Posted this on regular site was told I should post here...
Diagnosed 2008, RP same year, followed by salvage radiation in 2012, then Chemo (docetaxel) in 2016, then Lupron (for life), then bicalutamide(Casodex). In April, last year, switched out Casodex to Xtandi as psa rates were rising. Current psa Jan/21 7.24 with a doubling rate of 7.1 months. Last March PET scan shows some mets in bones small growth from previous scan. No mets in soft tissue. No bone pain.
New PET scan followed by MO appointment next week. MO to talk about next steps due to Xtandi's apparent inability to impact psa levels. Want to be prepared for meeting.
Seems only options are: switch to Zytiga, LU-177, XOFIGO.
Any recommendations out there?
Thanks!
Written by
GDeG
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Thanks for clarifying. Your profile is still not showing, but you've provided enough detail here, so that's fine. So, as I understand it, you are bone metastatic, castration-resistant, had chemo while hormone-sensitive, had Xtandi (now failing) while castration resistant,
(1) A recent trial in Australia, showed that Lu-177-PSMA-617 is a preferred next therapy to Jevtana:
If you're in the US, there is a trial starting next month for men in your situation, or you seem to meet the criteria for the trial at UCSF that includes Keytruda:
Alternatively, you can get that treatment in Germany, India or Australia.
(2) If any of your bone metastases are large enough and in convenient places, there may be a benefit in having it biopsied (preferably, your most recent appearing metastasis). A combination of histology, IHC, and genomics may provide actionable info. This is a good topic for discussion with your MO, who can explain all this.
(3) Jevtana ± carboplatin, and Provenge may be a good combination for you. Try Zytiga after chemo (not before). Xofigo is only indicated when there is bone pain.
Met with my MO two weeks ago and discussed go-forward options. The results of my most recent scan found no soft tissue invasion. Bone mets remain, all with sclerosis. I continue to have no bone pain.
He though the Lu-177 treatment would cause me to be more tired than I am already. Because of my last Hemoglobin determination (HGB) is 11.8 g/dL and was in the high 10's for awhile, and the several month refresh rate rate on bone marrow damage caused by the Lu-177 therapy he thought maybe not the best approach right now.
Due to sclerosis, sampling of bone mets was not advised since sclerosis would be picked up in the sample rendering the results inconclusive. He agreed such biopsies should be done on new mets unencumbered by sclerosis..
We discussed Provenge. His view is that the process may or may not have a positive impact on life expectancy but that it was difficult to determine what that impact might be.
Jevtana ± carboplatin - apparently did not discus.
Xofigo doesn't apply at this point due to lack of bone pain as you pointed out.
It seems a PSMA scan is a pathway to other options I wonder if I should travel to get such a test.
I had the Myriad genetic test using blood samples. The results came back negative. Although Variants of Unknown Significance included:
CDH1 c.1568A>G (p.Tyr523Cys) and
MSH1 c.2254-19T>G
Not sure how to interpret that.
I meet again with my MO in two weeks and he can walk me through that but I'm sure we were looking for a positive result from this test.
My MO is a Johns Hopkins guy but I'm wondering if I should have a Prostate Cancer MD on the team, as well. I started my journey with Peter Carroll at UCSF. I'm in Eugene Oregon and wondering if a trip someplace would be useful.
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