I was diagnosed with stage 4 PCa October 2020. My PSA was nearly 1100, and had Gleason of 8. I was immediately put on Eligard in October (every 6 months), PSA dropped immediately to 21, beginning of November. Urologist does eligard injections. Also had bone scan with bone mets and some in lymph nodes.
My MO (Dr. Bo) is in Springfield, Ohio, and I also had a referral PC doc from Ohio State U (Pariykh), they both told me chemo (taxotere) was a good route to go. I underwent these treatments starting in November, 6 every 3 weeks. PSA dropped to 8.3 at end of treatment in February 2021. I had my second Eligard shot in April, PSA was at 7.3. Month later I had my 6 month check-up with MO; PSA rose to 13 (Free PSA was 6; am not sure what good Free PSA is). Planned another check in 6 weeks, early July. In late June began having lots of pain in right hip. MO called for a bone scan with PSA. Just got results. PSA rose to 31 (Free PSA was 13). Bone scan showed regression of prostate growth, lymph nodes and many bone mets; however, definite developing activity in right and left hip regions. Dr. Bo says I am M1 CRPC (I am not really sure if this is really the case), and he suggested either Abiraterone, Enzalutamide, or Radium-233. Will also see Ohio State Dr. Min Yin July 21 to see what he thinks.
Any thoughts? Thanks
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RunThru
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You may be able to combine Radium-223 with enzalutamide. There is a clinical trial running now of the combination, with Zometa or Xgeva to maintain bone integrity. Hopefully, your insurance will approve them:
You can also try chemo again, this time with Jevtana (± carboplatin) or try for one of the clinical trials of Lu-177-PSMA-617. Provenge may work best as part of a combination too.
Interesting. Poster is similar to me. (Mine is Lupron, chemo, Zometa, Celebrex) I had nadir of PSA 8-9 for about a year (after PSA at DX 1600, widespread bone and lymph mets) and it just jumped to 40 after 3 month check this past week. Poster wonders if he is truly CResistant and as so often occurs it appears his MO doesn’t check T level. I will be in same situation.
I Just finished scans yesterday to check for progression and to have a baseline for new TX that will start in light of my jump to 40 PSA.
Mondays upcoming appt. with my MO starting Zytiga has been mentioned as a possibility although he in the past named off the list of possibilities that I might go on when CR appears— (Zytiga, enzalutamide, Apalutamide, Ra-223).
Unlike the poster I am not experiencing bone pain to the extent he is although I have developed a bit of a “hitch “in one hip and mild pain in upper femurs with certain motions but no pain at all when not moving. That is water under the bridge for now as my scans yesterday when compared to scans I had in April should shed light on that and R/O met progression vs. arthritic type degeneration.
Zytiga during or at least immediately after chemo would have been ideal but that didn’t happen.
Your reply to the poster seems to avoid the sequencing approach although he has bone pain and so rather than Zytiga first Enzalutamide when Zytiga fails just hit it hard with RA-223 and Enzalutamide may be recommended as he is experiencing bone met pain?
Regardless I think what I am seeing is even after initial TX with a combo approach (I.E. Zytiga + Chemo) these days that even in subsequent TX down the road combining when possible is best vs. one off TX until failure then onto the next one-off TX?
And of course, cases of combo being critical as cells may need to be re-sensitized by a treatment in order to respond to another being administered.
My ramblings remind me of this classic character from the old show “In Living Color “
Quote “a mind is a terrible thing to develop without help “.
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