Information please on next treatment options

[margretrburns]

My husband was diagnosed in Jan 2020 with stage 4 prostate cancer with bone metastasis. He is castrate-resistant. He is on Lupron every three months. Zytiga failed after about a year. He is now on his fourth chemo (cab) which the doctor thinks is not working. He mentioned four options that he thinks would be the next step. 1. Lu-177. 2. Clinical trial AR Degrader. 3. Modify chemo with the addition of another drug (may not be ideal because of increased neuropathy) I usually take good notes but I can't find the name of the drug 4. Stop all treatment. He has bone pain that is pretty extreme at times. He takes 4 mg of Dilaudid as needed for pain and Lyrica. The pain management nurse just added Cymbalta also for pain. He's still mobile (limited) but uses a cane and tires easily. I'm looking for any suggestions and information. Thank you.

Update-We saw the oncologist on Friday, Jan 13 when the above was discussed. The PSA result had not come back yet but the doctor was pretty sure that chemo was not working. He did schedule another chemo in three weeks. The result came on Jan 14. PSA 1,355.00

I am assuming that the oncologist will cancel the 5th chemo.

Past PSA results

10/7/22-338.643

10/31/22-535.906

12/20/22- 842.693

[Hidden]

I can’t answer your question, but there will be somebody on this forum who can help and advise. Have scans shown an increase in the spread of Mets in his bones and has any Mets gone to the soft tissues? Stay strong, stay pisitive, stay hopeful

[margretrburns in reply to Hidden]

Thank you for your response. Yes there has been an increase but no mets to soft tissues. (Something to be thankful for) Trying hard to remain positive but some days it's just a meltdown.

[Hidden in reply to margretrburns]

Margret I know how you feel. This is a horrible journey. I lost my sister last week to cancer, she was only 58. I lost my Dad to cancer too, and I found out the other day my Brother now has prostate cancer, but one of the lucky ones, as it has been caught early. My sister told me she was on a one way train journey with no return day or time. She said she was going to live every last minute to the full. She did for 14 months. You, your hubby, me, and my hubby and everyone who is suffering from this vile horrible disease needs to live every day as fully as possible for as long as possible.

The above sounds such good advice, but when you’re on the floor it’s it’s so bloody hard to get up.

Thinking of you both and all the other late stage 4 boys and girls going through this shit xx

[Tall_Allen]

Pluvicto is the usual next step. But you will probably want to check with both a PSMA PET/CT and an FDG PET/CT first.

[margretrburns in reply to Tall_Allen]

Thank you for your response. He had both of those tests done in Oct 2022. He had applied for the SPLASH trial. Randomized Lu-177 and Xtandi. He was accepted but not into the arm we wanted. The oncologist was against it because Zytiga had failed. He started chemo so he would be on track for Lu-177 if chemo didn't work. My husband said he is not ready to stop all treatment. That's what I was hoping he would say but the decision will always be up to him. I will support him anyway and all the way.

[Tall_Allen in reply to margretrburns]

That is so enlightened and empowering!

[margretrburns in reply to Tall_Allen]

Thanks again for responding. It's a journey no one wants to be on but it's so helpful to have great support.

[Grandpa4 in reply to margretrburns]

love your caring support. One of the scariest parts of this ordeal for me is that I will cause my wife to go through what you are dealing with. Can hardly bear the thought.

[Poowater]

Try Pluvicto.

[margretrburns in reply to Poowater]

Thank you. That's what we are thinking too.

[Djangler]

The drug he wants to add to cabazitaxel is probably carboplatin or a similar platinum-based chemo. Some people have a rough time on it, but it is more effective than Cab alone.

Has your doctor talked about Ra223 (Xofigo) for the bone mets? I have no personal experience, but my understanding is that it can help with bone pain.

[margretrburns in reply to Djangler]

Thanks for you response. We appreciate all the information. I think the doctor started him on cabizitaxel because is was not as harsh as docetaxel. I am not sure that my husband will do well on a tougher treatment. I know we asked about Xofigo but we will ask again.

[Djangler in reply to margretrburns]

Best of luck to both of you going down this difficult road. Remember to take care of yourself as well. Spouses of PC patients are going through a lot and are often shortchanged on support. Keep your trusted doctors, friends, and counsellors close.

[Wings-of-Eagles]

I would follow your docs best advice, sorry to hear Zytiga was only effctive breifly for him. Maybe a drug like Zytiga or another one could be reintroduced in the future, I dont know. As always Tall Allen always has very good advice and is "in the know".

[Hidden]

I can’t speak to which treatment but I am wondering about his bone pain. Has he tried a fentanyl patch? My guy was diagnosed 6 1/2 years ago with a PSA of over 1500. Pretty extensive bone metastasis which has continue to spread despite getting his PSA down to under one for the past five years or more.

He’s used a fentanyl patch to control bone pain pretty much from the beginning, with oxycodone for breakthrough pain. He’s also on Cymbalta mornings and evenings. He has good days and bad days. Early on a lot more good days. But it still allows him to get up and get out and get around and even put in a days work here or there.

We work with the hospital Pain Clinic. Opioids are a difficult sell these days but it is necessary in some cases so you just have to fight for it. We currently have a Doctor who understands and really tries to help. But we’ve come across some who felt like he wasn’t worth their time or their efforts to provide him the drugs. Thank God we still live in a country where you can say “nope, I don’t like that doctor and I won’t see her again.” I’ve done that twice so far with doctors I didn’t think gave a dang or who I felt were actively working against us.

And one quick word of caution. If you do go the opioid route look into Amitiza. It’s for opioid induced constipation. Regular constipation meds will not help with opioid induced constipation. But through trial and error we found a working balance by using Amitiza and senna every day and he has few problems now. Insurance will fight it. You have to point out that the other drugs don’t treat opioid induced constipation. Amitiza does. It’s winnable.

Hope you can find some relief as well as a new direction of treatment that helps.