Xtandi stopped working, Jevtana next??

[Cheerr]

The PSMA PET CT Scan lit up a lot

- Avid PSMA activity in skeleton bone.

- Avid tracer in Few soft tissues - lungs, perineum, scrotal [This is new since he never had soft tissue involvement]

Now it explains the horrible pain he has had for the last 2 months.

We have been told Xtandi / Enzalutamide has stopped working, have to move to the next treatment Chemo - Jevtana / Cabazitaxel.

I just want to know if there are other treatments to consider at this point? Or Jevtana is the right next step?

History:

- Diagnosed with widespread bone mets 2 years ago @ age 53

- Underwent chemo (Docetaxel), and later on Xtandi for last 8 months.

[Tall_Allen]

Jevtana+carboplatin is a good next step. However, Lu-177-PSMA-617 is even better. While we wait for FDA approval of Lu-177-PSMA-617, there are several trials of it in the US:

prostatecancer.news/2020/08...

There are also several PSMA-targeted BiTE and CAR-T trials that are listed at the bottom of this article:

prostatecancer.news/2019/12...

Provenge, if he hasn't had it.

Have any recent metastases been biopsied?

[Cheerr in reply to Tall_Allen]

No recent tissue has been biopsied yet. His PSMA numbers on the scan came very high - SUV max 20. Doc says its almost impossible for neuroendocrine to put out that much PSMA. So they're pretty confident its still Adenocarcinoma and are not looking for anything else.

[Tall_Allen in reply to Cheerr]

I agree - I didn't mention neuroendocrine. I was wondering more about "double negative" if his AR expression is low, and possible indications for immunotherapy and PARP inhibitors.

[Cheerr in reply to Tall_Allen]

Thank you. I was not aware of this. I shall ask the doc next time. Is the double negative very common in CRPC?

[Tall_Allen in reply to Cheerr]

Very uncommon.

[Shooter1]

Not working any more for me either.. Just 2 bony mets lit up on CT and NaF18 so starting radiation treatment tomorrow, Actually only set up and tattoos tomorrow, then High intensity radiation to my 2 mets.. Hope to get along a little longer this way. Jevtana/cabazitaxel would be a good choice as long as you don't have neuropathy from earlier treatments...

[Hidden]

Not sure where you live, but LU-177 is offered outside the US if you can afford it and are able to travel to wherever it is offered.

If you're considering LU-177, it's recommended that he get an FDG scan as well as a PSMA scan (sounds like he already had that). It's been proven that patients with low PSMA expression or discordant FDG-avid disease don't get a good response from LU-177.

Of course as mentioned, there is also Jevtana. Has he had a biopsy to look at IHC and for genetic sequencing? That might help to determine if adding a platinum chemo could be helpful and also see if he has any treatable mutations such as ATM,

BRCA1 or BRCA2.

Wishing him the best.

[Cheerr in reply to Hidden]

Hi Gregg,

Thank you.

No recent biopsy done. Hence we are missing info on any possible mutations. Although our doc said that the probability of having any of these mutations where treatments are available is very low? I still agree that its required to know incase dad has any of these.

[Ahk1 in reply to Hidden]

What does “low PSMA expression” mean and how they measure that please?

[Cheerr in reply to Hidden]

Gregg, can you please elabórate on what is FDG discordant

[Cheerr]

Thank you. Will ask our doc regarding the same.

[Hidden]

PSMA stands for Prostate Specific Membrane Antigen. It's expressed in different amounts in prostate cancer cells. Here's an article on the subject.

ncbi.nlm.nih.gov/pmc/articl...