Prostate Cancer-Thoughts

[margretrburns]

My husband was diagnosed in January 2020 with prostate cancer that had metastasized to his bones. His PSA was 30 and after the biopsy it was 130. He has had radiation three different times, Firmagon, Zytiga and Prednisone. His testosterone is low and his PSA did get as low as 2 but then started rising. It is now 300 but he is only on six month Lupron right now. He is castrate-resistant. We are in Philadelphia now and he was accepted into a clinical trial with Lu-177 and Xtandi. The trial is for men who have never had chemo. He did not make it into Arm A which is the Lu-177. After 2 months they will check how he is doing and will have the opportunity to cross over to Lu-177 if Xtandi is not working. He will have 8 months to cross over. The oncologist wants him on Zometa but if he does the trial he can't be on it. Should he do chemo now and hopefully get to the Lu-177 that way or stay with the trial? Any thoughts on all this? My brain is absolute mush.

[meowlicious99]

>Should he do chemo now and hopefully get to the Lu-177

I believe therap trial[1] showed that lu is isn't too much better at OS than cabazi after docetaxel. So the benefit you might be getting with LU after docetaxel is that its much less toxic and better tolerated. Which is still desirable.

I might be wrong here but I think the question you are asking ( chemo -> lu or lu first) hasn't been answered definitively yet.

Hopefully someone chimes in here with an answer for you. I am curious about this as well.

1. ascopubs.org/doi/abs/10.120...

youtube.com/watch?v=vsCrZul...(Not working as expected?)

[margretrburns in reply to meowlicious99]

Thanks for replying and the video and link. To be honest I'm not sure what my exact question is. I'm searching for the best options for my husband.

[Tall_Allen]

I'll make it even more confusing for you.

Xtandi usually works for at least a little while after Zytiga fails. A new trial showed that it may work for even longer if it is combined with docetaxel:

prostatecancer.news/2022/10...

So if he were to get Xtandi+docetaxel now, he might qualify for Pluvicto after that stops working (depending on his PSMA expression).

Maybe send the link to his oncologist and ask to discuss with him.

He can also get Xofigo+docetaxel+Provenge (+Zometa):

prostatecancer.news/2021/02...

Honestly, no one knows which sequence is best, or even if there is a best sequence (which is why they are doing that randomized trial). It is often highly individual and not something one can predict. There are pros and cons to all medicines, and there is no right or wrong decision.

[margretrburns in reply to Tall_Allen]

Thank you. Yesterday we agreed to try Xtandi on the trial. This morning his oncologist called and said with Xtandi my husband has a 10% chance of it working. He gave us the option of chemo since he feels that his cancer is growing quickly. PSA went from 200 to 300 to 500 in less than a month. My husband hasn't been on any treatment except Lupron for two months. The decision now is Docetaxel (Taxotere) or Cabazitaxel (Jevtana). We will discuss what you mentioned with the oncologist.

[margretrburns in reply to margretrburns]

BTW You did succeed in making it more confusing but knowledge is power. Thanks

[MateoBeach]

I think it is a good choice to go with the trial in the Xtandi arm. Only needs two months before he can cross over and get the Lu / Pluvicto for no cost. Good way to get it and the Xtandi may control things in the meantime. Docetaxel can be kept in reserve. Just a view to maximize options and choices.

[margretrburns in reply to MateoBeach]

We're under the impression that after one chemo session if he doesn't respond well he can go to Lu-177. We were told that he would be checked after 3 weeks. So we're thinking 3 weeks is better than waiting 2 months. Are we missing something?

[MateoBeach in reply to margretrburns]

Yes, true that would make him eligible for Pluvicto sooner. So good, But make sure they will be able to schedule him promptly in the lineup for treatment. Some centers have a backlog due to demand and limited isotope supplies.

[Hidden]

That's what makes this disease so tough. So many treatment choices and decisions and it all seems to fall on the patient to make those choices.

[margretrburns in reply to Hidden]

Exactly. My brain is fried with so many decisions. Of course my husband is in control and will make the final decision but I research everything.

[margretrburns]

So my husband had his first chemo today. Cabazitaxel. He will be checked in three weeks to see how he's doing.