What Next?

[taylor123]

So after starting Enzalutamide six months ago we now need to move onto to the next treatment due to it having failed.

Considering his oncologist told us Enzalutamide would only work for a month at best and if at all, we have to be happy with that.

Maybe the self administered BAT was the reason there.

Current PSA is 207 up from 168 with some progression on bone scans. Thankfully still no pain and Dad is still active and working, still running his own business at 81 years of age.

What are peoples thoughts on what to do next?



There seems to be some evidence that radioligand treatment is more effective before chemotherapy. 



And does anybody have any updated info on whether AC223 is indeed superior to Lu177? Or maybe even a mix?



If we do chemo, it would be low dose and likely with cabergoline added, to help mitigate the role of prolactin in hormone resistant prostate cancers. 



There may be some cachexia. Has anybody used Hydrazine Sulfate for cachexia by the way ?



We’re arranging a PSMA scan, so that it is ready whatever the decision, but if anybody has any comments, insights that would be great.



Please refrain from any doom mongering, sympathy and well wishes etc, I appreciate it, but I am after a pragmatic discussion only here.

Many thanks guys,

[Tall_Allen]

BAT may increase the useful life of enzalutamide, but unfortunately it does not extend survival, as you are learning.

"There seems to be some evidence that radioligand treatment is more effective before chemotherapy. 

" No, there is no such evidence. But IMO, they are probably more effective if used earlier rather than later, as most medicines are.

Lu177 is a longer-range but weaker beta-emitter. Ac225 is a shorter range, but stronger alpha emitter. Some trials mix them. There has never been a comparative trial. Ac225PSMA may have more serious, longer-lasting side effects.

[tango65]

Lu 177 PSMA could be a good choice. It has shown to prolong life and does not have major side effects unless there is extensive bone marrow infiltration by the cancer. It is also a systemic treatment attacking mets in lymph nodes, bone and viscera.

Ac 225 seems to be indicated when there is extensive bone marrow infiltration since it may destroy less normal bone marrow cells. It has the problem of affecting the salivary glands causing loss of saliva which may be permanent with a significant effect on quality of life.

[j-o-h-n]

I am refraining from any doom mongering, sympathy and well wishes etc.

j-o-h-n Saturday 11/13/2021 1:31 PM EST

[anonymousdady]

Please have a discussion with Dr. Ishita B Sen to clarify your doubts and further treatment options. She is happy to consult and offer advise for free. These are contact details and a link to her profile.

Name: Dr. Ishita B Sen MBBS, DRM,DNB (Nuclear Medicine)

Designation: Director and Head of the Department of Nuclear Medicine & Molecular Imaging at Fortis Memorial Research Institute (FMRI), Gurgaon.

Mobile Number: [phone]

Email ID: [e-mail]

Profile: nuclearmedicinetherapy.in/t...