what options after Zytiga

[Ollie1948]

After almost 10 years after prostate removal, followed by radiation, Lupron, Casodex, Lupron again, radiation again, Lupron + Zytiga... I am with 3 mets at the ribs, spine and iliac... and the the Zytiga is not being effective as my psa keeps climbing and the mets growing in size.

[tango65]

The usual SOC is doing chemo with docetaxel and continue with ADT. The cancer is mCRPC, and you qualify for Provenge a vaccine associated with improved overall survival.

Discuss having a direct biopsy of the mets or a liquid biopsy to do genetic. histological and IHC studies. The cancer may have mutations which could be targeted with drugs such as olaparib, rucaparib or keytruda or other drugs in clinical trials.

Other possibility outside the SOC since you have only 3 bone metastases, is continue with your treatment and have direct radiation of the mets. It is outside the SOC and it is not proven to improve survival, but it may delay the start of more advanced therapies.

pubmed.ncbi.nlm.nih.gov/339...

[Tall_Allen]

You can try extending the Zytiga by switching from prednisone to dexamethasone. After that, docetaxel and Provenge.

[Magnus1964]

Xofigo would be a good next step for bone mets. Maybe xtandi if Xofigo is not called for.

[Spyder54]

best of Luck Ollie ! As you see from some smart Brothers above, you have options. At 74 yrs old, and 10 years into this chapter, wouldnt it be great to get another 10 years of quality life? Your body has responded well for these past 10 years, why not? 84 yrs old would be a good full life in any language. Press on Brother, Mike

[Seasid]

I would get an appointment with an RO .

The RO could order a PSMA pet scan and decide if it is feasible to do the SBRT of your Mets.

I had SBRT with an MRI Linac and they are high precision machines. The accuracy is 1mm.