Post Xofigo, where do we go from here?

[Kentucky1]

I've finished all 6 rounds of Xofigo in December. My ALP dropped to the lowest in 2 years, bone scans have shown stable but active disease, MRI the same. However my PSA has bounced around from the mid 40"s to 70 and the last 2 jumping to 124 and 144 respectively.I've been told that the PSA jump following Xofigo is normal and that after 3 or 4 months things start to reflect normal activity. I've also experienced a drop in hemoglobin with the last 3 months readings being 11.3, 10.5 and 9.7, also from what I'm told happens with Xofigo. Even with no signs of radiographic progression and positive ALP results, my MO feels that the Xtandi is failing and wants to move to docetaxel. His fear is that it's not the Xofigo causing the drop in hemoglobin, but disease progression. He doesn't want to wait for fear my hemoglobin will get too low that I won't be able to tolerate chemo. For the last 4 years he has told me he determines treatment failure based on ALP,PSA, and radiographic progression. Now he's saying these parameters are not definitive enough and that the drop in hemoglobin is more important. I've put off the decision for a month to see if things return to "normal" following the Xofigo. I understand his concerns but it seems like he is ignoring any positive action that the Xofigo has done. I don't want to give up on the Xtandi too soon. Any feedback is appreciated.

[Tall_Allen]

Discuss continuing Xtandi and adding docetaxel as in this trial:

prostatecancer.news/2022/10...

[JDN0415]

Kentucky 1, any update?