I just met with my m.o today, once again my p.c progression is rapid xtandi failed PSA up from 0.08 to over 3 in 6 weeks. The bone scan indicated new Mets to lower rib and upper humerus as well two small ones on my cranium I am very discouraged and far less hopeful, tommorro I have a teleconference with a expert, specifically, a prostate doc we will discuss what's next. I made the comparison to myself and some guys I have read about on this very forum my m.o said your cancer has a high doubling rate and yours is very aggressive. The reason I mention this, is I hear of some of you guys with multiple Mets, and it seems like there are many of you that have lived for years and have many options according to my doc today said it's very limited to clinical trials and chemo for your type cancer which has a low likely hood of sucess 30 to 40% then I mention a combo that was recommended on this forum provenge and xofigo and basically she said that's old school approach it's just confusing and distressing to feel like your headed to the finish line especially weird when I still feel pretty good.and the solutions are narrowing with each appt..
Gleason 4 + 5 =9 diagnosed June 2016.
Rad prostectomy Aug 2016
37 sessions rad 2017
Zytiga 15 month 0.01
Zometa and xtandi last 4 mos PSA RISING from 0.08 to 3 or higher 4 new met one met blasted L 3 5 mos ago when zytiga failed.
Lupron for several years....
Should I push for these new Mets to be blasted off, and start docetaxal or immuotherapy a couple clinical trials are happening. of course I know your giving your opinions, but really value it especially before I speak with a doc on my next treatment. Thanks to all, and stay safe.
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Costarica1961
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I'm sorry to hear about the rapid growth of the cancer.
I don't know what the best medical approach is at this time. There are treatments that I presume you have not tried, and that might not have anything to do with the failure of hormone therapy that you are experiencing and could therefore still work. As you mentioned, docetaxel, Xofigo, Provenge (or better, Xofigo + Provenge), and Lutetium-223 are possibilities. Immunotherapy is only working for a small number of PCa patients, but it may be that you have a genetic profile that fits with it.
What I'm going to suggest here is more of a lifestyle approach rather than a specific treatment recommendation. You may have a limited amount of time and energy left. So I'm thinking that, while it's a good idea to look at more treatments, it's also a good idea to maximize the personal values that you can satisfy in the remaining time. In other words, in your shoes, I might not want to spend all of my time worrying and trying new and difficult treatments. I'd want to spend some time with my family (or zooming or skyping with them in this time of pandemics), gathering up photos, mementos, diaries, etc., writing things down or making voice or video recordings, taking some selfie photos, cleaning up any untidy financial affairs, and maybe taking time out for things I really like like watching favorite movies, listening to favorite music, visiting parks for walks in the woods. The goal might be both to leave things for your friends and heirs, and to enjoy as much as you can the time you still have. Trying a rough treatment like docetaxel might be worth it because you might find it works well and isn't as rough as you feared, but even while taking the drugs, ask for gentle doses and spend good days doing good things. Life is good and we can try to make the last of it as good as the first or the middle.
Well, I don't know if any of that is helpful, but I hope it is. We all wish you the best.
I have a pretty full life luckily clamming on the the beach and golfing. my grand son is been staying with us since the outbreak my twin sister has been coming down from Seattle every weekend to visit .the cancer has put a wet towell on some Joy's for sure but I manage to laugh a lot and joke around. Thanks for your helpful words.
Hello Tall_Allen. We landed on starting docetaxal next week as well as zometa infusion at the same time, do you believe that's wise, I would think they should be separated, I also requested neulasta in conjunction with chemo. Would you suggest anything else. I also understand most people tolerate this approach well, although I am very apprehensive. I will proceed regardless
my husband finished provenge in march and is starting xofigo this week. hope it has same benefit.
I would recommend getting molecular testing for genetic mutations. That could open up treatment options.
First line Docetaxel and second line Cabazitaxel chemotherapy are probably your best options as far as effective, proven treatments that you have left. I've been through Docetaxel chemotherapy and it is very tolerable for most. I'd certainly do it again. The new PSMA targeted radionuclides LU-177 and AC-225 are showing promise too although they are not as easy to find and may require travel and/or out-of-pocket expenses.
If you do chemotherapy, you might be able to rechallenge an anti-androgen like Xtandi, Zytiga or possibly try Darolutamide and get more time out of one of those.
Don't feel alone. Many of are in a similar situation. We are all eventually going to have cancers that don't respond to androgen-based treatments.
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Zytiga failure after 4 years what now 
Deciding a plan of care for Stage 4 with mets to skull, spine, ribs, shoulder and pelvis. 
Looks like just one bone met. Radiation or not?
J Stent: How long can men keep using stent if TURP is contraindicated? Stage 4 man with mets.
