Good morning!!! Well my husband has tried quite a few treatments thus far. He is castrate resistant Gleason 9. He has been on Zytiga, Lynparza, Keytruda, Docetaxel and now Jentava. He had his last round of Docetaxel around Oct. 25th . His psa at that point was 70 . He had his first round of Jentava three weeks ago just had a psa check today it’s now 83.4. He does have stiffness to the back, ribs as well as his left hip. He is not due for a bone scan just yet. I’m going to ask for more foundation testing as nothing seems to be working. Could it be that the Jentava needs some time? Any advice please would be so appreciated. Losing faith. When I asked about adding Carboplatin the Dr. Felt he didn’t need that just yet. Not having much knowledge to all of this doesn’t help. Please any advice!!! Could it be that’s it’s to soon on the Jentava? I’m sorry I just don’t have a lot of faith right now because nothing seems to be working. I also wanted to ask is Carboplatin just used just fro the braca gene mutation? Not sure if I spelled that correctly.
Psa: Good morning!!! Well my husband... - Advanced Prostate...
Psa
Discuss about a clinical trial with Lu 177 PSMA and if possible Ac 225.Lu 177 PSMA will treat metastases anywhere (bone, lymph nodes and organs). Xofigo will treat only bone metastases. Lu 177 PSMA have been show to prolong life and it does not have major side effects unless there is extensive infiltration of the bone marrow by the cancer.
There are several trials for Lu 177 PSMA and Ac 225 in the USA that are recruiting:
clinicaltrials.gov/ct2/resu...
clinicaltrials.gov/ct2/resu...
He may qualify for one or more of these trials. Ac 225 combined with Lu 177 PSMA may be better choice if he has too many bone metastases.
If it is possible financially you could get these treatment abroad, in Europe and India .
Can the CAR-T trial at Dana be of any help here tango65?
It could work. Cart T cells are an experimental treatment which seems to work in some patients but there are not definitive data showing a survival benefit..
Lu 177 PSMA showed a survival benefit in a phase 3 RCT done in heavy pretreated patients.
The other problem of the Car T cells are the side effects which could be severe in some patients. The trial also has a initial treatment of chemo with Rimiducid which could also have a lot of side effects.
If he can have a biopsy done on one of the metastases, genetic sequencing may determine if there are any treatable mutations. It may also be possible to see if Carboplatin would be beneficial.
Carboplatin does work on BRCA mutations as well as prostate cancer with neuroendocrine differentiation. Parp inhibitors can also be used with BRCA mutations.
Keep the faith in good. He suffers so do you.. Stat strong and care for self also . 🙏🙏💔
He could get a liquid biopsy (with a PSA of 83 is possible to have a good yield) to do histological, IHC and genetic studies. If there were components of neuroendocrine PC as Gregg said Carboplatin could be beneficial .
Is that foundation one?
You need to discuss with your doctor about what studies will be done in the liquid biopsy. The liquid biopsy (a blood sample) may contain cancer cells , cell free DNA and cell free RNA.
Foundation one does the genetic studies.
They also need to look to histology if possible (they need to get cancer cells in the liquid biopsy) and also do IHC studies such as :
MSH2, MSH6, PD-L1,chromogranin A (CGA), neuron-specific enolase (NSE), synaptophysin (SYP), DLL-3, CD56, Somatostatin (SST) etc.
If they can determine there are components of NEPC, chemo with platinum compounds could be useful.
Tango thank you for your frequent helpful support here.Faith's husband has burned thru a lot of treatments in a hurry and when tx has failed his PCa goes off to the races.
So of course continue the Jevtana now as they wait for Foundation One results and treatment options continue the Jevtana.
My humble opinion to go along with that is maybe add the Carboplatin. Unless his blood numbers are not too good which could be the case.
Anyway would it be best (considering time until tx based off of Genetic results could take awhile) that they add the Carboplatin just to be safe and cover potential bases?
I agree. The problem is that the MO does not consider it is the time to add platinum compounds. If there is evidence of treatment induce NEPC, then it will be time to add the platinum compounds with or without etoposide.
Do you know anything about provenge ? I wonder if that would be an option next?
Provenge will not affect the PSA,, but it has shown a survival advantage . It is the only vaccine for PC approved by the FDA.
nejm.org/doi/full/10.1056/n...
It may be more effective if used early in the evolution of the disease. It may be used in combination with chemo or Xofigo. If he has bone mets Xofigo could be a possible treatment for these metastases (it will not treat organ and lymph node mets).
We went down the Provenge path, early. I'm sure someone knows more about Provenge than me. From what I read, at the very least it could add at least 3 months to my husband's life and it could also add more time. We will never know the benefits of Provenge.
My brother did Provenge as well very early on. It was after chemo. Like you said, we will never know the benefits because there are no markers to see if it’s working or not. It doesn’t affect the PSA. However I do know he has been over three years and we still have him with us. So I think it was worth a shot.
LOVE THIS!!! I will tell my husband!
2nd opinions are invaluable.2Dee
Gods speed and peace to you both...
I failed Lu177 and expect to start Jevtana plus Carboplatin any day - just waiting on insurance approval. I’ve read the Florida Blue policy on Jevtana (which includes adding carboplatin) and I think it comply so expect approval soon. I’ll write up some more detail once I get started on the treatment.The Lancet Vol 20 October 2019 has a publication showing the benefit of “Cabazitaxel plus carboplatin”. I used this to initially get my Oncologist’s attention.
I hope your husband’s chemo is successful - whatever it ends up being.
Does he have the BRCA mutation? If so, use of a PARP med like Lynparza should be discussed with the doctor.
No Lynparza did nothing for him!!
You again.Exercise some common sense. This is a near term life and death need of advanced care from the poster.
Your insistence on marketing a herb are not welcome.
healthunlocked.com/user/iyo...
Your bad and you know it. You also know that nutrition2000 was banned by the FDA for false advertising and more.
You are also a chicken my friend. I dare you to make a post rather than interrupting other peoples posts by sneaking in your nutrition2000 recommendation.
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