77 Year old father inical PSA 3270 advance prostate cancer , After Radical prostatectomy, Chemotherapy with Docetaxel and Xtandi PSA 1200

[Damirm]

Hello I would like to share new results of my father after one year using Xtandi PSA start to rise very quickly now PSA is 1200ng/ml and father for first time have strong pain in right leg and arm . We check Alkaline phosphatase 390 U/L, Tomorrow my father is going to Medical hospital to see with oncologist some new therapy maybe Zytiga we will see. Also he should do MRI of spine . My father now have to take tramadol 50mg for pain, but pain especially stronger during night. If You have any suggestion regarding next therapy please send msg I was thinking that radiation on spot where is cancer pressing nerves cause strong pain but we will see after MRI .

Thanks in advance !!!

[tango65]

When a new anti androgen fails, it seems it is better to start chemo with jevtana than trying another new anti androgen since the mechanisms of resistant are similar for the different new anti androgens. Chemo may re sensitize the cancer to the anti androgens.

He qualifies for provenge a vaccine which has shown a survival advantage,

You could discuss to get a direct biopsy or a liquid biopsy to study the genome of the cancer and see if there are mutations making the cancer susceptible to drugs such olaparib, rucaparib, keytruda, ipatasertib etc. If they obtain cancer cells they could do IHC studies to determine if there is an indication of possible small cell or neuroendocrine cancer which could respond to chemo with cisplatin,

You could also discuss treatment with Lu 177 PSMA which has shown a survival advantage and even better results than jevtana in patients with multiple previous treatments. There are clinical trials in the USA for Lu 177 PSM, but it can be done also in Europe and in India, if financially possible.

He should consult about starting bone agents such as zoledronic acid or denosumab to try to reduce the incidence of bone events,

[Tall_Allen]

Xofigo