My friend is 56. Already gone thru Chemo (docetaxal), provenge, zytiga and xandi.
MO wants him to start chemo which he doesnt want to do (again) and wants to know thoughts from others. Success (O.S) statistics with Radium 223?
Running out of options.
His PSA is rising but still low at .7 and imaging shows new bone mets.
Help a brother please!!
Second-line chemotherapy Cabazitaxel is his best remaining. proven treatment IMO. Many people have found the side effects of Cabazitaxel to be more tolerable than Docetaxel.
I would suggest trying one cycle and see if it working and how tolerable the side effects are. He can always quit at any time if it's not tolerable. He only has to commit to one cycle at a time. It's a small commitment for the potential gain.
Thx Gregg
His concern is that if extends the runway only 3-4 months and he has to endure 6 months of chemo it’s not worth it
I understand that concern and have been through Docetaxel myself for 18 weeks. I found that having one week out three where I felt crappy, but not debilitated was worth the other two weeks of feeling normal. And with symptomatic PCa, you can end up feeling better overall, despite the side effects.
I had some really memorable and enjoyable experiences during chemotherapy so for me, it would have been worth just extending my life for the time I was on chemo. I realize that not everyone would feel the way I do about it. I just didn't think that life on chemo was that bad.
Of course you really don't know how much it can extend your life, could be more than 6 months who knows.
Wishing the best for him, whatever he decides.
If he does Xofigo, why not add Provenge?
he's already done provenge. Are you suggesting do repeat provenge?
No - it can't be repeated. He would have adapted to it by now. Xofigo seems to combine well with chemo too, if he were amenable to that.
This is link to a RCT with Xofigo. They found an OS advantage with Xofigo:
pubmed.ncbi.nlm.nih.gov/273...
Xofigo could be associated with Provenge
ajmc.com/view/radium223sipu...
Cabazitaxel could be also effective in controlling bone metastases
Here are trials using combinations with Xofigo (Radium 223):
cancer.gov/about-cancer/tre...
Would it be better than Cabazitaxel? (My dad is looking for next steps)
Don't have experience with Xofigo, but do with Docetaxel and Cabazitaxel/Carboplatin combo. I found latter quite tolerable, even more so considering the fact it was a bit more than 1 year after the former. After completing the course my blood markers were quite good and disease stable. In my case it was a bit late as cancer started roaming around cerebral spinal fluid and targeting brain.
Overall, I think Cabazitaxel effects are less pronounced than Docetaxel.
Others have also shared that Cabazitaxel has better side effects than Docetaxel. Just have to watch the neutropenia.
Has he qualified for any clinical trials? I been through the 6 infusions of docetaxel. I'm currently on my second clinical trial. I was offered cabazitaxel, but declined. For me there is no tolerable chemo. One is just as bad as the other
Which clinical trials are you in? Thanks in advance
Currently on a trial combo of cabozantinib 20 mg pill., and atezolizumab as an infusion. Go every three weeks. Been on for over four months now. It’s working on all my metastasis except my lungs. I have a pleural effusion that is causing me breathing problems because my lungs need to be drained. This is a roller coaster of a cancer. It will be my demise eventually. But look into trials before you consider any form of chemo again. Ralph
I can only give my suggestion that I'm using, as close as possible to a keto diet, and cannabis suppositories the I make myself, grow local stevia, solvent extract, Do Not decarboxilated, and add CBD crystals(so as to achieve THC :CBD, 1:1)0.36g topped up with Cocoa Butter substitute in 1ml viala(00)start 1 a night, 2 at night, 1 day 2 night.
I recently had a proscribed series of 6 docetaxel dosings; the last 3 had carboplatin added. I ended that series with a PSA 12 points higher than when I began (48.3). After having 2 outside consultations with GU specialty oncologists, both of whom recommended that I continue the doctaxel/carboplatin for 3 more dosings before giving up on it, I was able to talk my general onc into restarting it for 3. (Theory is that it is suppressing the cancer and making it rise more slowly.) There is a concern that I 'save' cabazitaxel until I really need it.
There is an interesting divergence on radium223. Local oncologists see it as pain relief and prefer to save it for a time of significant metastatic pain. The consulting GU oncs lean towards using it as treatment, assuming it works better (and maybe gives better OS?) if used before the metastatic burden is too large. A local onc said, "If you use radium223 all you're going to do it sit around and watch your PSA rise for 6 months without being able to do anything else about it." But, of course, mine is already rising while on docetaxel/carboplatin.
One hopes for lutetium's availability (& efficacy!) to add an option in the coming year, but who know?
R-223 works best if all the mets are confined to the bones.. Combining it with Jevtana sounds great if you can get your insurance to agree...
Starting Radium 223 (Xofigo) next week
Advice for next steps for 82 year old dad
Zytiga did not Work - Chemo or RA 223 Next
what next? Really need your advice. 
