What's next?

[Curehunter]

It's been quite a journey since my DX in Feb 2020. ADT just worked for 3 months before becoming CR. Zytiga did not work for me at all. Found to be BRAC2 so on Parp Inhibitor since late November (Triton3 trial). Last PSA reading was 0.38 (rise from 0.23 previous month). I know it's the trend that's important rather than a one off increase.

I'm looking to get a full molecular analysis done. What markers should they be looking for (other than the usual MSI, PD-1, PD-L1). If no other actionable mutations then what treatment (or clinical trials) should I consider next (chemo, Lu-177)?

Many thanks for any suggestions.

Best wishes.

[lewicki]

Can you find a LU-177 trial? In the US they are doing direct in California without a trial. Travel?

[Curehunter in reply to lewicki]

Thanks. Will first look for trials here in the UK, but am open to travelling if required.

[Tall_Allen in reply to lewicki]

No they are not.

[Curehunter]

Thanks. I know my consultant will propose chemo.

[Rahul_Patel]

How many cycles you completed?

[Tall_Allen]

It may be more useful to have cell histology and IHC than genomics. The genomics are pretty standard. Those companies look for mutations, expression or loss of specific genes known to be associated with PC.

When PARP inhibitors work, the combination of a taxane + a platin also works.

You should also look at the various Xofigo combination trials:

prostatecancer.news/2021/02...

[Curehunter in reply to Tall_Allen]

Thank you, I'll discuss these at my next appointment.

[ellie2211 in reply to Tall_Allen]

Could xofigo be used by someone with osteoporosis? ( With xgeva) this is a treatment we are considering at the moment but are afraid of bone marrow/bone issues.... The option is xofigo or jevtana

[Tall_Allen in reply to ellie2211]

Yes, with Xgeva. In the link above there is a trial where Xofigo was combined with docetaxel at a reduced dose.

[MateoBeach]

I would want to start bone strengthening/ protecting right away with Xgeva (or Zometa). And ask for Provenge immunotherapy now. Get it on your side as earlier is better. Xofigo to treat the bone Mets also without delay as it also works better before smaller Mets grow. And you should discuss combining chemo with the Xofigo per T_A’s article. The lower dose docetaxel (60mg/M^2) and possibly with carboplatin look good. If they won’t agree to give it simultaneously per trial protocols, then in sequence after the Xofigo series is done. Or vice-versa.

Not the time to hold back, Hunter. Aim and fire. Talk these options through with the best oncologists available to you. Paul