"Stable but evolving"

[Shamrock46]

Brief history: Husband 1st diagnosed 2014, age 67. PSA 18, robotic surgery. No follow up recommended. Recurrence 2018, PSA 17. Lupron, then Lupron+Bicalutamide unsuccessful. Lupron+Xtandi started early 2020, PSA undetectable but lots of side effects. July 2022, PSA first slight rise. August 2022 increased/worsening side effects and minimal PSA increase. Xtandi discontinued. CT scans of abdominal area and torso ordered. Radiologist commented one lesion is "stable but evolving." Anyone ever see those words together which seem contradictory? Also MO mentioned she's considering increasing dose of Lupron. Anyone know about increased side effects or efficacy of that? Meeting with MO tomorrow and writing down all my questions. Thank you.

[tango65]

What is his testosterone? Request a PSMA PET/C to determine where the cancer is located , number of mets etc. The study could help to plan further therapy. Did he have salvage radiotherapy?

[Shamrock46 in reply to tango65]

No radiotherapy. Has trouble tolerating PET scans due to cardiac issues but MO says she will push him for new one.

[Tall_Allen]

What do you mean by " increasing dose of Lupron" - I've never heard of that. It's either all or nothing. Why hasn't he tried Zytiga, if Xtandi was too harsh? Where is the lesion?

[Shamrock46 in reply to Tall_Allen]

Don't know yet...meeting with MO this afternoon. Lesion is S1-L5. Xtandi was working very well, undetectable for 18 mos. As doctor said when he started it, it would work until it stopped working because PC would break through at some point. Xtandi was chosen because it had fewer/lesser side effects for his many cardiac issues.

[Tall_Allen in reply to Shamrock46]

The next step is docetaxel when the PSA is high enough.

[TN1932 in reply to Tall_Allen]

Is Zytiga not a possible choice in this case after Xtandi fails?

[Tall_Allen in reply to TN1932]

There is cross-resistance between Xtandi and Zytiga. Zytiga usually does not work for long, if at all, after Xtandi fails. Sometimes docetaxel can restore sensitivity to them.

[TN1932 in reply to Tall_Allen]

That is what I'm afraid: when Xtandi fails to work, my dad won't have another choice of hormone therapy. Casodex was working well for him when he switched to Xtandi (b/c Xtandi is superior). I wonder if he can go back to Casodex now (while Xtandi is still working) so that when Casodex stops working he can take Xtandi again?

[Tall_Allen in reply to TN1932]

Cross resistance occurs between all such substances. Why would you ever use a less potent medicine that would allow the cancer to overcome it more easily?

[London441]

Where is he getting his care?

[Shamrock46]

Loyola University Health System, Maywood/Burr Ridge, IL