Next Move

[Kentucky1]

I've been on Lupron, Zytiga, Prednisone for 3 years now and it appears that it has run it's course. I am grateful that it has worked for this long, but it appears I will be needing to make a move to the next therapy. My PSA has gone from 14 to 71 over the last six months and ALP has jumped to 190 after being within normal range for over 2 years. I'm dealing with progressive MS with a 22 year history of the disease. Otherwise relatively healthy with hypertension controlled with Losartan. I am chemo naive, but have concerns with neuropathy side effects from the taxanes. What's everyones thoughts? Taxanes,Provenge,Xofigo or something else?

My first thought is to switch to dexamethasone from prednisone and see if I can extend the Zytiga's effectiveness for a little while longer. Next thought was Xofigo due to having just bone mets at this time. Provenge a maybe,but haven't heard of great results from this group. Guidelines point to docetaxel or Jevtana, but still stuck on those neuropathy side effects. I feel that if I see increased neuropathy from the chemo it will be the end of my mobility, as I have gone from cane to rollator since the cancer was diagnosed. I now have limited mobility with the rollator and if my neuropathy worsened I would most likely end up using a wheelchair. The longer I live the more the probability of the MS worsening exists and moving to a wheelchair would be a lifechanging event. Any feedback is appreciated.

[Magnus1964]

Xtandi would be a good next move if you haven't had it already.

[Kentucky1 in reply to Magnus1964]

It was my understanding that when one of the androgen blocking drugs failed the others would not be very effective due to cross sensitivity. Is that not true?

[Magnus1964 in reply to Kentucky1]

Not true, I was on abiratorone for 3 1/2 years. When it failed I went on xtandi and it worked for 4 years.

[Tall_Allen]

I think Xofigo+Provenge is a good combination. Neither effects PSA, so the way you know they worked is you live longer.

[Seasid]

I would try chemotherapy. You can always stop if you feel unwanted side effects. I had an early chemo 6 cycles. I developed grada 1 neuropathy. It is not a a big deal now. You could switch to weekly chemo. Just try it. After that you could switch to something else. Alfaradiaton is not helping you with the cancer, only with the symptoms. I woul definitely try Provange. urotoday.com/journal/everyd...

[j-o-h-n]

Your seem like an very nice retired pharmacist. I suffer from peripheral neuropathy for years, (not from chemo) and it's treated with Neurontin/Gabapentin (600mg 2X) and with1 Duloxetine (Cymbalta) Hcl Dr Caps 30mg . Everything is working around 95% and I'm living with it. So if you're going the Chemo route then use ice packs on hands, feet, head and ice chips in your mouth. Stay Well....

Good Luck, Good Health and Good Humor.

j-o-h-n Saturday 03/26/2022 7:46 PM DST

[Grumpyswife]

My husband got a few months from changing to dexamethasone. The trouble with Provenge is no way to know if it’s working as it doesn’t effect PSA. Lots of support for it on here.

[Seasid]

My MO said that xofigo doesn't help with the cancer. Only with the bones. I would try first a system therapy. You can ask for Jevtana in order to avoid peripheral neuropathy:grandroundsinurology.com/dr...

urotoday.com/journal/everyd...

[Seasid]

If you can get provenge parallel with Jevtana it would be the best. Start with Jevtana as soon as you can. You can always stop.