PSA still rising after 9 cycles of Docetaxel

[Finlay66]

My PSA has now risen to 96 after settling to 62 from 88.

They tell me not to worry about the numbers too much but it seems that Docetaxel is not working. That said scans in November were positive showing no cancer progression to lymph nodes.

So my question is what is the next treatment that actually reduce my PSA? Enzalutamide was effective year ago but only for 7 months?

Thanks

[Tall_Allen]

I think Pluvicto is available in the UK. After that, Jevtana (perhaps along with a rechallenge of enzaluatmide) would be a good choice.

[Finlay66 in reply to Tall_Allen]

Thank you. I think that Pluvicto has not been recommended by NICE for the NHS due to cost. Rechallenge with Enzalutamide sounds like a very good suggestion although I think UK Oncologists have doubts about it, so they may take some persuading. Jevtana does seem to be the next logical progression in terms of chemo.

[Tall_Allen in reply to Finlay66]

Maybe email this to your oncologist:

thelancet.com/journals/lano...

[Tall_Allen in reply to Tall_Allen]

If you have some bone pain, I think NICE approved Xofigo.

[Finlay66 in reply to Tall_Allen]

Thanks. I think they are considering this for the next phase.

It is true I did very well with Enzalutamide for 7 months but they stopped it after my PSA started to rise quickly.

[Benkaymel in reply to Finlay66]

As you noted in another post, NHS funding rules are pretty restrictive and they may not approve going back on Xtandi having stopped it. I've been told that the cost of Xtandi in the UK is around £3,500 per month so expensive to pay for yourself. Hopefully, the paper TA refers to might persuade them to let you go back on it.

[spw1 in reply to Benkaymel]

Our MO in the UK will not rechallenge after chemo failed. Enzalutamide had failed and we wanted to rechallenge with Abiraterone. They follow a flowchart. Our experience of working with MO in India recently was totally different. Caring and optimistically looking for options. We felt for the first time that someone is on our side leaving no stone unturned.

[Finlay66 in reply to spw1]

Thanks. Do you work in India or did you make a decision to seek treatment there?

[spw1 in reply to Finlay66]

Flew to get treatment there. Our experience of doctors there has been great but we always go with personal recommendations.

[Finlay66 in reply to spw1]

Thank you. I'd welcome any personal recommendations if you are able to message me.

It might be worth thinking about if all I'm left with is life extending drugs.

[tango65]

i would discuss getting a biopsy, with a PSA of 88 a liquid biopsy may have enough yield to do genomic, histological and IHC studies and determine if the cancer may respond to Olaparib, Keytruda or cabazitaxel plus platinum compounds or to experimental treatments in clinical trials.

[Finlay66 in reply to tango65]

Thank you. That's helpful. At the start of my treatment I was tested for genetic suitability for Olaparib but sadly did not meet the requirements.

[winkoliu in reply to Finlay66]

If your genetic BRCA1/BRCA2 is negative that is not suitable for Olaparib, you can check your ATM. If ATM is defect, you may be qualified for Olaparib.

[Finlay66 in reply to winkoliu]

Thank you. I have made a note of that for my Oncologist appointment in January.

[dmt1121]

Typically, the best results come from combining docetaxel with lupron. For me, the the lupron suppressed my PSA, not the chemo.

[Hidden]

Question. Are you on any Gonadotropin-releasing hormone agonist while on chemotherapy?

Gourd Dancer

[Finlay66 in reply to Hidden]

I'm in Firmagon which is supposed to be good for spine mets.

[CRPCMan]

Honvan is your answer as long as you take warfarin with it.

[Mrtroxely]

Something giving rise in PSA score.....UK just give you what's on the bottom shelf, when it doesn't work, then more of bottom shelf until at a push start looking on another shelf....

Im using the knowledge and experience on here and try get what seems and feels right.

Personally I think the pmsa pet scans to at least see what the issue is.

cryo freezer to the crap part of prostate,

Radiation to parts that need it(from a PSA pet scan)

But instead little bit of an MRI, to pelvice, a bit of a crude bone scan, some hormone injections and now chemo.....

Doesn't seem like scientific administration,...

If they reluctant to put back on enzalutamide

Ask them for applutimide (it's on the nice I think) it was offered to me after side effects of enzalutamide.

Cabizital can be tried after doxetaxel in UK for number of reasons, but they have to go through bottom shelf first....

I hope you guys get handle on it.

Nobody worries at this n that figure! Until it's them in a similar situation.

[Finlay66]

Many thanks. This is really helpful and this thread is helping me to be well advised before meeting the Oncologist. They are doing new scans before my appointment.

[Proflac]

I think you could get Pluvicto privately now u have had chemo but it's not cheap. NICE will decide on this tx funding in March 2023 but who knows which way that will go. Ask for a second opinion perhaps from the Royal Marsden? Good luck. Spw from the UK on this site has experience of trying to access Lu 177 so you could check out those posts.

[Finlay66 in reply to Proflac]

Thank you. I will speak to the Oncologist next month and explore the other treatments mentioned in this thread. Clearly it will depend on the outcome of the scans but it would be good to find a treatment that will impact on my PSA.