My SO is 83 year old. He was diagnosed with PC stage 4 in October 2018 with a PSA of 947 and Gleason 8. He first tried Zytiga which worked for 4 months, then he was on chemo for 5 sessions. He developed a bad case of lymphedema and had to quit chemo. He is now on Radium 223 and Provenge. Just finished his last Provenge treatment and have 3 more Radium 223 left. HIs PSA is now 85 and has doubled for the last 2 months. He has had bone pain on his tail bone and have been taking Tylenol every 6 hours just prior to taking Radium 223.
Doc is recommending adding Jevtana with his radium 223 this coming Friday.
He agrees to this and never questions his Oncologist. What other treatments are there after jevtana? Would he run a risk of lymphedema with jevtana just like he did with taxo(?) chemo?
His blood work seems to be normal.
I am so sad cause he is 100 percent mentally together and his PSA is doubling.
He could get a biospy and molecular testing to see if his cancer has a treatable mutation such as BRCA1, BRCA2 or ATM. If he has one of these, he could be treated with Olaparib (Lynparza), a PARP inhibitor.
Otherwise, second-line Jevtana may be a good option for him. Depending on what is found in a biopsy, a platinum chemotherapy can be added. Jevtana tends to be easier than Taxotere as far as the side effects go.
After that, he might be able to go back to another anti-androgen such as Enzalutamide and get some more time out of that.
Wishing the best for him.
in reply to
I mentioned to him about asking for foundation one testing.
Be careful about combining Jevtana and Xofigo - they can both be myelosuppressive. Maybe if he takes Neulasta with it. Still, it bears very close monitoring.
I did better on Jevtana than I did on Doce..It was more effective with fewer side-effects..But heed TA's warning, he would need to be watched closely.. Talk with a Radiation Oncologist about zapping the tail bone with a little SBRT to stop the pain. Did his scans show the cancer concentrated anywhere ??
Its a pity that your SO ( ? ) had such a high Psa at diagnosis. If he had been having yearly Psa tests he may have been diagnosed years ago when Psa was < 5, and that is easier to treat. I was diagnosed in 2009, age 62, Gleason 9, inoperable, and no spread big enough to shown in any scans. I was still diagnosed too late, because if I'd been properly examined in 2004, I bet I would have have had a Gleason 5 at Psa 3.0, and no spread, and an operation would have worked and no more Pca troubles.
So many men get caught my seeing a doctor too late.
In late 2018, after chemo failed, Psa had only gone to a peak of 50, but I had countless small mets, none of which were very painful.
I had 4 shots of Lu177 with Xtandi added after 3rd shot which reduced Psa to 0.32 a year after beginning Lu177.
Psa is now rising again, so I probably will need more Lu177, and I was told I can repeat a couple of doses twice thus maybe live another 3 years without pain and with Psa < 5.
What happens after that is unknown. Pca looks like it will kill me given enough time, and if whatever is available in coming years does not work.
But I am cycling on my bicycle about 200km A week regularly, and very fit and healthy and I have no pain.
I'll have another PsMa Ga68 PET/CT scan soon to see if Lu177 will work again.
I may be Brca1+2 positive and may benefit with olaparib PARP inhibitor. I just have to wait and see what scan shows.
I have survived over 10 years since diagnosis, and had a very good quality of life.
The worst side effects I have had are from the 5 shots of Docetaxel chemo, with legs becoming numb, and a bit unresponsive to what brain wants them to do, but 2 days ago I cycled 26km across town in exactly 1 hour, a higher speed that I have not achieved since years before having chemo and getting both knee joints replaced in early 2017.
The 26km has a few hills along the way and this result is good considering that at 61, before I had ADT, I was very fit, but could not do that 26km at less than 57 minutes, or about 28kph average speed. To be able to ride the way I do, I MUST be very healthy. I am 11 years older than I was at 61, so ADT and a pile of other medical treatments have not slowed me down more than natural ageing effects.
Ra223 does have side effects of making bones brittle, and it won't have any effect on Pca mets in soft tissues. I am trying to avoid future chemo and Ra223. Chemo makes immune system weaker, and getting C19 virus would be a death sentence.
Lu177 was slow to act at first, but it worked well on all soft tissue mets and eventually worked well on bone mets. I hope to live long enough for other treatments being trialed now become therapy in years ahead.
My dad has been fighting this monster for 20 years. Seed implants,shots and on and on. PSA as high as 1000. Then it would go down. 88 now . 2 oncologist later to weak for chemo, zytiga for a year, side effects were terrible. Dementia ,we think due to the Adt treatment over the years. His current PSA is back down to 9. It’s a matter of quality versus quantity. We have pulled him off all cancer drugs and are doing 6 month checkups with the oncologist. This monster is a awful thing. Prayers out to your dad 🙏🙏🙏
Your Significant Other has been through alot since 2018 when he was 81 years old. I hope he can weather the storm for at least another 9 years. They made tough people back in the 1930s. Give him my regards and if possible tell him to laugh....
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What to do next for treatment
Chemo treatment/What happens after chemo? 
Why is Jevtana used as one of the last options for the cancer?
Decision time on Tuesday morning after progression shown in scans
Xtandi Resistance Treatment
