Xtandi failed

[MyDad76]

My dad was diagnosed in September 2016 following a TURP procedure. His initial PSA was 5.2, Gleason 4+3.

Treatment so far:

Casodex 150mg, reduced to Casodex 50mg (Sepetmebr 2016 - January 2019)

Eligard + Casodex 50mg (January 2019 - March 2019); Eligard only (from March 2019 on)

Radiation treatment in fall of 2021 - failed, PET CT in May 2022 showed numerous local and distant lymph node mets, inconclusive for bone marrow involvement.

PSA mid June: 13

Xtandi from beg July 2022

PSA Aug 8th: 19.86

PSA October 26th: 15

PSA December 14th: 17

I guess it is safe to say that Xtandi failed. What are our options now? Not sure if chemo will be offered at all (he has no comorbidities, but is 80 years old). Does anyone have experience with chemo at such age? Is it worth perusing or side effects would be too much to handle at this age? Are there any "easier" chemo protocols where side effects are less severe?

We have sort of "local" immunotherapy available in the last year - dendritic cells therapy - it has to be approved by comity - they might not approve it as research findings indicated, that it is more successful in case there are no mets present.

Since his mom had ovarian cancer and his brother had prostate cancer (aggressive), thyroid and kidney cancer (yes, all 3), I will push for genetic testing.

Anything else I should look into? What would be your steps if you were in our shoes?

Thank you in advance for sharing your thoughts and wisdom.

[Tall_Allen]

Where are you located?

Chemo at 80 is no problem if he is healthy enough to tolerate it. The only way to know is to try it.

ncbi.nlm.nih.gov/pmc/articl...

ncbi.nlm.nih.gov/pmc/articl...

[MyDad76 in reply to Tall_Allen]

We are located in Slovenia, Europe. Would there be any alternative to chemo at this stage?

If it would be possible / approved, should we push for Jevtana instead of Docetaxel? My impression from stories on this page is, that it might be easier to tolerate.

[Tall_Allen in reply to MyDad76]

Docetaxel, not Jevtana. Don't avoid his best chance at delaying progression. There's no evidence that one has fewer side effects than the other.

He might want to try a combination of Xtandi and docetaxel, as in this clinical trial:

prostatecancer.news/2022/10...

[MyDad76 in reply to Tall_Allen]

Thank you. Will see if they will even consider him for chemo (due to his age - ageism is a big factor in our state health system - no private healthcare).

[Tall_Allen in reply to MyDad76]

Email his oncologist those links.

[tango65]

Have you investigated the possibility of getting Lu 177 PSMA treatment in Germany, Netherlands, Finland ,Austria etc.?

If he does not have bone mets, this treatment most probable will be well tolerated and it has an efficacy similar or better than chemo.

[MyDad76 in reply to tango65]

I'm afraid my father will not want to travel. But I agree, that these are viable options.