Cabazitaxel update and variations of PSA

[spw1]

Hi all, those who have followed my husband's history will know that Docetaxel did not work for him although the MO insisted on 4 infusions. Cabazitaxel was given on 10 Sept (nearest PSA was 468 on 2 Sept in London). On 22 Sept PSA was taken again and two samples in the same lab, same time, gave results of 821 or 676. The second sample was also used to work out LDH which is 1180, a little lower than 1373 on 7 Sept (but from a London lab). Clinical picture is that symptoms are worse esp of pain and discomfort.

How is PSA so varied? The same place had shown a difference of 23 in the past (readings were 288 or 311). This time the difference is too big to be ignored. But either way, I do not think that Cabazitaxel is working. The MO might insist on the next infusion on 1 Oct. as he has nothing else to offer at the moment.

[Tall_Allen]

I think PSA error can be ±20%.

Cabazitaxel+carboplatin may be more effective.

He seems like a good candidate for Pluvicto.

Any recent biopsies of tumor tissue?

[spw1 in reply to Tall_Allen]

NHS does not offer that but Royal Marsden might do a biopsy as my husband has offered to join Phase 1 or 2 trials. Timing is crucial. Already I am worried that my original plan for India to do Lu177 does not seem practical given the discomfort of a long journey. NHS still does not use Lu177. Trials in the UK are offering Lu177 to hormone sensitive patients.

[Tall_Allen in reply to spw1]

Does NHS approve Xofigo?

[spw1 in reply to Tall_Allen]

yes. They have not offered it but so far radiation has not had a good effect when we tried SBRT on prostate and general pelvic radiation in March this year.

[CAMPSOUPS in reply to spw1]

I am far and away from any expert knowledge but I think its safe to say the SBRT to prostate and general pelvic radiation is a totally different animal than the systemic Xofigo treatment. Xofigo might be helpful if he has numerous bone mets to slow progression.

[spw1 in reply to CAMPSOUPS]

Thank you. We are seeing the MO later today. Much is in his hands. The NHS does not offer much choice. He did not want to add carboplatin for example.

[hansjd in reply to spw1]

would travel to Germany or elsewhere in Europe for Lu177 be out of the question? Many sites offer it.

[spw1 in reply to hansjd]

yes they do. It is a question of money and comfort level.

[Shooter1]

Nothing else to offer.... I've heard those words from my MO and RO. Now getting PSMA scan to try to get on the Pluvicto waiting list... Good luck with treatments and maybe Pluvicto.

[spw1 in reply to Shooter1]

Thank you. We are looking at anything and everything incl trials.

[Medline]

LDH level seems to be the only robust prognostic factor associated with both progression-free survival and overall survival in cabazitaxel chemotherapy. Administration of cabazitaxel after reduction of LDH may be favorable to maximise the benefits of cabazitaxel chemotherapy.

pubmed.ncbi.nlm.nih.gov/319...

[spw1 in reply to Medline]

Thank you. Is there a way to reduce LDH level?

[Proflac]

I think the NICE decision on NHS funding Lu-177 is due on 23rd November. But even if its accepted I guess there may well be a waiting list - especially for the scans. But if you are at the Marsden you are in the best place and a PSMA scan might be available for you. These treatments are available privately in the UK currently, as I am sure you are aware - but mega expensive. Let us know how things go for you. Wishing you all the best.