According to PSMA PET Scan all metastases found are in bones; so after discussion with Oncologist about options, Xofigo (Radium-223) is next

[diamondrn]

I have been taking ADT with Firmagon, Zytiga and Prednisone for Advanced Prostate Cancer for about a year.

About 3 months ago my PSA started rising; went from 5 to 120, so the prostate cancer is officially classed as castration resistant.

The Veterans Administration (My cancer is traceable to Agent Orange exposure in Vietnam) is referring me to the Levine Cancer Institute for therapy with Xofigo (Radium-223). It is normally given IV once a month for six months.

I am going in for an interview with a radiation specialist at Levine on February 2.

My VA MO says that he will be adding either Xgeva or Zometa to prevent bone fractures.

We decided to go this route because I have at least 3 bone metastases that are on my spine and could possibly cause spinal cord compression and paralysis later.

Has anyone on this hub been where I am and where I am headed who can tell me what to expect and what to look out for?

Thanks and Blessings.

[Magnus1964]

If the only ADT drugs you have had are zytiga and firmagon, you are not castrate resistant. Along with Xofigo you suggest to your doctor the xtandi is a possibility.

[diamondrn in reply to Magnus1964]

It was my understanding that Xtandi was the choice before PSMA scan results.

[Magnus1964 in reply to diamondrn]

I'm not sure what one has to do with the other. If you were never on xtandi, it is still a possibility.

[diamondrn in reply to Magnus1964]

Magnus, If my PSA is up to 120 on ADT combo why am I not considered castration resistant? I would appreciate clarification. Thanks.

[Magnus1964 in reply to diamondrn]

Just because one ADT drug failed does not mean another won't work. I was on zytiga for 3 1/2 years befory PSA started to rise

I then went on xtandi and it worked for 4 years.

[Hidden in reply to Magnus1964]

So you went directly from Zytiga to Xtandi? Making sure i'm reading your post correctly.

[Magnus1964 in reply to Hidden]

There was a few months in between. Both were drug trials so I had wait for the zytiga to exit my system before I could start xtandi..

[diamondrn in reply to Hidden]

Going to Xofigo after dropping Zytiga, Nameless999.

[joeguy in reply to Magnus1964]

I believe “castrate resistant” is when your PSA rises despite testosterone being at castrate levels. I think once you also stop responding to next gen drugs like Xtandi, you are “ horomone refractory” or something like that.

[diamondrn in reply to joeguy]

That's exactly where we are, joeguy. Testosterone is less than 7 and PSA is rising fast.

[joeguy in reply to diamondrn]

sure sounds like you are castrate resistant

[Nellienoodle in reply to Magnus1964]

That's great that it worked for you but the liklihood is that the Xtandi worked for 4 years because the Zytiga had also been successful for a number of years. Our oncologist has explained to us that if Zytiga doesn't work for very long then it's probable that Xtandi will follow the same pattern. Zytiga worked for my husband for 9 months, Doctaxel hasn't worked at all, he is now on Jevtana, If this fails, and as his PSA is still rising that's looking likely, they will try Xtandi, but we've been told it will only likely work for a short time because the Zytiga failed quickly. We're hoping they're wrong.

[dac500 in reply to Magnus1964]

What is your definition of castrate resistant? My understanding is that cancer not responding to ADT is castrate resistant.

[diamondrn in reply to dac500]

PSA went from less than 5 to 120 in about 3 months, dac500,

[Magnus1964 in reply to dac500]

Castrate resistance means not responding to "any" ADT drug. ADT drugs work differently. Just because one fails does not mean another won't work.

[Magnus1964 in reply to dac500]

That is a shot definition of castrate resistant. Castrate resistant is when you failed many ADT drugs. Failing one is not.

[Javelin18]

I’m mCRPC with bone mets, and no evidence of soft tissue mets. (I think there’s a six character acronym of letters and numbers for that).

I haven’t tried Xofigo yet, but am concerned about bone marrow damage. My understanding is the effective range of the radium extends into the marrow.

Others can provide more information n

[diamondrn in reply to Javelin18]

XOFIGO - LIMITED DAMAGE TO NORMAL TISSUE

The short range of alpha particles emitted by Xofigo (<10 cell diameters) limits damage to surrounding normal tissue1,3 >>> xofigohcp.com/about-xofigo/moa

[Tall_Allen]

You may want to read this to ask about combinations.

prostatecancer.news/2021/02...

[diamondrn in reply to Tall_Allen]

Thanks, Tall-Allen. That about is my only reservation at this time.

[Tall_Allen in reply to diamondrn]

Good results when a bone-strengthening agent is used with it.

[sharoncrayn in reply to Tall_Allen]

"In the reference cohort (mostly using Zytiga or Xtandi, no Xofigo), there was still an increased fracture rate, albeit lower. After 24 months of follow-up, they found:

33% had new fractures

1.3 fractures per patient with fractures

Only 38% occurred at sites of metastases

This trial shows that all men taking hormone therapy for mCRPC are at high risk for fracture, but particularly if they use Xofigo, and if they previously used corticosteroids (e.g., prednisone with chemotherapy). The effect on bone continues after Xofigo is stopped. These are predominantly "fragility" fractures, not metastasis-related, and can be prevented with bone-strengthening agents like Xgeva or Zometa."

[spw1]

I suppose you have checked your T levels and they are castrate level? And DHT? My husband's ADT injection was not always keeping T below castrate level and we had to change injections. At the moment we have seen a small rise on Zoladex so we are waiting for T results. In the UK, the blood test was done on 18 but the results are still pending. If T is rising, we might switch him to Firmagon as suggested by Tall_Allen before choosing anything else. If you had a PSMA scan, why is Lu177 not an option? eurekalert.org/pub_releases...

[diamondrn in reply to spw1]

Testosterone is less than 7. Normal is around 240, spw1,

Our goal right now is to keep the spinal metastases from pressing on my spinal cord and crippling me.

[spw1 in reply to diamondrn]

Wish you lots of good luck. Take care