I got the news today I didn't wanna hear.

[Costarica1961]

A 3mos break, after a very successful chemo treatment, carboplatin and cabataxal, PSA went down to 6.7 from 247, the recent bone scan indicated one small spot on 9th rib. Today the PSA bounced up to 76, My oncologist says there is very little we can do, I asked if the previous chemo would be a option, she indicated it could be toxic and life threatening, considering I had 12 rounds just 3 short months ago, I then asked LU177 and she downplayed its efficacy, she then mentioned some immuotherapys and possible clinical trials, I left a bit defeated and less than hopeful. I have great deal of bone related Mets although no organ or lymph involvement, i am relatively healthy otherwise, I am still active and still working part time. My question is, are there other options or do I need to go out of country for Lu 177. She did say we would do the chemo again sooner than later if necessary but with much risk. I just received my PSA, My onc may not even be aware yet, of the 70 point swing up. I need this forums wealth of knowledge and insight, thankyou in advance.

[Tall_Allen]

Here are the US trials:

prostatecancer.news/2020/08...

[Costarica1961 in reply to Tall_Allen]

Thankyou, based on the limited knowledge of my profile, I have Mets with a 76 psa ,which trial would be most beneficial. My labs are good.

[Costarica1961 in reply to Costarica1961]

T_A Which couple studies do you think are most advanced and effective for someone in my situation. I have looked at all of them but its somewhat confusing.

[Chugach]

Hey brother I feel your frustration. Regarding immunotherapy options- have you had your cancer tested for the genetic markers to see if you might have the correct markers that make that an option? I discovered on the second time I tested that I had a marker. I used the Foundation One - ‘Liquid Biopsy’ (vial of blood). My doc didn’t think it was an option but decided to test again since the science had changed since the first evaluation. Stay strong!!

[Costarica1961 in reply to Chugach]

Yes I have the braca2 gene I may do another one, although the first was on my spine L3 and it was horrifically painful. The pain blocker didn't block. Thanks I am speaking to a different doc soon. I need a plan and hope if ones available.

[Chugach in reply to Costarica1961]

Hammer those mets with high dose radiation! Stay strong brother- Pura Vida!!

[kaptank in reply to Costarica1961]

checkpoint inhibitors such as olaparib are one option for those with BRCA2

[Hidden]

I have great deal of bone related Mets although no organ or lymph involvement

In that case you would be a candidate for Radium 223 (Xofigo). I'm curious why your doctor doesn't think LU-177 would be a good treatment option unless you've had a PSMA scan that shows you are not PSMA avid. It's something you could look into.

[Costarica1961 in reply to Hidden]

No I have not shown to be psma avid or not as of yet, its difficult for her to articulate why it seems, thats why I am speaking to Dr Beers at OHSU sooner than scheduled, I don't need a doc not exhausting every available viable option. She is leaving in December anyways to go do research. She also said radium 223 was a last resort, although I have contrary opinions about that from other docs, I don't know it gets confusing and concerning at this stage.

[Hidden in reply to Costarica1961]

Not sure when you had a PSMA scan to determine how PSMA avid you are, but you tend to become more PSMA avid after castrate resistance so things might have changed.

I think my doctor generally feels the same way as yours about Radium 223. He thinks that LU-177 will make Radium 223 obsolete. I do still think there will be a place for it, but probably confined more to the end of available treatments and pain relief.

You said you have BRCA2. Have you tried a PARP inhibitor?

[Costarica1961 in reply to Hidden]

I have not determined psma avid because I have not been tested as of yet

[Concerned-wife in reply to Costarica1961]

There have been discussions on UroToday by expert physicians about souping Radium 223 earlier urotoday.com/video-lectures...

[Nickhmcg]

My father has widespread mets also, minimal lymph node (no soft tissue) & did 9 rounds of doxetal which brought his psa down from 86 to 10 but it started climbing soon after 😞. His oncologist started him on the Peace 111 Trial, Xtandi & Xofigo (radium 223) with monthly zometa infusions. He is tolerating them well so far, he has had 2 lots of Xofigo, 4 left to go. We are staying positive & hopeful. He has CT & bone scans in the next couple of days to check progress of the trial treatments. He has had spot radiation to both hips and shoulder which helped tremendously with pain.

[Costarica1961]

I have had multiple spot radiations has helped as well. I have tried docetaxal it did not work at all. Then went 12 rounds of carboplatin and cabataxal it had a similar sucess as your father. Good luck on test results

[HopefulSis]

Have you tried to get on a PARP inhibitor? Rucaparib?

[Costarica1961 in reply to HopefulSis]

I asked my doctor 6 months ago and he believed I would not be a good candidate for that treatment. I will revisit that on our next appt thankyou