What is best along with Xtandi?

[davebliz]

I've become mCRPC with many small tumors on spine identified via PSMA scan. I've been on Zoladex for 2 years after radiation. Meet with MO on Tuesday and expect him to suggest Xtandi. Any thoughts on what might a good add on to be more aggressive with treatment? Thanks.

[GP24]

I would discuss Xofigo with a specialist in nuclear medicine. If you have many bone mets this could work well.

[davebliz in reply to GP24]

Thanks.

[tango65]

You need to continue ADT. You could discuss Provenge at this time

You have other options beside Xtandi, including chemo with docetaxel, zytyga, or apalutamide.

If there are metastases which could be biopsied you should dicuss studying the genome of the metastases and see if there ae mutations which could make the cancer susceptible to olaparib, Rucaparib or Keytruda,

You could also discus about bone agents such as zoledronic acid or denosumab (Xgeva). Xofigo is indicated in mCRPC with bone metastases which are symptomatic. Xofigo could be done intercalated with Provenge.

[davebliz in reply to tango65]

Thanks, I plan on getting testing for mutations.

[tango65 in reply to davebliz]

Best of luck.

[davebliz]

I should add, my PSA is 7, having doubled each of the last 3 months, and I don’t have any pain.

[Tall_Allen]

You would probably be better off doing chemo first. That way, in 15 weeks, you can move onto Zytiga. You can do Xofigo+Provenge, but that takes 6 months. There is a clinical trial combining Xofigo and Xtandi and Zometa or Xgeva, but I wouldn't combine them outside of a clinical trial.

[davebliz in reply to Tall_Allen]

TA, thanks for the reply. Why do you suggest chemo before Zytiga? Why not use Zytiga or another hormone blocker before chemo? And only do chemo after Zytiga stops working. Thanks.

[Tall_Allen in reply to davebliz]

For the reason I just gave - if you start with chemo, you can move onto Zytiga in as little as 15 weeks. If you start with Zytiga, it can be several years before you can add chemo. In general, the sooner you use any cancer medicine, the more effective it is and the longer it lasts. Also, side effects are much less if used earlier.

[RyderLake2]

Hello,

If you have many small tumours on the spine, you might want to add a maintenance dose of Prolia (denosumab). It won't help with the cancer but it will strengthen your bones, thereby reducing the chance of a Skeletal Related Event (SRE). My oncologist feels it is easier to take than Zometa (zoledronic acid). Prolia entails a simple subcutaneous skin injection compared to Zometa's intravenous infusion. Zometa also requires that kidney function be monitored regularly. Patients receiving Prolia (aka Xgeva) do not necessarily have to closely monitor kidney function. I have been on Zoladex for over six years), Firmagon (degarelix) for one year, Xtandi (enzalutamide) for over three years and Prolia for over seven. Are their side effects? You bet, including fatigue and some brain fog. Fortunately, for me nothing serious and nothing I can't handle. Hope that helps!

[davebliz in reply to RyderLake2]

Thanks, I expect to start Xgeva for bones.

[George71]

What did the doctor say about Lu-177 and try and wipe out the mets?

[davebliz in reply to George71]

I talk with the MO on Tuesday, I wanted to get thoughts from this knowledgeable group to help with my questions.

[immunity1]

Seeing the lesions are PSMA-avid I would initally go with Lu177 if available and you can afford it. Followed by chemo, then AR blockers (enzalutamide etc).; Stay on Zoladex.

[HopingForTheBest1]

Where did you get the PSMA scan? Possible further treatment with PSMA, like lutetium 177?

[davebliz in reply to HopingForTheBest1]

I'm in Canada, got the PSMA scan as part of a clinical trial in Vancouver. I'm not sure if Lu-177 is available in Canada?

[j-o-h-n]

Add a great knowledgeable person like Tall_Allen to accompany you.....

Good Luck, Good Health and Good Humor.

j-o-h-n Sunday 09/27/2020 6:43 PM DST

[Thinus]

I still recommend the artemether/lumefantrine combination. Read up on the success of Lumefantrine as complimentary to chemo when treating brain cancer.

As in writing , my PSA is 0.09. I don't have prostate cancer. I've got tubular prostate cancer. It starts in the tube running through the prostate gland. Fast, aggressive, 60 % of the life expectancy of normal prostate cancer. I am in year 5 with clean MRI scans.

Get a pharmacist to give you Coartem. There are other brands.

Kind Regards Thinus Coetzee

[davebliz in reply to Thinus]

I'm not familiar with those drugs, will have to read up on them. Do you have any articles showing clinical trial results?

[Thinus]

Hallo Davebliz

There are a lot of information on artemether, a little bit less on lumefantrine.

The University of Washington and also the University of Maryland have done extensive research on artemether. You can simply Google artemether cures cancer and start reading.

An article that gives you a lot of insight how to block cancer is a USA patent paper on Lumefantrine. Simply put in the search bar: Lumefantrine US Patent. The article is written high tech with all the lab stuff on one side. Fight through it, after the tenth reading you will understand that lumefantrine inhibits autophagy. It is imperative that successful cancer treatment has this as a goal.

I don't know whether I am allowed to give my email, but here it is: [e-mail].

To close I want to echo the words of Dr Neandra Singh of the University of Washington: In time to come, artemether will be proven to be the best cancer killer ever. A bold statement, and I think not totally all said. Experience have shown the combination of artemether/lumefantrine helps cancer treatment like chemo and ADT to be just more successful. Good luck, God bless and you can email if you want to.

Kind Regards Thinus Coetzee