Scan indicates progression. Determined, Next step??

[Barbara345]

Hi all --- Determined despite devastation. Looking at "What next." Husband Barry was diagnosed last August with pc, extensive bone mets, no pain (cancer found on Xray after he pulled muscle when kayaking). PSA over 60 when he started Casodex followed bey Lupron. It dropped to 4 within about two months. Started on Docetaxel with minimal side effects, However, after second treatment PSA rose from 4 to 11.3. MO discontinued Docetaxel after 5th treatment when scans indicated disease progression. And now Barry's in pain!! I thought he'd escape that, at least for longer. Now -- considering what next? -- enzalutamide vs carbataxel -- or in what order? Hoping cancer hasn't gone visceral. Barry's in MRI as I type this in waiting room. New bone biopsy scheduled Monday,and Foundation One study ordered.

Thinking of asking about a PET scan. Is it time to do that? ?

Any clinical trials known or is it too early? MO at MSK said they didn't have any for him now. I'm checking other places. I'm doing research (science background helps). Thought it wouldn't be so fast.... he's been so fit, dragged himself on his usual route up and down hill, hurts to bend down. MO also will be checking on pain issue. I admit I'm shook up..... and motivated .... Glad you're here. .....

[Fairwind]

Has he tried Zytiga or Xtandi ? Are his mets confined to his bones ? If so, R-223 might be an option..

[Tall_Allen]

This may help:

pcnrv.blogspot.com/2019/12/...

The biopsy and F1 study may provide some clues - you never know. A PET scan will tell you nothing you don't already know. It may be useful later if you want to pursue a PSMA-based therapy (but the bone biopsy IHC can tell you that anyway).

[tango65]

Discuss radiation to the metastases which are causing pain and the use of drugs like zoledronic acid or denosumab. He could be also treated with abiraterone, enzalutamide and Xofigo ( Radium 223) and the vaccine Provenge. They could try an anti androgen ( abiraterone or enzalutamide) and when it fails , he could be treated again with chemo using cabazitaxel.

Depending on the mutations of the cancer, he could be treated with drugs such as Olaparib or Keytruda or similars. There are clinical trials for these drugs:

clinicaltrials.gov/ct2/resu...

Keytruda is approved if the cancer has microsatellite instability-high (MSI-H) or is mismatch repair deficient. There are clinical trials for other drugs like Keytruda:

clinicaltrials.gov/ct2/resu...

He could qualify for clinical trial of Lu 177 PSMA treatment:

clinicaltrials.gov/ct2/resu...

Consider calling the people running the trials to see if he could qualify.