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

[Barbara345]

Hi all --- (original post gone) -- 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 by Lupron. It dropped to 4 in about two months. He Started Docetaxel with minimal side effects, However, from 2nd to 5th treatment PSA rose from 4 to 11.3. Scans indicated progression, so MO discontinued Docetaxel after 5th treatment. 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. Bone biopsy scheduled Monday, and Foundation One study has been ordered.

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

What can detect visceral cancer? (some questionable material).

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

[Fairwind]

Save chemo for last, try Enzo first..

[tom67inMA]

I'd make a weak recommendation to try enzalutamide or another second generation androgen drug. My thinking is that will give him time to recover from the first chemo before starting a different chemo. But I'm not an expert on such things, let's see what others have to say.

A PET scan would only be useful if it informs a treatment decision. If a bone or CT scan showed widespread disease, that may be all you need to know.

It really sucks how fast cancer can progress and be painful. At my original diagnosis, and just again recently, I went from virtually pain free to debilitating pain in only a week or two. Pinching a nerve or blocking the urinary tract can turn pain on like a switch. I sympathize with your situation completely. Tell your husband to keep moving, he's doing the best thing he can outside of medical treatments to improve his prognosis and quality of life.

[Hidden]

One of the best ways to find visceral mets is MRI imaging.

academicradiology.org/artic...

If visceral mets are found, I would want to have a biopsy done to determine if there are neuroendocrine cells there. That will help direct the treatment.

Based on his PSA nadir of 4 and the short time of effectiveness for primary ADT (Lupron), I would think Cabazitaxel will be a better option than Enzalutamide or other second-line ADT agents. Depending on what they find in a biospy, platinum chemotherapy may be added.

His biopsy may also find treatable mutations and give other treatment options.

[tango65]

Your original post is not gone. Go to your profile and it is there. Fairwind, TA and myself made replies yesterday.