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