Docetaxel 12 infusions now psa up

[Judymin]

Started at 35 dropped to 5 however 2 months later up to 10!!! Scans stable. Oncologist wants him to do more chemo in 3 months. My husband wants to do now!!! What is next? So afraid. This is 9 and half years of hell with no remission. The only good news is he still feels good. Thanks

[Tall_Allen]

12 infusions is very hard on the body (in spite of how he feels). Let his body recover for a bit before he does more. Now may be a good time to try Xtandi - it sometimes works longer than expected after chemo. Also consider one of these Lu-177-PSMA trials:

prostatecancer.news/2020/08...

[Judymin in reply to Tall_Allen]

He tried xtandi with keytruda in trial. Did not work. Did have genetic test no braca but did have atm

[Tall_Allen in reply to Judymin]

Did he have histology and IHC done (especially AR, PSMA, NSE, synaptophysin, MSH2) on a recent metastasis? That may be more informative than genomics.

[Hidden in reply to Judymin]

With an ATM mutation, he may benefit from a PARP inhibitor.

[Hidden]

Another option would be to switch to second-line Cabazitaxel chemotherapy if Docetaxel becomes ineffective. I agree with Tall Allen about taking a break though, especially if the scans show stability in disease progression.

Has he had a biopsy to do genetic sequencing? He might have a somatic mutation that's treatable such as BRCA1, BRCA2 or ATM. They can also look to see if he has developed any neuroendocrine differentiation. In that case he might benefit from adding a platinum-based chemotherapy if he continues with chemotherapy.

[tango65]

Explore the possibility to get him into a Lu 177 PSMA treatment trial. This treatment has few side effects, unless there is bone marrow infiltration.

This link has info about the clinical trials of Lu 177 PSMA in the US:

clinicaltrials.gov/ct2/resu...

You could also consider to go abroad (Europe, India , Australia) to get Lu 177 PSMA treatment , if financially possible. It is difficult to travel with the pandemic but it is not impossible.

The Lu 177 PSMA could help to control the cancer for a while and give him time to recover from the chemo. Request having Provenge, the only approved vaccine for PC which offers a survival benefit.