My husband was diagnosed in 2011, gleason 8, psa 22, many years of treatment, IMRT, zytiga, Lupron/Avodart. Treated with Dr. Snuffy Myers until his retirement. Psa has never been to 0. All scans stable, cancer in lymph nodes, no bone involvement. He feels good, has had 9 chemo treatments (Doxetaxal) which he has handled very well. Scans still stable, put last psa 5.8. Started chemo at 35. He has one more to go, question is, what next?? thanks all
judy
It sounds like he has gotten a good response from chemotherapy so far. I wouldn't focus too much on the PSA at this point, but whether or not he is having progression as determined by imaging. That's the standard you use before making treatment decisions. In general, you would continue with chemotherapy until it either stops working , the side effects become intolerable or the patient is no longer fit.
He could try another anti-androgen such as Xtandi and might find he has gained some sensitivity. There is also second-line chemotherapy Cabazitaxel if Docetaxel becomes ineffective.
LU-177 is an option, although he would need to get scans and determine whether is he PSMA avid.
In the meantime, he could get a biospy to test for treatable mutations such as BRCA and ATM.
He has been doing very well on chemo few side effects. I asked doc about trying zytiga again he said wouldn’t work. I have seen it has with some people. He had genetic test no BRCA will check if atm. Thanks for reply
The stable scans is the main thing. Has he had a biopsy of any of his metastases? Jevtana often works after Taxotere. It may be worth a re-challenge with Xtandi.
No biopsy. Tried xtandi with keytruda in trial did not work at all. Had good run on zytiga 3 years
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