Radium 223 before Cabazitaxel?

[Finlay66]

This was prescribed today to manage bone pain and also because my PSA has not particularly responded to Docetaxel and the bone scan shows further cancer growth. There is some doubt as to whether more chemo will do any good.

Has anyone had experience of doing things this way round?

I assume I could still have chemo later. Would I also be able to have LU177?

I would be grateful for any thoughts/reassurances.

Thanks

[tango65]

You could request Lu 177 treatment now which will treat mets everywhere and not only mets in the bones. Lu 177 PSMA hasbbeen found to be as effective as chemo. You could have Ra 223 after Lu 177 PSMA.

[Finlay66 in reply to tango65]

Thanks. My inclination was to try Ra223 before LU177 which would need to be self funded in the UK. I suppose I'm mainly seeking reassurance that all options remain open after trying Ra223?

[Tall_Allen]

You can have cabazitaxel later or Pluvicto after 6 months.

[Finlay66 in reply to Tall_Allen]

Thanks. I think the objective is to make some progress on the tumours in the bones before trying more chemo or Pluvicto which is only self funded in the UK or through private medical insurance . I'm reassured if you think this is sensible.

[Tall_Allen in reply to Finlay66]

For guys with bone metastases only, there are many advanteges to Xofigo. Maybe your oncologist would be willing to try a combination:

prostatecancer.news/2021/02...

[Benkaymel in reply to Tall_Allen]

Allen I note in your article that Xofigo is taken up by bone mets since it's similar to calcium. Does this mean that calcium feeds bone mets so is not good to supplement?

[Tall_Allen in reply to Benkaymel]

It isn't good to supplement calcium for many reasons, if you don't have a deficiency. Bone metastases are similar in many ways to super-actively growing bone. They cause bone overgrowth instead of normal homeostasis. They recruit calcium to grow. If you don't have enough calcium, they will rob your healthy tissues of calcium, so you can't slow them down by depriving yourself of calcium either.

[Benkaymel in reply to Tall_Allen]

Thanks Allen.

[FionaElbourne]

hi my husband had 10 rounds of Cabazitaxel in 2021, but it had little effect. He then did Radium 223 in 2022, but he now has more tumours than when he started. We are now having a PET scan next week in London with a view to starting Pluvicto shortly.

[Finlay66 in reply to FionaElbourne]

Thanks. My Oncologist's concerns about the Cabazitaxel were similar yesterday. A lot of side effects and unknown benefits, unless you were lucky with side effects?

Your experience with Ra223 does suggests possible benefits of combining with Pluvicto? Where are you having it done in London? I know that Royal Marsden do them privately.

[FionaElbourne]

yes we are doing it through the London Clinic with scan and treatment at the Wellington hospital London.

[FionaElbourne in reply to FionaElbourne]

my husband had no side effects with Cabazitaxel or Radium didn’t even feel like he had treatment.

[Finlay66 in reply to FionaElbourne]

Did the bone pain improve?

[FionaElbourne in reply to Finlay66]

he had very little pain before he started, so we were hoping it would kill those tumours and prevent any more, pain exactly the same but far more tumours which was a blow, he was hoping to get a bit more respite before Pluvicto. He is also having a biopsy to see if he is BRAC2 positive which would then all The drug Olaparib to be used.

[Finlay66]

I was tested for the BRAC gene mutation when Olaparib was still in trial in 2021. Sadly was negative. Enzalutamide was spectacularly effective for about 7 months and then it failed.

Reading these posts I'm beginning to sense that LU177 would be a natural progression after trying Radium 223?

[Leps]

For whatever it's worth. I had 6 infusions of Radium 223 followed by , now, 5 infusions of Cabazitaxel. My PSA increased during the Radium 223, which is common. My PSA also increased during the first three Cabazitaxel infusions but decreased significantly after the fourth infusion. I've had few side effects from either. Good luck in your journey

[Benkaymel in reply to Leps]

Did you have a scan after the Radium 223 to see the effect on the mets?

[Leps in reply to Benkaymel]

I have lots of mets. Except for two hot spots, the rest are quiet. The RO considers the Xofigo a success for me.

[Benkaymel in reply to Leps]

Great to hear.

[Finlay66 in reply to Leps]

good to hear

[deepika_agnihotri]

Yes, to manage diffuse bone pain Lu-177 PSMA therapy is a better option, but prior there are certain prerequisites. Your disease should express the PSMA receptor positivity, which can be detected with PSMA PET CT scan.

[docbulldog]

I am hoping to go to the radium 223 after I finish my current treatment. I am now into my fourth infusion of Docetaxel and carboplatin but the concern has been very low platelets.

My understanding of radium 223, would also be very rough on bone marrow and the production of platelets, which may eliminate me from that procedure.

Maybe a return to Cabazitaxel is a possibility also, since I only had three infusions a year ago last May before I started for pluvicto. By the way, Pluvicto did not work for me as my PSA continue to rise to the 700’s. It is now down to low 200s with my current treatment.