Ten months ago after trying Docetaxel, Xtandi and just 2 cycles of Jevtana all since 2019, our oncologist said the only thing left to do was a clinical trial. We were referred to another cancer center that was a NCI center as the clinic we were at was not. A clinical trial was begun last August. Progress was being made but the company was looking for a better rate of decline in PSA and the trial was stopped in November. The new oncologist has been holding out for Lu-177 and in the meantime Zytiga was prescribed to maintain levels. Last week my husband had the PSMA scan. Today we received word that his levels were too low for the drug to be effective. We will meet next week to discuss another plan of action. I would appreciate any thoughts and ideas we could bring to the discussion.
The Journey continues : Ten months ago... - Advanced Prostate...
The Journey continues
Has he had Xofigo?
Has he had any of his metastases biopsied? Any findings from histology, IHC, and genomics?
He may qualify for the following clinical trials:
clinicaltrials.gov/ct2/show...
That report was done at the first clinic and we did not get a copy. I assume it was passed along with the other records to the new clinic and will add that to my list of questions for next week.
Dwight's wife here. I would recommend you get a copy of the pathology report. I didn't realize my husband had ductal cancer until I read the report. The urologist, MO and RO never mentioned it to us.
When they gave your husband Xtandi, did they give him Lupron or degarilix or some other major androgen hormone blocker at the same time?
He was taking Trelstar but the new clinic has changed that to Lipton. He also gets Xgeva.
He could be a candidate for bipolar androgen therapy (BAT). My oncologist decided to try it post Jevtana and it’s working…at least for me.
Yes , insist upon referral for Provenge treatments. It is non toxic and just takes a little time for the three cycles. Not chemo, it is an immune therapy. Can work synergistically with Xofigo if that is offered.
Also, celecoxib, the anti inflammatory, can be combined with his Xgeva for additional effect on bone mets.
What were the SUV values of lesions on his PSMA scan? You should have a copy of that and all pathology and scan reports. If there are mets that light up on PSMA scan and are concordant (match) on a different PET
Scan such as FDG or Axumen, then Lu-PSMA treatments might still be beneficial. Ask to have this reviewed at a Pluvicto treatment center. It is perfectly appropriate to question further and ask for 2nd expert opinion.
Finally, a personal trial of BAT (cyclic testosterone) even per the protocol outside of a trial, may be worth trying. You can quickly determine if it is helping. And it can be promptly stop it if he does not respond positively. So the downside risk, while not zero, appears to be low. He will likely need an MO who is familiar with this though. Many are not at this time.
Best of luck and kind regards. Paul (MB)
Thank you for your insight and the thoughts of all who responded. We will bring forth all suggestions. In addition to our scheduled appointment with our MO next week, we also have one with the RO we were referred to. We intend to keep that meeting for a second opinion. Both doctors are at Pluvicto treatment centers and the RO has already given it to at least one other patient.