New Bone Mets Throughout Skeleton

[Islandboy2021]

I had a bone scan done and the results show new bone mets throughout my skeleton. My PSA has been climbing and is currently at 4.66.

Looks like the cancer has worked around both the Zoladex and the Abiraterone. Not sure what is next.

Apparently the oncologist that was treating me has left for a sabbatical. This might be good news because I was looking for a second opinion anyway. I have a CT Scan appointment on Saturday then I will get an appointment with another oncologist.

Any ideas on the next treatments I should be considering.

Thanks,

Rick

[MarkBC]

Sorry to hear this news Rick. I'm not sure what the next step usually is. I'll be curious to hear what the oncologist says. I'll be in your shoes eventually when my Zoladex / abiraterone starts failing. Good luck and let us know what happens.

[tango65]

The cancer is castration resistant with bone metastases.

You could request treatment with Provenge a vaccine which could prolong life.

Discuss about switching to dexamethasone instead of prednisone and see if it can help to control the cancer .

If the cancer continue to progress discuss treatment with docetaxel if you never had chemo and see if it can control the cancer an perhaps resensitize the cancer to abiraterone.

Other possibility outside the SOC is to continue with abiraterone and also have chemo with docetaxel.

[Tonyliv]

In the same boat; extensive bone mets, PSA climbing, and abiraterone failing. I switched to dexmethasone, PSA dropped for a month. In uk, next SOC is cabitaxel. Lu177 an option if you pay.

[Finlay66 in reply to Tonyliv]

The other alternative that I'm about to start is Radium 223 to target the bone mets

[Islandboy2021 in reply to Finlay66]

Which treatment is preferred in my situation. Lu-177 or Radium 223. I know its difficult to get PSMA scans here in BC.

[Finlay66 in reply to Islandboy2021]

Both treatments seem to offer similar life extending outcomes. I don't think LU177 is the magic bullet. I'm going to try Radium 223 first in terms of QoL outcomes as my mets are mainly in the bones but I'd be willing to pay for LU177 later in the year unless it becomes available on the NHS. I expect they might offer you Docetaxel first but I've been reading that Radium 223 does well as a first or second line of treatment,

[max00]

You might look into Pluvicto (Lu-177). Enter either PSMA Scan or Pluvicto or Lu-177 into the search box at the top of this page. I believe Medicare now pays for treatment in the US as do some other Health insurers. You might also look into Apalutimide (Erleada). Good Luck!

[meowlicious99 in reply to max00]

do you if they approve LU without chemo first. Looks like OP didn't get chemo at all.

[Seasid in reply to meowlicious99]

He had 6 cycles of early chemotherapy as you would expect that in Canada as a standard of care. He was diagnosed in 2017 therefore his prostate was also radiated according to standard of care in 2017 in Canada. In 2018 the standard of care changed reflecting the results of the latest clinical trials for multi metastatic prostate cancer and you would not get early radiation of your prostate from 2018 onwards.

That early chemotherapy enabled him to enjoy long life on ADT alone. Just before ADT failure in Canada at PSA 1 they would give you simply Bicalutamide until your PSA gets to 2. After that PSA 2 they prescribed Abiraterone.

István Hoffmann