Update - ADT with Zytiga Failure (Castration Resistant) after 6 Months (PSA 90.3); Firmagon still Working; PSMA PET Scan Ordered

[diamondrn]

I came right out of the gate with Gleason 9 Stage 4 Advanced Prostate Cancer with more than 5 Metastases in January of this year.

Firmagon brought the Testosterone down to < 7 almost right away, but PSA went to 160.

Zytiga and Prednisone were added in March and brought the PSA back down to 5.

The PSA starting rising again about 2 months ago and is back up to 90.3 as of a blood test yesterday.

The VA Medical Oncologist stopped the Zytiga and ordered a PSMA PET Scan which was scheduled for January 19.

The MO discussed the likelihood of Radium 223 for the bone metastases, some sort of chemo, if soft tissue cancer is found; and, he mentioned Xtandi.

The bone metastases on my ribs, hips and sacrum are causing me enough pain to interfere with me getting to sleep right away.

The MO said he would order opioids for me if it became necessary; my call.

2 Naproxen 240mg tablets orally twice daily and (Lidoderm) Lidocaine 5% patches are taking care of the worst pain for now.

Yesterday's lab test results below:

PSA (ONCOLOGY) 90.300 High ------Reference ng/mL 0.01-4.0

TESTOSTERONE (VA) <7.00 Low ------ Reference ng/dL 241-827

ALKALINE PHOSPHATASE (VA) 385 High ------ Reference U/L 45-117

We are on hold, as far as therapy for possible soft-tissue tumors is concerned; waiting for the results of the PSMA in about 3 weeks.

[Tall_Allen]

I'm not sure what you're waiting for. You know your metastases are active. Xofigo combined with docetaxel did well in a recent trial. Also, a good idea to get Provenge at the same time. Spot radiation to a few of your larger metastases will give you some pain relief (pain may increase for 1-2 weeks).

Discuss a biopsy of one of your large metastases. There are many clinical trials.

[diamondrn in reply to Tall_Allen]

Thanks for responding, Tall_Allen.

Xofigo is a probably a sure thing. I believe that decision was made when the PSA started taking off.

I'm not sure about what is being planned for soft tissue involvement. The MO mentioned several possibilities, based on the PSMA results, etc.

[beogradjanin]

Have you tried Zometa (Zolendronic acid) for bone pain and reparation? In Serbia it cost around 60 Euro. I used it once a month, when I had that isue with bones, than once in a 3 months, now once a year, or less - according with needs. I use regular ADT for 7,5 years, 2,5 year ago went on Docetaxel 6 dose, and last year and a half I added Xtandi full dose. No significant side effects, exept loosing muscels and hot flushes due to ADT, and maybe some lack of concentration due to Xtandi. Of course - plant based diet, vitamin D3, RSO...Best wishes for 2022 😃