My Dad is 74. He was diagnosed with a huge PSA number. It was in his pelvic lymph nodes, but not his bones. He did Taxatore and his PSA went to .1 for a couple of years just on ADT shot. Excellent Taxatore result for anyone considering that course of action.
The last check his PSA was just up a tiny bit, .2.
He has his next check in a week and is worried that it has spread.
What is the next best treatment after Taxatore?
Dr Nordquist mentioned radio pharmaceuticals, but is that really best?
What about more Taxatore? Or perhaps new drugs? I am not overly wild about Zytiga. Seems to have bad side effects and it doesn’t last long. How about Immunotherapy?
Has anyone had great results doing something after Taxatore? If so what?
Thanks!
Karyn
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Kcski
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It sounds like your dad had a good response on ADT so in all likelyhood, second-line ADT drugs such as Xtandi or Ztyiga would also work well and could work for years.
I've gotten 3 years so far out of Zytiga and still have an undetectable PSA. Out of the 2 drugs, Zytiga has less side effects for most. ADT itself has the majority of the side effects for me. I haven't really noticed any worse side effects with Zytiga.
IMO, those are his best treatment options, but of course he should dicusss this with his doctor.
You can do Provenge while you're waiting to get into the trial or do it afterwards. It combined well with Xofigo so it probably will combine well with Cu64PSMA.
Thank you so much Tall_Allen!!! This is exactly what I was looking for and is especially meaningful considering your intellect, understanding, and wisdom. I feel you have added years to my dad’s life. You have also put my mind at ease, as well as my dad’s and mom’s minds. The idea of doing Provenge while waiting or after, is also so smart. This information means so much to me and my family and I thank you from the bottom of my heart for your kindness and helping so many people on this site! You are my honorary Medical Oncologist (perhaps better than one). “Dr.” Tall_Allen, you have made my day. It is hard to understand/decide the next best course of action against PC. It seems apparent to me that the order is extremely important with regards to overall longevity. Thank you again and again and again for your beyond helpful information. You are wonderful! Sincerely, Karyn
Thanks for the heads up! He has not had second line ADT (Eurleda,Xandi) or Zytiga.
From what I just read, it sounds like 64 CU PSMA beats LU PSMA 617. It was showing quicker cancer location/kill time (I think).
Obviously I have no medical degree and am not well enough read on PC, but from what I gather Taxatore seems to work really well, but is not fun towards the last couple of doses. The radio pharmaceuticals seem to be very promising and next in line for effectiveness. Jevtana seems to offer another good result in the way of chemo
but not fun towards the last doses. Then the second line ADT, Eurleda, Xandi, Zytiga etc, seems to be least effective. I don’t like that Zytiga can cause higher blood pressure and heart events.
Thank you again for your thoughtful, smart responses.
You got me thinking and looking everything up on Wikipedia.
In a nut shell, the chemos (Taxotere, tree bark and Jevtana, tree needles) posion the cancer. The radioactives (Lutetium and Copper) target the cancer inside the body and destroy it by heat. The second line ADTs block androgens, produced by male hormones, and deprive the cancer of food.
Correct me if I am wrong, but the chemos are given via IV. The radioactives are shots. The second line ADTs are pills.
I need to research Provenge more, but it sounds like a good vaccine to teach your body to attack the cancer cells hiding that your body does not recognize.
How important do you feel Provenge is? To me if feels like an important thing to have, although taking out cells and infusing them with the vaccine sounds a bit invasive/risk of germs/infection.
I think the hormonals are equally as good as chemo. They may work for a couple of years, after which he can get on the trial, or who knows what other trial they will have then.
There are some who believe Provenge doesn't work because it doesn't lower PSA. I think it works especially well when combined with something like chemo or radiation that increases antigen presentation. Just my opinion.
Taxotere and Jevtana are given via infusion. So is Provenge, after dendritic cells are extracted in process called leukapheresis. The hormonals are all pills. The radiopharmaceuticals destroy cancer cells with radiation, not heat. The radiation degrades the cancer DNA.
All medicines have the risk of side effects. If you're lucky, you'll have fewer side effects.
My onco is on some committee that analyzes current practice and says that oncologists have pretty much stopped using Provenge, that it is now used mainly by urologists. He himself, who used it a lot several years ago, has not used it for a couple of years. I am not clear why not, he did say one of his patients emerged from the treatment "loopy" and the results in general were unclear to him. For myself, for now I am persuaded by your reasoning and, as always, grateful for your dedication.
I assure you that oncologists have not stopped using Provenge. I know several guys, treated by top oncologists, who have used it. It does take faith, however. Faith that the RCT was right, because there are no biomarkers to judge its effectiveness in an individual. He "just" lives longer. I do believe that it works best in combination with therapies that increase antigen presentation (radiation, chemo).
Tall-Allen, thanks again for your response. I enjoy learning from you.
You are right about the CU64PSMA being biased because it is an advertisement. Thanks for pointing that out.
I really appreciate your Provenge comments. I totally agree with you about it making PC patients live longer. The vaccine concept makes a lot of sense to me. Teach your body to identify an “elusive bad guy” and go after him. I have read Todd Seals’ story, which is packed with true life tips. He had to fight to get Provenge and attributes it to be a major factor to his 20+ life span after diagnosis.
It is interesting to hear you say second line hormonals are equally as good as chemo. That makes me think about them in a more important way. I feel that chemo first,
before second line hormonals, was major in giving my Dad an advantage, though. Maybe it was because his strength was/is up at the beginning of his fight or who knows, but the taxotere had a big cancer kill for him. From what I read, it seems the second line hormonals don’t last that long.
I have been researching radio pharmaceuticals, trying to understand what happens better. I think basically Cu or Lu is put via IV into the body. The substances somehow locate the cancer area. Then since they have an unbalanced amount of protons or electrons (radioactivity) the atoms throw off (shed) electrons or protons (trying to get to a balanced stable number) which is energy that penetrates cancer cells and knocks their electrons off orbit, rendering the cancer cells useless. Am I right?
At first all these treatments seem so mysterious and complicated. Once simplified and broken down you realize they are real life substances (tree, rock, metal) that kill cancer. Even the hormonals are chemistry at work. It makes it easier to manage and think about PC, thinking about it this way (imho).
Anyway thanks again and again Tall_Allen. You are a wise person that can see through the noise and propaganda and find the truth.
Something like that. Lu177 emits "beta" particles, which are high energy electrons. Cu64, Th227, and Ac225 emit "alpha" particles, which are 2 protons and 2 neutrons all bound together (the nucleus of a helium atom), Those particles destroy the DNA of the cancer in the cells they attach to and some nearby cells, so the cancer can't replicate. They are attached to a PSMA "ligand," which is a molecule that chemically bonds to the PSMA protein on the surface of prostate cancer cells only.
The standard of care will be the new anti androgens zytiga (abiraterone), enzalutamide (Xtandi) and apalutamide (Erleada). Possibilities outside the standard of care could be Lu 177 PSMA treatment. He will need to have a PSMA PET/CT scan when the PSA is around 0.4 and see if there metastases expressing PSMA. There are clinical trials for these studies :
If his PSA continue to go up meanwhile he is on ADT, he could qualify for Provenge which is a vaccine approved by the FDA and paid by insurances including Medicare. This vaccine has shown a survival advantage and it seems it may be more effective if used early.
I will get the Lu 177 PSMA treatment. I already did in 2016 when I was diagnosed with recurrent PC extended to nodes in the pelvis and abdomen. I needed only one treatment. The treatment was very well tolerated.
If there is not a clinical trial in the USA, it could be done in Europe (is financial possible) , mainly Germany or in India. I went to the Technical University in Munich.
I got good initial results from Lupron and Taxotere, but it didn't last long. My second layer of ADT is abiraterone (+prednisone) and my second chemo was Jevtana (cabazitaxel), with *really* good results -- no new mets, reduction of existing mets, and PSA has been 0.05 and below for six months now.
I had worse side effects from Jevtana than Taxotere. I'm told that is unusual. In both cases it took about six weeks after the last session to feel like I was back to normal. Not fun, but worth it.
I am not finding the effects of zytiga to be any different or worse than lupron. Occasional hot flashes, some fatigue and occasional mild brain fog. Ive been on zytiga for 3 months now.
Everyone is different! Some get a great and long result from Zytiga. Some don’t at all. I would almost assert the potential side effects from Lupron are much greater than Zytiga. Gotta try different things, follow the lead of your good MO.
Well, you do say that the PSA remained at .1ng for a few years but fail to really say the duration while at .1ng and to the new reading of .2ng.
PSA Doubling time should hold a significant assistance in determining if and what to do and if course when... And you're still currently below any threshold that would allow any of the sensitive scans to even see what's causing the PSA. But as noted, there is options available.
It is definitely good to be prepared, but maybe not so much to worry about the need to do something that may be down the road a bit.
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