Dad has brain cancer, heart issues, and now PSA has increased. Concerned about medication complications..

[Lynsi13]

Hello friends!

It's been a long time since I've posted. It's hard to keep up with my dad's health on my end.. we've had so many close calls that his prostate cancer has felt like a bump on the head compared to all the rest of his concerns!

So, to bring everyone up to speed as quickly as I can, dad was diagnosed stage 4 PC in 2015 with only a single local lymph node affected. He had 6 rounds of chemo and began on Lupron + Casodex. That worked for five years until his PSA started increasing again and he was able to receive a two of three rounds of Provenge immunotherapy (the last round was cancelled due to Covid just starting in March 2020). He started Xtandi shortly after.

Last September (2021) he had to have a quadruple bypass which was complicated by afib. Five weeks later, he was diagnosed with Primary Central Nervous System Large B Cell Lymphoma (brain cancer) after brain surgery (for what we were told was Glioblastoma) revealed that he had lymphoma in his brain.

He began chemo + immunotherapy immediately (methotrexate and rituximab). He experienced bouts of afib during this time and was placed on a more aggressive afib medication. He also contracted covid and thankfully did remarkably well.

After five rounds of chemo he was able to get into remission. Since then, he has suffered a heart attack due to a failed bypass (I didn't even know that was possible!) and had to have a stent in place.

Which brings me to today.

His PSA has increased from .41 to .55. It's the biggest jump it's made in quite a few years.

Now, I know that there are other medications available to him, but I'm concerned about them being complicated by my dad's other health conditions and medications. He is on several medications for afib, blood pressure, and anticoagulants. Presently, he is not on any medications for his lymphoma.

Can anyone fill me in on what could potentially be a next step in his treatment as well as potential interactions with his current medications?

I would appreciate any prayers you could offer on his behalf, as well. He sure could use a break.

Thanks so much! (Picture of my dad with my mom and sons!)

Lynsi

[Tall_Allen]

Orchiectomy may be a good choice because it is not a medication.

[Lynsi13 in reply to Tall_Allen]

Thanks. I hadn't considered that. We go to see his oncologist on Tuesday. Do you know what would be the *typical* next step beyond Xtandi? Zytiga or perhaps a newer medication? I've been away from the scene for a while and quite a few other medications have become available.

Can you tell me, regarding an orchiectomy, how effective it is compared to the other lines of drugs available? And what is one to do if their PSA begins to rise after an orchiectomy?

Thank you, Allen.

[Tall_Allen in reply to Lynsi13]

Docetaxel is usual. Castration is effective.

[Lynsi13 in reply to Tall_Allen]

I didn't realize they rechallenge Docetaxel. I doubt my dad would agree to more chemo. He had a hard time with Docetaxel the first time and then the chemo for his brain cancer nearly killed him.

I'll run the idea of castration by him. I sure never imagined I'd have that conversation with him.

[Tall_Allen in reply to Lynsi13]

If he is PSMA-avid, he can have Pluvicto.

[Lynsi13 in reply to Tall_Allen]

How would one go about finding out if he is PSMA avid?

[Tall_Allen in reply to Lynsi13]

PSMA PET scan

[Lynsi13 in reply to Tall_Allen]

Ok. Thank you. In December the doctors at the James cancer center in Columbus, Ohio went searching for cancer. They did multiple scans and could not find any cancer (beyond his brain at the time).

Since that time his PSA has risen fewer than two-tenths of a point. Would you expect there to be any activity on a scan at this time with such a small upward movement in his PSA?

[meowlicious99 in reply to Lynsi13]

Lynsi13 was that PSMA PET in December. That's a special scan specifically for cells expressing PSMA . A generic scan won't detect PSMA avidity.

Maybe you can check his files for all the scans that were done and see if you can see a PSMA PET in there.

[Lynsi13 in reply to meowlicious99]

It was a PET scan. I will certainly talk with his doctor about getting a PSMA scan. Thank you!

[Tall_Allen in reply to Lynsi13]

His PSA is high enough to detect PSMA-avid tumors.

[Lynsi13 in reply to Tall_Allen]

I'm not sure of the threshold. When he had his previous PET in December 21 his PSA was .36. It is currently at .55.

[Tall_Allen in reply to Lynsi13]

That's sufficient.

[Lynsi13 in reply to Tall_Allen]

Thank you, Allen. Would you mind explaining to me aside from being more sensitive, how this scan would benefit him? You described it as detecting PSMA avid cancer cells. Does it also detect cancer that is not psma avid? Or am I completely misunderstanding?

[Tall_Allen in reply to Lynsi13]

It is a requirement for Pluvicto. It only detects PSMA-avid cancer cells.

[CAMPSOUPS in reply to Lynsi13]

I believe TA will respond but I just wanted to jump in here quickly too.

It has been suggested that Pluvitco treatment might be beneficial and often has less toxicity than chemo. Although keep in mind Cabazitaxel chemo has less side effects than Docetaxel.

A PSMA pet scan is required before Pluvitco treatment can be given and according to TA your fathers PSA of .55 is high enough for the PSMA scan to "read" metastases' that can be treated with Pluvitco.

[tango65]

He needs a PSMA PET/CT.

If there are PSMA positive mets with a SUV greater than the liver, Lu 177 PSMA treatment could be a good option. Other option is to try chemo with cabazitaxel.

If there are mets in the PSMA PET/CT you could consider requesting a biopsy to do histological, IHC and genetic studies to see if there are mutations or markers indicating the cancer may respond to specific drugs, such as Olaparib, Rucaparib, Keytruda, chemo with platinum compounds etc.

[Lynsi13 in reply to tango65]

Thank you! I'll see if I can get his doctor to order one on his behalf. His last full scan was in December 2021. At that point there was no evidence of disease. Since then his PSA has risen less than .2. I'm wondering if another scan would detect anything?

[meowlicious99 in reply to Lynsi13]

my dads psma found 2 new bone mets at .9 psa

[Lynsi13 in reply to meowlicious99]

Good to know. Thank you!

[tango65 in reply to Lynsi13]

You could wait until the PSA is 0.5 or greater. The detection rate will be higher around 70%.

[cesces]

I would just follow TA's recommendations.

Probably better than you will get from most docs.

[Lynsi13 in reply to cesces]

Thank you. Yes, Allen's opinion is quite valuable. He's a gift to our community. I'm certainly taking his opinions to heart!

[KingNeptune]

Was your dad fully vaxxed and if so, how long after he was vaxxed did the brain cancer and heart problems occur? There appears to be a possible correlation between the two. Godspeed to you and your dad.

[Lynsi13 in reply to KingNeptune]

He was. His last shot was in June and his heart issues started in late August. He had the bypass on September 10th and five weeks later the brain tumor was discovered.

Do you mind sharing why you believe there is a possible correlation between them?

Thank you!

[KingNeptune in reply to Lynsi13]

You can PM me, I don’t want to post on the open message board. I see your dad had his procedure(s) performed at The James, as did I 13 years ago, great place and staff. Be your own advocate and stay strong 💪

[cesces in reply to KingNeptune]

Vaccinations causing cancer, you mean COVID -19 vaccinations?

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That is a very touching family photo . Thanks for sharing ! He has much love . You are a wonderful advocate for your father . We should all be so lucky to have such a daughter . I really respect this kind of love . I don’t have any med advice . Only that your love for him and his family are his blessings .I too was dxed in 2015 . My dad had this also .. Your father is so tough to go through so much . I pray that your love for each only gets stronger now.. Stay together ! May God bless your family ! 🙏❤️