combination treatments for locally advanced PCa in UK?

[boromir18]

UK is quick to adopt some new approaches viz:- I had PSMA-PET Ga68 scan 8/2021

However looking at US, combination treatments e.g. ADT + taxotere+ zytega is commonly offered.

Does anyone know if this approach is available in UK?

[Tall_Allen]

No, that combination is not yet standard of care in the US. Some insurance companies will approve paying for it, others will not. PEACE1 was done in France - you may have better luck there.

[Brysonal]

My UK MO told me this triple was gold standard based on stampede trials. I am BUPA though so not sure if NHS is different.

Interestingly he is not so keen on the chemo bit preferring the double whereas many seem to say go early with chemo ( which he will support but was a bit brutal re side effects- trying to be honest I think)

Interesting he is more chilled about side effects of the double HT with prednisolone when boobs/ weight gain/ loss of fitness and low libido are my primary concerns! Just back from gym but it’s harder to keep weight down already and I haven’t started second hormone and prednisolone yet.

[NickJoy in reply to Brysonal]

I think NHS just ADT and chemo or xtandi so double but not triple but not entirely sure.

[Ian99]

I had the Gallium68 pet PSMA CT scan at UCL. Am now on ADT + Zytiga. Mentioned adding Docetaxel to MO, he thinks it’s better to stay on current medication, for time being. The PEACE trial btw was for de novo patients. But there is no evidence to say it won’t work for all afaik.

[spw1]

UK offers Zytiga or Xtandi once. If it stops working, they will not do a re-challenge after chemo. This is on the NHS. Also, even for a short burst of time, they will not replace Zytiga by Xtandi or vice versa.

[lcfcpolo in reply to spw1]

I didn't know this but am not surprised. I might even need to go to India when the time comes then to get generic Zytiga as I'm currently on Xtandi but I would hope a rechallenge or switch between the 2, even if it 'only' gives a few extra months should be allowed. Crickey, were on palliative care not cure. I'm sure I read on the prostatecanceruk site that if you are refused Xtandi or Zytiga that you can call the specialist nurses.

My current plan when Xtandi starts to fail is to probably go to Baku for LU177 and AC225 if the scans are positive and hopefully remain on Xtandi if it is resentivised. The key will be the timing though.

[spw1 in reply to lcfcpolo]

Best wishes. Hopefully Xtandi will keep on working for you. My husband's PSA is rising on it at the moment so we are looking at chemo if the CT scan shows that there is more activity than can be targeted by SBRT. Our back up plan is India and Lu177 and/or generic Zytiga.

[lcfcpolo]

I'm also not aware that this approach is available in the UK but do ask as the 3 pronged attack is proven to be the best and keep us posted. Indeed Ian and yourself have done really well to get the PSMA-PET GA68 scans. I have not been offered this and when I asked about a MRI was told 'there is no value' in doing one. Good luck my friend, hopefully yours doesn't progress to Advanced. Sorry if I'm sounding negative today.