I have stage 4 had chemo docetaxel bicudimate and then xtandi which quit working cancer spreading more and more in bones will be starting more docetaxel for four weeks once every two wks at reduced dose thsn first done 1 1/2 ago and then will get LU-177 added to the mix
24 weeks regimen for about 8 months
Comments please most welcome
Thanks and wish everyone the best
You could omit Docetaxel and start Lu177 right away. Less side effects than Docetaxel and a second Docetaxel therapy is often less effective than the first.
Is there evidence that beginning the journey with LU177 is more effective? I'm in the transition phase and if treating with LU177 first, before ADT or chemo, was effective, I would be all in favor of using up my frequent flyer points to India to do that.
Lu177 PSMA is a new therapy so there is no phase III data regarding overall survival yet. A good alternative to a second Docetaxel chemo would be a chemo with Cabazitaxel / Jevtana which is only approved for a chemo following a chemo with Docetaxel.
Tango65 cited the TheraP trial which showed a much better PSA response for a Lu177 therapy compared with this Cabazitaxel chemo. This were all patients like you, who already had Docetaxel.
Then there is this retrospective study which showed an improved overall survival when patients got the Lu177 therapy before chemo: snmmi.org/NewsPublications/...
On the other hand I am not aware of a study which showed that patients had a worse outcome if they got a Lu177 therapy before chemo.
Please be aware that you will need several cycles of Lu177 which will make it expensive.
Actually I haven’t had chemo or hormone therapy either one yet. I just wondered if there was evidence indicating to jump straight to LU177. One of my cores indicated Intraductal and I had read somewhere that Docetaxel was not good for that
I overlooked that the question was not asked by Livetodayok 
You have a recurrence after a Tulsa-Pro therapy. I cannot image that anyone will offer a Lu177 therapy for this situation. You could get salvage surgery or salvage radiation. Both will cause more side effects after the Tulsa-Pro than they would as a primary therapy. I think Cyberknife radiation would be a good option. After placing fiducials.
Can you explain what you mean about the statement that salvage radiation will cause more side effects than if it had been the primary therapy? The plan seems to be to put in gold seeds for use in focusing the radiation plus six months Lupron and Eligard
The TULSA-PRO therapy has damaged the urethra and the nerves to some extend. The radiation will cause further damage to these. On the other hand there is not much else you can do now.
fortunately the urethra damage during Tulsa Pro was minimal, if any. I'm thinking that one of the things that procedure does is cool the urethra area to prevent damage, though at the same time, that also leaves some cancer. That area being spared is what Dr. Scionti thought might be why i had a 2.1 nadir.
The cancer usually grows near the border of the prostate capsule and not near the urethra. A PSMA PET/CT will tell you where it is. Maybe there are mets causing the current PSA value. I would have recommended a PSMA PET/CT instead of a Choline PET/CT this year.
Tulsa Pro is usually used as a focal therapy for Gleason 6 or 7a. A Gleason 7(4+3) with intraductal and cribriform morphology, I think, should not be treated with Tulsa Pro.
Probably not, though it seemed okay at the time based on the MRI. I was told that one characteristic of intraductal was it stayed within the capsule. But probably clearing out the entire capsule is not always possible. My present RO thought perhaps it was only 80% effective and was slowly coming back and possibly some DHEA I took sublingually fired it up. Right now only, I think, Dr. Busch is doing TP with higher grades. PSMA scans seem commonplace now but a year ago, not as much. Inhad one in September 2020. It was not conclusive. Some low uptake in a iliac common node.
The PSMA PET/CT is more sensitive than a Choline PET/CT. At a PSA level of 6.5 it should detect your lesions. Here is a review comparing the imaging systems:
practicalradonc.org/article...
Usually you read that intraductal PCa is more active spreading than normal PCa. Here is a study which observed more extracapsular extensions with ductal PCa:
pubmed.ncbi.nlm.nih.gov/200...
This one reports poor outcomes with radiation:
pubmed.ncbi.nlm.nih.gov/310...
reader.elsevier.com/reader/...
And here is a collection of studies discussing ductal PCa:
acsjournals.onlinelibrary.w...
europeanurology.com/article...
pubmed.ncbi.nlm.nih.gov/209...
pubmed.ncbi.nlm.nih.gov/274...
ncbi.nlm.nih.gov/pmc/articl...
I also have ductal PCa and therefore a lot of bookmarks about it.
I had 2.4 PSA before the PSMA, which should be plenty, and it had low uptake, 2.8 SUVmax range in an iliac common node. The two Choline-11s showed a couple others with faint uptake, plus a very faint dot on my scapula. I’m hopeful it’s inflammation but I’m not Pollyanna. I’ll hVe my fiducials next week and ADT after that and hope for the best. There is so much unknown about all this but I am giving myself 5 to 10 years and anything after that is gravy. Thanks for the citations. I did note one of the graphs in one of the publicatuons for OS was not terrible but defijitely below the average line of thr most common prostate cancer type. Mucinous then Nonvariant, the vast majority, then Ductal and Signet Ring. With big drops then for Adenosquamous, Sarcomatoid, and Neuroendocrine
A PSA value of 2.3 is usually sufficient but I would not say plenty. It will not show mets in about 20% of the cases. Here is an image from a study at UCLA:
jamanetwork.com/journals/ja...
A choline pet has a lower sensitivity.
I’ll probably fork over the dough to get another soon. Thats one thing about Chokine-11-BCBS FEP works hand in hand with Mayo and pays most everything. I think they charged $14,000 for each of those Cholines. Yet if I asked them to pay for PSMA I’m about certain they would say no.
Thanks for the reply
I got my first round of chemo alone yesterday and they give two smaller ivs couple weeks apart and is called 1 of 7 total treatments and after second iv I get the LU-177 medicine hope it kicks the tar out of this cancer
I will say after 14 hours of first taxotere treatment my resting discomforts appear gone and after up for 2 hours already feel much better than past month
Thanks for your support
Yes thats what i kind of thought but i am hoping these guys looked into all that. When i asked about it was told that part was already proved out by the trial ill be inThanks for you advice
Lu 177 PSMA treatment could be less effective after chemo. You could consider to do Lu 177 PSMA treatment which has been found to be more effective than chemo with Jevtana
healthunlocked.com/advanced....
After treatment with Lu 177 PSMA you could try again any of the new anti androgens and see if they work.
If you do not know the genome of the cancer consider a direct biopsy if possible or a liquid biopsy. The cancer could be susceptible to treatment with keytruda or similar or PARP inhibitors like olaparib or rucaparib.
I dont know much about that area one doctor i spoke to recently told about the Parp inhibs i will drill down on it
Thank you
Best of luck.
It sounds like a great plan to me.Let us know how it goes.
Docataxal failed Has any other form of chemo been discussed ?
I myself had a very good response to Docataxal
Maybe the reduced dosage will be effective
Praying for a good response for you
The docetaxel worked great killed off tons of cancer judging how i felt
Whst happened was the cancer outsmarted the bicalcudimate and then when i went to xtandi it started losing butt kicker ability after 7 months so my cancer has been ramping up but what kicked it into high gear was i had severe ulcer colitis for 3 months nothing much being absorbed of my cancer meds way i saw it and doc kept me off xtandi for a month after collitis turned around by some exotic infussions i now get
Am feeling pretty good overall
Thanks for help
Hi my friend
If all else fail, read the Chinese handbook. And it is no joke. Artemether is a first line treatment in China. I strongly recommend the malaria tablet Coartem. It is a known cancer fighter, very successful in clearing up metastatise cancer in the bone structure.
Coartem is a combination of artemether and lumefantrine.
Read up: Artemether cures cancer. You welcome to contact me.
Kind Regards
Thinus Coetzee
I will look into
It my friend thanks
I had my first round of new go around with doxetaxel today i slwsys tell my friends the first dsy of treament is s freebe and see what next 4 or 5 days bring
Hope a million dead cancer cells just for the warmup
Thank you
If you've got time on hand, you can read up on how capsaicin enchance the success of doxetaxel. I drink 4000 mg of cayenne pepper in capsule form with a heavty shot of tomato puree every day. God bless and good luck
Thinus thanks
Where do you buy this stuff?
At a health buff store or drugstore?
You can buy it at a health shop or big pharmacies. Here in SA I buy it 'bulk'. Big bottle with 360 capsules. 500 mg. I drink 4 capsules in the morning and 4 in the evening with about 3 big spoons of tomato paste.
You can google: capsaicin and docetaxel. And quite a lot of info will pop up.
I did try to drink cayenne pepper a little bit mix with water. But it is too volatile for me, lost some good meals by vomiting. Start with the capsules. Your stomach will get used to it. There is a massive amount of info of the capsaicin/lycopene effect on PCA
Anyone have a good order or sequence of medicine choices as stage 4 prostate cancer in spine and ribs and pelvic area when prostate gland kept intact?So far for me started with radiation to right pelvic area first later foubd out that was not s good move and after that complete went on bicalcudimate and couple weeks later added Lupron to the mix and then came 7 rounds of doxetaxel chemo keeping Lupron and Bicalcudimate and after it didnt work so well anymore after one year switched to xtandi which lasted maybe 7 months now transitioning over to a trial with lower dose of docetaxel for 4 weeks and will add Lu-177 to the mix with the Docetaxel and get both every 2 weeks once all up and running and do for 8 months
Ideas? Thoughts? Anyone
And what is likey course of action which will follow?
Ideas most welcome thanks
I recommend cycles of Lu177 first (4+). Not published that I am aware of, but anecdotal evidence is for better reponse in earlier cases, as it was with me (see my profile). Pity about the $.
Two publications that urge you to start drinking cayenne pepper and lycopene
German clinics and Lu-177
Xtandi and LU-177
Lu-177 and cremation
Lu-177 and chemo naive patient (me)
Lu-177 and PSA Flare
